PMH-C Psychopharmacology 2 — Questions and Answers
Question 1: A breastfeeding mother with postpartum OCD is being considered for an SSRI. Which agent has the most safety data supporting use during lactation?
- Paroxetine
- Sertraline (Correct answer)
- Fluoxetine
- Fluvoxamine
Correct answer: Sertraline
Sertraline has extensive lactation safety data, showing low breast milk transfer and minimal infant serum levels.
Question 2: Which benzodiazepine characteristic is most relevant when prescribing to a breastfeeding mother who needs short-term anxiolytic coverage?
- Half-life and active metabolites (Correct answer)
- Mechanism of action at GABA-A receptor
- Available tablet formulations
- CYP2D6 metabolism
Correct answer: Half-life and active metabolites
Shorter half-life agents with fewer active metabolites (e.g., lorazepam) reduce infant accumulation during breastfeeding.
Question 3: A patient at 10 weeks gestation has bipolar I disorder and is stable on lithium. What is the primary fetal risk that must be weighed in the decision to continue?
- Neural tube defects
- Ebstein's anomaly (Correct answer)
- Cleft palate
- Pulmonary hypertension
Correct answer: Ebstein's anomaly
Lithium is associated with Ebstein's anomaly (tricuspid valve malformation), though absolute risk is low (~1 in 1000 exposed).
Question 4: Which antidepressant is generally avoided in breastfeeding due to the highest relative infant dose (RID) and long half-life?
- Sertraline
- Paroxetine
- Fluoxetine (Correct answer)
- Citalopram
Correct answer: Fluoxetine
Fluoxetine has the longest half-life and an active metabolite (norfluoxetine), resulting in the highest RID among SSRIs.
Question 5: A patient taking valproate who becomes pregnant is at highest risk for which fetal outcome?
- Ebstein's anomaly
- Neural tube defects and cognitive impairment (Correct answer)
- Neonatal abstinence syndrome
- Premature closure of ductus arteriosus
Correct answer: Neural tube defects and cognitive impairment
Valproate carries the highest teratogenic risk among mood stabilizers, causing neural tube defects and significant neurocognitive impairment in exposed children.
Question 6: A postpartum patient with severe depression requires augmentation. Which atypical antipsychotic has the most favorable lactation profile due to low milk transfer?
- Quetiapine (Correct answer)
- Olanzapine
- Clozapine
- Risperidone
Correct answer: Quetiapine
Quetiapine has low relative infant dose (<1%) and is generally preferred when an atypical antipsychotic is needed during breastfeeding.
Question 7: When discontinuing an SSRI during pregnancy to minimize neonatal adaptation syndrome, what is the recommended timing?
- Discontinue at conception
- Discontinue at 36 weeks gestation (Correct answer)
- Discontinue at 20 weeks gestation
- Continue through delivery without tapering
Correct answer: Discontinue at 36 weeks gestation
Tapering SSRIs around 36 weeks may reduce neonatal adaptation syndrome while balancing the mother's relapse risk in late pregnancy and postpartum.
PMH-C Psychopharmacology 2
A breastfeeding mother with postpartum OCD is being considered for an SSRI.
Which agent has the most safety data supporting use during lactation?