PMH-C Psychopharmacology 3 — Questions and Answers
Question 1: Neonatal adaptation syndrome (NAS) following SSRI exposure near delivery most commonly includes which cluster of symptoms?
- Bradycardia, hypoglycemia, and jaundice
- Jitteriness, irritability, feeding difficulties, and respiratory distress (Correct answer)
- Seizures, hyperthermia, and rhabdomyolysis
- Hypotonia, poor reflexes, and hypothermia
Correct answer: Jitteriness, irritability, feeding difficulties, and respiratory distress
NAS from SSRIs presents with jitteriness, irritability, feeding difficulties, and mild respiratory distress, typically self-resolving within days.
Question 2: Which factor most significantly increases the risk of postpartum psychosis in a patient with bipolar disorder?
- Breastfeeding duration
- Abrupt discontinuation of mood stabilizer peripartum (Correct answer)
- Use of epidural anesthesia
- Gestational diabetes diagnosis
Correct answer: Abrupt discontinuation of mood stabilizer peripartum
Abrupt discontinuation of mood stabilizers peripartum substantially increases relapse risk, particularly postpartum psychosis in bipolar disorder.
Question 3: A pregnant patient with schizophrenia requires antipsychotic medication. Which risk is most associated with first-generation antipsychotics in pregnancy?
- Cardiac septal defects
- Neonatal extrapyramidal symptoms and withdrawal (Correct answer)
- Neural tube defects
- Ebstein's anomaly
Correct answer: Neonatal extrapyramidal symptoms and withdrawal
First-generation antipsychotics, especially haloperidol near delivery, are associated with neonatal extrapyramidal symptoms and withdrawal.
Question 4: Why is lamotrigine dosing particularly complex during pregnancy?
- It is converted to a teratogenic metabolite in the second trimester
- Pregnancy increases renal clearance, drastically lowering serum levels
- Estrogen strongly induces glucuronidation, reducing lamotrigine serum levels (Correct answer)
- Fetal absorption requires maternal dose reduction
Correct answer: Estrogen strongly induces glucuronidation, reducing lamotrigine serum levels
Elevated estrogen during pregnancy induces UGT enzymes that glucuronidate lamotrigine, reducing serum levels by up to 50-65% and requiring dose increases.
Question 5: A patient on bupropion for depression wants to conceive. What perinatal consideration is most critical to discuss?
- Bupropion is a category A drug with no risks
- Some studies suggest a possible small increased risk of cardiac defects and miscarriage (Correct answer)
- Bupropion causes severe neonatal abstinence syndrome
- Bupropion is the safest antidepressant in pregnancy with no known risks
Correct answer: Some studies suggest a possible small increased risk of cardiac defects and miscarriage
Some studies suggest a small increased risk of congenital cardiac defects and spontaneous abortion with bupropion, though evidence is mixed and absolute risks remain low.
Question 6: Which psychotropic medication requires monitoring of maternal serum levels each trimester due to significant pharmacokinetic changes in pregnancy?
- Sertraline
- Lithium (Correct answer)
- Quetiapine
- Buspirone
Correct answer: Lithium
Lithium clearance increases significantly during pregnancy due to increased GFR, requiring regular serum level monitoring and dose adjustments.
Question 7: Persistent pulmonary hypertension of the newborn (PPHN) has been associated with which exposure in the third trimester?
- Lithium
- SSRIs (Correct answer)
- Lamotrigine
- Quetiapine
Correct answer: SSRIs
Late-pregnancy SSRI exposure has been associated with a small increased risk of PPHN, though absolute risk remains low and benefits often outweigh risks.
PMH-C Psychopharmacology 3
Neonatal adaptation syndrome (NAS) following SSRI exposure near delivery most commonly includes which cluster of symptoms?