Pharmacology Central Nervous System Agents 3

Question 1

A patient taking clozapine develops a fever, sore throat, and absolute neutrophil count of 400/mm³. What is the immediate action?

Accepted Answer

Permanently discontinue clozapine and notify the registry

Answer

ANC below 500/mm³ indicates severe agranulocytosis; clozapine must be permanently discontinued and the REMS registry notified immediately.

Question 2

Which opioid is contraindicated in patients with renal failure due to accumulation of an active neurotoxic metabolite?

Accepted Answer

Meperidine

Answer

Meperidine's active metabolite normeperidine accumulates in renal failure and causes CNS excitation, tremors, and seizures.

Question 3

A depressed patient starts an SSRI. Which adverse effect should be specifically discussed during the first 1-2 weeks of therapy?

Accepted Answer

Increased suicidal ideation, especially in patients under 25

Answer

The FDA black box warning for antidepressants highlights increased suicidal thinking and behavior in patients under 25, most prominent in the first few weeks.

Question 4

Which drug combination is most likely to cause serotonin syndrome?

Accepted Answer

Phenelzine + meperidine

Answer

Phenelzine (MAO inhibitor) combined with meperidine (which also inhibits serotonin reuptake) causes dangerous serotonin excess.

Question 5

A patient receiving haloperidol develops sustained muscle rigidity, hyperthermia of 40°C, and autonomic instability. What is the diagnosis?

Accepted Answer

Neuroleptic malignant syndrome

Answer

Neuroleptic malignant syndrome is characterized by the tetrad of hyperthermia, rigidity, autonomic instability, and altered consciousness from dopamine blockade.

Pharmacology Practice Test

Pharmacology Practice Test

Pharmacology Central Nervous System Agents 3