NCMHCE Psychopharmacology and Co-occurring Disorders 5

Question 1

A client with treatment-resistant depression is being considered for ketamine infusions. Which co-occurring condition would be the GREATEST contraindication?

Accepted Answer

Active psychosis or schizophrenia spectrum disorder

Answer

Generalized anxiety disorder

Answer

Mild cannabis use disorder in remission

Answer

History of a single manic episode 10 years ago

Question 2

A pregnant client in her first trimester has severe bipolar disorder. Which medication carries the GREATEST risk of congenital malformations, particularly Ebstein's anomaly?

Accepted Answer

Lithium

Answer

Quetiapine

Answer

Lamotrigine

Answer

Aripiprazole

Question 3

Which of the following BEST describes the mechanism by which buprenorphine reduces opioid cravings without causing euphoria at therapeutic doses?

Accepted Answer

It is a partial agonist at mu-opioid receptors with a ceiling effect

Answer

It is a full agonist at kappa receptors, blocking mu receptors competitively

Answer

It is an opioid antagonist that blocks all opioid receptors

Answer

It increases endogenous endorphin production

Question 4

A counselor's client with co-occurring ADHD and methamphetamine use disorder achieves sobriety and asks about ADHD treatment. Bupropion is being considered. What should the counselor know?

Accepted Answer

Bupropion has shown some evidence for reducing both ADHD symptoms and methamphetamine cravings

Answer

Bupropion is a Schedule II controlled substance contraindicated in SUD

Answer

Bupropion is only FDA-approved for smoking cessation and cannot treat ADHD

Answer

Bupropion's stimulant-like properties make it too risky for any SUD history

Question 5

Which of the following best describes 'pharmacodynamic tolerance' in the context of substance use?

Accepted Answer

The brain's receptors become less sensitive to a drug's effects with repeated exposure

Answer

The body metabolizes a drug faster over time, requiring higher doses

Answer

The drug is absorbed less efficiently in the GI tract after prolonged use

Answer

The liver produces more enzymes to break down the substance

Question 6

A client with bipolar II disorder and alcohol use disorder is prescribed valproic acid. What laboratory monitoring is MOST essential given heavy alcohol use?

Accepted Answer

Liver function tests (LFTs) due to hepatotoxicity risk from both alcohol and valproate

Answer

Monthly CBC and serum iron levels

Answer

Quarterly thyroid panel

Answer

Weekly serum creatinine levels

Question 7

In integrated dual diagnosis treatment (IDDT), which of the following is a core principle that distinguishes it from sequential treatment models?

Accepted Answer

Mental health and substance use disorders are addressed simultaneously by the same treatment team

Answer

Substance use disorders must be fully addressed before any psychiatric medication is prescribed

Answer

Clients must be completely abstinent before entering mental health treatment

Answer

Psychiatric diagnosis is withheld until the client has achieved 6 months of sobriety