MTM Behavioral Health Pharmacotherapy 4 — Questions and Answers
Question 1: Which antiepileptic mood stabilizer requires monitoring for Stevens-Johnson syndrome, particularly in Asian patients carrying the HLA-B*1502 allele?
- Valproate
- Lamotrigine
- Carbamazepine (Correct answer)
- Gabapentin
Correct answer: Carbamazepine
Carbamazepine is strongly associated with Stevens-Johnson syndrome in patients with the HLA-B*1502 allele, which is prevalent in Asian populations; genetic testing is recommended before use.
Question 2: An MTM pharmacist identifies that a patient with PTSD is taking prazosin. What is the primary indication for this medication in PTSD?
- Reducing hypervigilance during daytime
- Treating trauma-related nightmares and sleep disturbances (Correct answer)
- Augmenting SSRI antidepressant effect
- Preventing panic attacks
Correct answer: Treating trauma-related nightmares and sleep disturbances
Prazosin, an alpha-1 adrenergic blocker, reduces noradrenergic activity during sleep and is used off-label to reduce trauma-related nightmares and improve sleep quality in PTSD.
Question 3: A patient develops tardive dyskinesia after years of haloperidol use. Which medication is FDA-approved to treat this movement disorder?
- Benztropine
- Diphenhydramine
- Valbenazine (Correct answer)
- Propranolol
Correct answer: Valbenazine
Valbenazine (Ingrezza) and deutetrabenazine are FDA-approved VMAT2 inhibitors indicated for the treatment of tardive dyskinesia.
Question 4: Which medication is considered first-line pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) in adults?
- Atomoxetine
- Bupropion
- Amphetamine salts or methylphenidate (Correct answer)
- Venlafaxine
Correct answer: Amphetamine salts or methylphenidate
Stimulant medications (amphetamines and methylphenidate) are first-line pharmacotherapy for adult ADHD due to superior efficacy compared to non-stimulant alternatives.
Question 5: A patient on lithium is started on ibuprofen for arthritis pain. What effect will this interaction have on lithium levels?
- Lithium levels will decrease due to increased renal clearance
- No clinically significant interaction exists
- Lithium levels will increase due to decreased renal clearance (Correct answer)
- Lithium levels will decrease due to hepatic enzyme induction
Correct answer: Lithium levels will increase due to decreased renal clearance
NSAIDs inhibit prostaglandin-mediated renal blood flow, reducing renal lithium clearance and increasing serum lithium levels, potentially causing toxicity.
Question 6: Which of the following is a key counseling point for patients initiating methadone maintenance therapy for opioid use disorder?
- Methadone can be self-administered at home immediately
- Methadone requires daily observed dosing at a licensed opioid treatment program initially (Correct answer)
- Methadone has no drug interactions because it is synthetic
- Methadone is safe to combine with benzodiazepines for anxiety
Correct answer: Methadone requires daily observed dosing at a licensed opioid treatment program initially
Federal regulations require that methadone for OUD be dispensed at DEA-licensed opioid treatment programs with observed daily dosing initially, with take-home doses earned through program compliance.
Question 7: A pharmacist reviews a patient's medication profile and finds clonazepam prescribed long-term for panic disorder. Per current guidelines, what counseling should be provided?
- Long-term benzodiazepine use for panic disorder is recommended by all guidelines
- Benzodiazepines are preferred over SSRIs for panic disorder maintenance
- Long-term use carries risks of dependence; gradual tapering and transition to SSRIs should be considered (Correct answer)
- Clonazepam is safe to discontinue abruptly when symptoms resolve
Correct answer: Long-term use carries risks of dependence; gradual tapering and transition to SSRIs should be considered
Guidelines recommend SSRIs/SNRIs as first-line maintenance therapy for panic disorder; long-term benzodiazepine use risks physical dependence, cognitive impairment, and abrupt discontinuation seizures.
MTM Behavioral Health Pharmacotherapy 4
Which antiepileptic mood stabilizer requires monitoring for Stevens-Johnson syndrome, particularly in Asian patients carrying the HLA-B*1502 allele?