MRCPsych Pharmacology Fundamentals 4

Question 1

Which antidepressant acts as a noradrenaline and dopamine reuptake inhibitor (NDRI) with no direct serotonergic activity?

Accepted Answer

Bupropion

Answer

Bupropion selectively inhibits reuptake of noradrenaline and dopamine, explaining its lack of sexual side effects and utility in smoking cessation.

Question 2

The therapeutic drug monitoring target range for lithium in acute mania treatment is:

Accepted Answer

0.8–1.0 mmol/L

Answer

For acute mania, lithium levels of 0.8–1.0 mmol/L are targeted (12 hours post-dose); maintenance levels are lower at 0.6–0.8 mmol/L.

Question 3

Which pharmacological property of clozapine is thought to contribute most to its superior efficacy in treatment-resistant schizophrenia?

Accepted Answer

Low D2 affinity combined with 5-HT2A antagonism and multi-receptor actions

Answer

Clozapine has low D2 affinity (fast dissociation), potent 5-HT2A blockade, and broad receptor binding (H1, M1, alpha-1), collectively explaining its unique efficacy.

Question 4

Which enzyme does acetylcholinesterase inhibitors (e.g., donepezil) target, and what is the net effect?

Accepted Answer

Inhibit acetylcholinesterase, increasing acetylcholine at the synapse

Answer

Donepezil inhibits acetylcholinesterase, the enzyme that degrades ACh, thereby increasing synaptic acetylcholine concentrations.

Question 5

Which adverse effect is most associated with long-term use of antipsychotics and is characterised by involuntary orofacial movements?

Accepted Answer

Tardive dyskinesia

Answer

Tardive dyskinesia results from prolonged D2 receptor blockade leading to receptor upregulation and hypersensitivity, presenting with repetitive involuntary movements.

(MRCPsych) Member of the Royal College of Psychiatrists Practice Test

(MRCPsych) Member of the Royal College of Psychiatrists Practice Test

MRCPsych Pharmacology Fundamentals 4