Behavioral Health Pharmacotherapy Flashcards

An MTM pharmacist is counseling a patient on valproate for bipolar disorder who is considering pregnancy. What is the most critical concern?

Answer: Valproate is a known teratogen causing neural tube defects and cognitive impairment

Valproate is a category X teratogen associated with neural tube defects (spina bifida), cognitive impairment, and autism spectrum disorder; alternative mood stabilizers should be considered in reproductive-age women.

Which receptor mechanism explains why mirtazapine causes sedation and weight gain as side effects?

Answer: Histamine H1 receptor antagonism

Mirtazapine's potent histamine H1 antagonism is responsible for its sedating and appetite-stimulating (weight gain) side effects, which can be beneficial in depressed patients with insomnia and weight loss.

A patient with schizophrenia refuses oral antipsychotics due to nonadherence history. Which formulation would best address long-term adherence?

Answer: Long-acting injectable antipsychotic

Long-acting injectable (LAI) antipsychotics (e.g., paliperidone palmitate, aripiprazole lauroxil) are given every 4–12 weeks and are the preferred option for patients with known nonadherence to oral medications.

Which medication used for alcohol use disorder works by causing an aversive reaction (flushing, nausea, tachycardia) when alcohol is consumed?

Answer: Disulfiram

Disulfiram inhibits aldehyde dehydrogenase, causing accumulation of acetaldehyde when alcohol is consumed, producing an unpleasant aversive reaction that deters drinking.

A patient on fluoxetine is prescribed tramadol for pain. What pharmacokinetic interaction is most concerning?

Answer: Fluoxetine inhibits CYP2D6, reducing tramadol's conversion to active analgesic metabolite and increasing serotonin syndrome risk

Fluoxetine inhibits CYP2D6, reducing tramadol conversion to O-desmethyltramadol (active metabolite), decreasing analgesia; additionally, both drugs are serotonergic, increasing serotonin syndrome risk.

Which second-generation antipsychotic is associated with the lowest risk of metabolic syndrome (weight gain, dyslipidemia, hyperglycemia)?

Answer: Aripiprazole

Aripiprazole (and ziprasidone) have the most favorable metabolic profiles among SGAs, with minimal effects on weight, lipids, and glucose compared to olanzapine and clozapine.

A pharmacist performs an MTM session for a patient with obsessive-compulsive disorder not responding to sertraline alone. What is the most evidence-based augmentation strategy?

Answer: Add an atypical antipsychotic (e.g., risperidone or aripiprazole)

Addition of low-dose atypical antipsychotics such as risperidone, aripiprazole, or quetiapine is the most evidence-based augmentation strategy for SSRI-refractory OCD.