NCMHCE Psychopharmacology and Co-occurring Disorders 4

Question 1

A client with schizophrenia who is treated with clozapine begins using tobacco heavily. What is the PRIMARY clinical concern regarding clozapine levels?

Accepted Answer

Tobacco smoke induces CYP1A2, reducing clozapine blood levels

Answer

Polycyclic aromatic hydrocarbons in tobacco smoke induce CYP1A2 enzymes, which metabolize clozapine, significantly lowering plasma concentrations.

Question 2

During a clinical assessment, a client reports taking St. John's Wort for depression while also on an SSRI. The counselor's FIRST action should be to:

Accepted Answer

Alert the prescriber due to risk of serotonin syndrome

Answer

St. John's Wort has serotonergic properties, and combining it with an SSRI significantly increases the risk of serotonin syndrome, requiring immediate prescriber notification.

Question 3

A client with opioid use disorder and ADHD is requesting stimulant medication. What is the MOST evidence-based approach?

Accepted Answer

Use non-stimulant alternatives like atomoxetine or strattera first, or stimulants under close monitoring with MAT

Answer

Non-stimulant medications are preferred first-line for ADHD in those with substance use disorder; stimulants may be used cautiously under close monitoring alongside MAT when benefits outweigh risks.

Question 4

Which of the following best describes the term 'dual diagnosis' in mental health counseling?

Accepted Answer

The co-occurrence of a mental health disorder and a substance use disorder in the same individual

Answer

Dual diagnosis (also called co-occurring disorders) specifically refers to the simultaneous presence of a mental health disorder and a substance use disorder.

Question 5

A client with panic disorder and alcohol dependence asks why their panic attacks have worsened since they stopped drinking. What is the BEST explanation?

Accepted Answer

Alcohol withdrawal causes GABAergic rebound and CNS hyperexcitability, exacerbating anxiety

Answer

Alcohol potentiates GABA; withdrawal causes GABA downregulation and glutamate rebound, producing CNS hyperexcitability that manifests as panic and anxiety.

NCMHCE - National Clinical Mental Health Counseling Examination Practice Test

NCMHCE - National Clinical Mental Health Counseling Examination Practice Test

NCMHCE Psychopharmacology and Co-occurring Disorders 4