Close-ended questions will help identify when patients are taking medications incorrectly.

• Question 3 • Question 4

VERSION A

Choose the correct option regarding the major classes of GABA receptors and the ions involved in inhibition of the neurotransmitter pathway

Response

Feedback:

“GABAB receptors, akin to the metabotropic glutamate receptors, are G- protein-coupled receptors rather than ion channels. Activation of GABAB causes downstream changes in potassium (K+) and Ca+2 channels, largely via G-protein-mediated inhiation of cAMP.”

Close-ended questions will help identify when patients are taking medications incorrectly.

What is the therapeutic plasma level of carbamazepine?

Which of the following statements below is NOT considered an appropriate treatment strategy for treatment-resistant depression?

Response

Feedback:

“Combination of an SSRI OR an SNRI with a norepinephrine-dopamine re-uptake inhibitor (bupropion) or a serotonin-norepinephrine antagonist (mirtazapine or mianserin) is a commonly used combination”

Which of the following medications used for treatment of bipolar disorder may increase stroke risk among older patients, particularly those with dementia?• Question 5 • Question 2 1 / 3

• Question 8 Response

Feedback:

“Notably, pharmacovigilance studies suggest that atypical antipsychotics may increase stroke risk among older patients, particularly those with dementia, so use of SGA requires more caution in this group.”

Which antiepileptic drugs should we avoid in pregnant women in the treatment of bipolar disorder?

• Depakote

ii. Lamotrigine iii. Topiramate iv. Carbamazepine

• Gabapentin

Response

Feedback:

All the others listed except for lamotrigine are not used in treatment of bipolar disorder.

Which neurotransmitter is considered the major inhibitory neurotransmitter?

Choose the appropriate statement regarding lamotrigine dosing.

Response

Feedback:

Carbamazepine induced metabolism of lamotrigine – increase dose of lamotrigine; Valproate may inhibit clearance of lamotrigine, so dose reduction of lamotrigine is needed

Of the following antipsychotic medications listed below, which one has a Black Box Warning for seizure, agranulocytosis, and seizures?

Response

Feedback:

Box 7-5 * indicated clozapine-specific black box warnings

• T. is a 35-year-old woman who was diagnosed with Generalized Anxiety Disorder about
• weeks ago. She was prescribed Clonazepam 2 mg at bedtime but was referred to you

to determine chronic treatment. K. T. states the new medication has been helping a lot but worries about all the side effects that come with it. She wants to discontinue the medication. What is the appropriate next step to help K. T.?

Response

Feedback:

“The regular use of benzodiazepines for more than 2 to 3 weeks may be associated with physiological dependence and the potential for significant withdrawal symptoms with discontinuation. Discontinuation of benzodiazepines is best done with a gradual taper to minimize withdrawal symptoms.”

- Answer choice A: Honor the patient’s request of discontinuing the

medication.

- Answer Choice C: An abrupt stop of a benzodiazepine will likely send

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• Question 11 • Question 14 the patient into having withdrawal symptoms.

- Answer D: Patient will likely experience withdrawal symptoms due to

how often the patient uses it OR patient will experience withdrawal symptoms after missing one dose, thus the therapy wouldn’t have changed at all from how she has been taking it.Which atypical antipsychotic(s) require a meal for better absorption?

• Quetiapine

ii. Ziprasidone iii. Asenapine iv. Olanzapine

• Lurasidone

Response

Feedback:

• Ziprasidone – best with a fatty meal
• Lurasidone – best with a meal of at least 350 calories (no effect

of fat composition)

Which of the following are NOT primary target(s) symptom for antipsychotic agents in schizophrenia?

• Depression, anxiety, demoralization, suicidality, excitability, and agitation

ii. Delusions, hallucinations, disorganized thoughts iii. Affective flattening, alogia, avolition, anhedonia, social withdrawal iv. Attention, memory, and executive functions Response

Feedback:

“For schizophrenia, the primary target symptoms for antipsychotic agents

fall into three categories: psychotic symptoms (e.g., hallucinations,

delusions, disorganization); agitation (e.g., distractibility, affective lability, tension, increased motor activity); and negative symptoms (e.g. apathy, diminished affect, social withdrawal, poverty of speech.” AND “Although cognitive deficits are an important contributor to disability in schizophrenia, cognitive deficits usually are not considered a target for antipsychotic agents because they are not very responsible to current agents.”

How do you manage a patient who develops neuroleptic malignant syndrome while on an atypical antipsychotic?

• M. is 27-year-old female student pharmacist who presents to the ER after experiencing

extreme lightheadedness during her fourth-year seminar presentation. Her vitals are as follows: BP (107/65) and HR of 45. What medication below is likely the cause of these symptoms?

Response

Feedback:

“The use of beta-blockers may be associated with orthostatic hypotension, lightheadedness, bradycardia, and nausea.”

• Question 15 • Question 13 • Question 12

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