PMH-C Psychopharmacology 2

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?

Accepted Answer

Sertraline

Answer

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?

Accepted Answer

Half-life and active metabolites

Answer

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?

Accepted Answer

Ebstein's anomaly

Answer

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?

Accepted Answer

Fluoxetine

Answer

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?

Accepted Answer

Neural tube defects and cognitive impairment

Answer

Valproate carries the highest teratogenic risk among mood stabilizers, causing neural tube defects and significant neurocognitive impairment in exposed children.

(PMH-C) Perinatal Mental Health Certification Practice Test

(PMH-C) Perinatal Mental Health Certification Practice Test

PMH-C Psychopharmacology 2