MTM Behavioral Health Pharmacotherapy 3 — Questions and Answers
Question 1: Which SSRI has the longest half-life, making it least likely to cause discontinuation syndrome?
- Paroxetine
- Sertraline
- Fluoxetine (Correct answer)
- Citalopram
Correct answer: Fluoxetine
Fluoxetine has a half-life of 1–4 days and an active metabolite (norfluoxetine) with a half-life of 4–16 days, providing a self-tapering effect that minimizes discontinuation syndrome.
Question 2: An MTM pharmacist counsels a pregnant patient with depression. Which antidepressant is generally considered safest in the first trimester?
- Paroxetine
- Sertraline (Correct answer)
- Duloxetine
- Venlafaxine
Correct answer: Sertraline
Sertraline is most commonly recommended during pregnancy due to the largest safety database and relatively favorable risk profile, though all antidepressants carry some risk.
Question 3: A patient with generalized anxiety disorder and comorbid depression would be best treated initially with which medication class?
- Benzodiazepines
- Buspirone alone
- SSRI or SNRI (Correct answer)
- Beta-blockers
Correct answer: SSRI or SNRI
SSRIs and SNRIs are first-line for both GAD and depression, making them ideal when both conditions are present, while benzodiazepines do not treat comorbid depression.
Question 4: Which mood stabilizer requires monitoring of thyroid function because it can cause hypothyroidism with long-term use?
- Valproate
- Lamotrigine
- Lithium (Correct answer)
- Carbamazepine
Correct answer: Lithium
Lithium inhibits thyroid hormone synthesis and release, leading to hypothyroidism in up to 40% of patients with long-term use; thyroid function should be monitored every 6–12 months.
Question 5: A patient on bupropion reports a new-onset generalized tonic-clonic seizure. Which pre-existing condition most likely increased this risk?
- Hypertension
- Bulimia nervosa (Correct answer)
- Type 2 diabetes
- Hypothyroidism
Correct answer: Bulimia nervosa
Bupropion is contraindicated in patients with bulimia or anorexia nervosa because electrolyte disturbances from purging significantly increase seizure risk.
Question 6: Which atypical antipsychotic is FDA-approved as adjunctive therapy for major depressive disorder unresponsive to antidepressants alone?
- Haloperidol
- Quetiapine (Correct answer)
- Clozapine
- Chlorpromazine
Correct answer: Quetiapine
Quetiapine (Seroquel XR) is FDA-approved as adjunctive therapy for MDD when used with antidepressants, along with aripiprazole and brexpiprazole.
Question 7: A patient with opioid use disorder is started on buprenorphine/naloxone. When should the first dose be administered to avoid precipitated withdrawal?
- Immediately after last opioid use
- When the patient is in mild-to-moderate withdrawal (COWS score ≥8) (Correct answer)
- 24 hours after last opioid use regardless of symptoms
- Only after a confirmed negative urine drug screen
Correct answer: When the patient is in mild-to-moderate withdrawal (COWS score ≥8)
Buprenorphine should be initiated when the patient is in mild-to-moderate withdrawal (COWS ≥8) to prevent precipitated withdrawal caused by buprenorphine's high opioid receptor affinity displacing full agonists.
MTM Behavioral Health Pharmacotherapy 3
Which SSRI has the longest half-life, making it least likely to cause discontinuation syndrome?