PMH-C Psychopharmacology 4

Question 1

A postpartum patient with treatment-resistant depression is being evaluated for brexanolone. What is its primary mechanism of action?

Accepted Answer

Positive allosteric modulation of GABA-A receptors via neuroactive steroid

Answer

Brexanolone (allopregnanolone) is a synthetic neuroactive steroid that acts as a positive allosteric modulator of GABA-A receptors, targeting the neurobiological cause of PPD.

Question 2

Which statement best describes zuranolone compared to brexanolone for postpartum depression?

Accepted Answer

Zuranolone is an oral neuroactive steroid taken for 14 days; brexanolone is a 60-hour IV infusion

Answer

Zuranolone is an oral neuroactive steroid (14-day course) approved for PPD, while brexanolone requires a 60-hour continuous IV infusion in a certified healthcare facility.

Question 3

What is the primary clinical implication of the 'omega sign' or abrupt postpartum estrogen drop on psychotropic medication?

Accepted Answer

Rapid hormonal decline may trigger mood episodes, and medication doses may need adjustment

Answer

The abrupt postpartum drop in estrogen and progesterone can precipitate mood episodes, and psychotropic medication needs (e.g., lamotrigine levels) may shift requiring reassessment.

Question 4

A lactating patient taking clonazepam reports her infant appears sedated. What is the best next step?

Accepted Answer

Evaluate the infant's serum benzodiazepine level and consider switching to a shorter-acting agent

Answer

Infant sedation signals significant benzodiazepine transfer; clinical evaluation and serum levels guide the decision to switch to a shorter-acting, lower-transfer agent.

Question 5

A patient with perinatal anxiety disorder is reluctant to take SSRIs during breastfeeding. Which non-pharmacological approach has the strongest evidence as an adjunct or alternative for mild-to-moderate symptoms?

Accepted Answer

Cognitive behavioral therapy (CBT)

Answer

CBT has robust evidence for perinatal anxiety and depression and can serve as a primary treatment or adjunct to pharmacotherapy.

(PMH-C) Perinatal Mental Health Certification Practice Test

(PMH-C) Perinatal Mental Health Certification Practice Test

PMH-C Psychopharmacology 4