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PSYCHOPHARMACOLOGY… 21. Instead of the harsher…
PSYCHOPHARMACOLOGY…
21. Instead of the harsher anticonvulsants, Lithium-resistant bipolar disease can respond
well to a relatively safe medication. This medication even can be used with Lithium thus
requiring lower doses of both. It can also be used with the MAOIs. It is:
A. Gabapentin (Neurontin).
B. Tegretol.
C. Carbamazepine.
D. Oxycarbemazepine.
22. Empirical tests have demonstrated that about what percent of the population responds to
any kind of treatment, whether or not the treatment has a direct or active effect?
A. 11 – 15%
B. 30 – 35%
C. 55 – 65%
D. 88 – 95%
23. In order for a medication to be absorbed into the blood stream, it has to pass through
two types of membrane. These are: (choose one of the following)
A. Transparent and translucent.
B. Internal and external.
C. Water-based (hydrophilic) and fat based (hydrophobic).
D. Mucous-based and smooth muscle-based
24. The generally safe substances that facilitate the closest thing to natural sleep are:
A. The newer benzodiazepines.
B. The barbiturates.
C. The herbal teas.
D. Large shots of alcohol.
25. Some chronic schizophrenics are not very reliable taking their medications. These
patients often need to receive large injections, usually into the gut, to guarantee a steady
state of the drug. The problem is that most medications would have to be injected
several times a day (impractical), unless they are given in this manner:
A. In a “depot” shot.
B. In a large suppository.
C. In chewing gum.
D. In several injection sites at once.
26. A practical concern when considering medications for an elderly client is:
A. Will the client be able to remember to take the medications and take them properly?
B. Will the client be able to travel with the medications, or require administration only at home.
C. Is the medication the client is given suitable for the diagnosed problem?
D. Can the client pronounce the names of the medications in case of emergency?
27. One of the common factors that can quickly stop adherence to a medication regimen is:
A. The side-effect profile.
B. The popularity of the medication.
C. Its potential for dependence and withdrawal.
D. The rapid onset of therapeutic effects.
28. Many people have trouble staying with the antidepressant long enough for an adequate
clinical trial. All they do is complain of the side effects. This is because:
A. The clinical effects only appear after all of the side effects subside.
B. The side effects are very aversive; most clients cannot tolerate them at all.
C. The side effects occur right away; the clinical effects can take weeks to appear.
D. The clinical effects, if and when they occur, are very weak at best (not worth it).
29. Particular concern exists over the use of one of the tricyclics when considering treating
depression in pre-adolescent children. Which one of the following should never really be
used (or only with extreme caution) with this population?
A. Eskalith (Lithium)
B. Elavil (Amitriptyline)
C. Norpramin (Desipramine)
D. Paxil (Paroxetine)
30. Which one of the following is considered to be one of the “gold standard” medications
for major depression?
A. Nardil
B. Lithium.
C. Calcium.
D. LSD.
31. The pharmacological treatment of bipolar disease often involves the use of very toxic
substances. For this reason, and because of the multiple possible causes of the disease,
it is important to rule out possible:
A. History of psychological trauma.
B. Gender-related differences in the manifestations of bipolar.
C. Negative client-therapist interactions.
D. Physical disease processes causing mood swings.
32. Your client has been taking Prozac for several months. They come to one session and
seem “really up.” They are energetic, excited, and even look a little hypomanic.
Eventually, they start to become confused, disoriented, sweat heavily, and look a little
drunk. Eventually they pass out. What has just happened?
A. They probably mixed their Prozac with alcohol.
B. They probably missed their last dose and are in serotonin withdrawal.
C. They may have been supplementing their Prozac with another serotonin enhancer.
D. They are developing extrapyramidal signs and need to be taken off the medication.
33. The greatest problem using sedative-hypnotics to induce sleep relates to the fact that
these medications:
A. Block Stage III sleep thus making sleep not very physically restful.
B. Block REM sleep and thus disrupt the sleep architecture.
C. Interact poorly with other medications making it necessary to choose between them.
D. Prove that the person has a significant clinical issue that needs more than medication.
34. The anticonvulsants have also been found to work well with bipolar disease. The main
problem with these medications is that some of them:
A. Can be toxic and cannot be tolerated by some people; they can damage blood chemistry.
B. Are very weak and have to be used in very high doses.
C. Are only good for people who show both the mania and the depression.
D. Are Associated with a dementing syndrome that can be more debilitating than the
bipolar disease.
35. The SSRIs are actually quite good for treating some forms of anxiety. The problem with
these meds alone is that:
A. They have so many side effects that clients won’t use them.
B. They do not play well with other drugs, so the client has to choose.
C. They can initially increase anxiety and agitation – they make anxiety worse at first.
D. They are very dependence producing and should not be used for long.
36. A potentially troubling side effect of the benzodiazepines, yet one that is exploited by the
medical profession to help patients with, for example, outpatient surgery, is:
A. The meds also produce a mild form of euphoria; the patients no longer care about
their problems even after the medication is stopped.
B. The meds make people more manageable and less likely to sue for medical malpractice.
C. The meds produce a form of amnesia (thus reducing trauma) for events that occurred
for a period of time after the drug administration.
D. The meds are so popular with people that giving them before surgery makes people
happier; this speeds recovery.
37. When a traditional antipsychotic does not work very fast and does not cause movement
problems very quickly, the patient might experience:
A. Weight gain and hair loss.
B. Weight gain and gait disturbances.
C. Dry mouth and sedation.
D. Restlessness and anemia.
38. One particularly problematic side effect of many medications with an elderly population,
can contribute to confusion, motor instability, dizziness and falling. This side effect
relates to reductions in which one of the following neurotransmitters?
A. Norepinephrine
B. Dopamine
C. Acetylcholine
D. Serotonin.
39. One reason why it is important to have a dose-response curve, and information on the
half-life of a drug is so that we know how many times a drug has to be taken per day. For
therapeutic purposes, this ensures that:
A. The person will always have the highest blood levels of the drug.
B. The person can take the drug whenever they need to.
C. The blood concentration of the drug will be relatively constant.
D. The person doesn’t have to take any more drug than absolutely necessary.
40. The phenomenon of waking from a bad dream after drinking too much alcohol before
going to bed can reflect:
A. The REM rebound from a “mini-withdrawal”
B. Your body’s revenge for mistreating it.
C. The disinhibition of unconscious material due to alcohol intoxication.
D. Recall of the day’s bad events that led to drinking in the first place.
41. A relatively dangerous medication that is very effective for depression can also be
effective with people with bipolar disease who do not respond to Lithium. This
medication should not be taken with certain foods. It is:
A. A TCA.
B. An MAOI.
C. An SSRI.
D. A benzodiazepine.
42. One of the “easier” psychotic conditions to treat is the Shared Psychotic Disorder.
Which treatment is indicated for this problem (usually not seriously recommended,
however)?
A. Traditional antipsychotics, like Thorazine of Stellazine.
B. Atypical antipsychotics, like Zyprexa or Olanzepine
C. An activating antidepressant like Paxil or a secondary tricyclic.
D. A basic roommate-ectomy; i.e. moving out.
43. Although most of the mood-stabilizing medications work best on patients with “true”
manic/depression bipolar disease, a fundamental problem with the diagnosis and
prescribing is:
A. The diagnosis of “true” bipolar does not require the occurrence of depression.
B. The vast majority of people with bipolar actually have a medical condition.
C. The diagnosis of “true” bipolar does not require the occurrence of mania or hypomania.
D. The diagnosis still has many similarities to the old “lunatic” diagnosis and is archaic.
44. Most people who present with clinical depression, even if it is correctly diagnosed, are inappropriately given which one of the following medications considering the long-term
treatment of their depression?
A. Benzodiazepines
B. Mood stabilizers
C. Anticonvulsants
D. Antipsychotics
45. When a person with major depression has trouble falling asleep, which one of the
following antidepressants is probably the best choice for him or her?
A. A Secondary tricyclic
B. A Tertiary tricyclic
C. A Primary tricyclic
D. Lithium
46. Which one of the following is a valid argument against the use of medications in
psychotherapy?
A. They can demotivate the client from working on his or her problem.
B. They are not safe and always harm the client in some way.
C. They reflect the client’s inherent character weaknesses, and reinforce client passivity.
D. They assume people are machines with no free will or sense of self.
47. Drug treatment of bipolar disease with Lithium requires the person to be screened first
for what kind of problems. If any problems are found, the drug is not a good idea?
A. Heart problems
B. Liver problems
C. Endocrine problems
D. Kidney problems
48. When an older person is placed on a tricyclic, the anticholinergic effects can be dramatic
and mistaken for a degenerative condition. This side effect involves which one of the
following?
A. A reduction in cognitive status
B. The anti-inflammatory effects
C. Agranulocytosis or Aplastic anemia
D. Increased Stage III sleep
49. From a strictly pharmacological perspective, which one of the following can constitute
drug abuse?
A. Using a medication over the counter
B. Using a medication for other than what it was prescribed
C. Using a medication to get an acetylcholine rush.
D. Using a medication with a narrow T.I. for long-term treatment
50. In discussions of schizophrenia, what is a “negative symptom?”
A. One that disrupts the person’s life. For example, unusual creativity is fine, agitated
acting out is not.
B. One that is not valued by society. For example, angelic possession is fine, demonic
possession is not.
C. Ones that are associated with negative affect. Anger, suspiciousness, depression,
and the like, are negative symptoms.
D. Ones that reflect an absence or reduction in thought instead of bizarre or disorganized
thought.
51. A new antipsychotic medication is found to produce severe urinary retention and
dizziness in many clients. In terms of this medication’s potential for treating psychosis,
it will probably be:
A. Not very powerful, and will also be slow to produce Parkinson’s signs.
B. Not very powerful, but will probably produce Parkinson’s signs quickly.
C. Free of Parkinsonian signs, but possibly too potent to use clinically.
D. Very potent and likely to produce Parkinson’s signs.
52. Research on the non-specific factors in therapy, both psychological and pharmaco-
logical, has suggested that the healing atmosphere, the personal involvement of the
physician or psychologist, the climate of competence and concern, and other factors
contribute more to therapeutic change than the actual therapeutic perspective or
intervention. With regard to pharmacy, collectively, these factors contribute to:
A. The client’s self-esteem – critical in the change process.
B. The therapeutic relationship – the only factor relevant in the change process.
C. The placebo effect – a much more important part of therapy than previously thought.
D. The costs of treatment – insurance companies are now tracking these factors.
53. If you are already taking a prescription medication, but want to augment its effects with
an “alternative” medication, it would probably be wise for you to:
A. Have your liver and kidneys screened for pathology
B. Buy the medications on-line to avoid higher costs
C. Check with a physician or epocrates.com to determine if there might be bad drug
interactions
D. Make sure the alternative medications are produced in a hygienic and standardized
manner
54. Many of the newer, atypical antipsychotics appear to work primarily by affecting GABA
or Serotonin activity instead of the more traditional suppression of Dopamine. A
surprising result of this difference in neurotransmitter effects has changed our thinking
about schizophrenia. What was this surprising result?
A. These new drugs have no extrapyramidal effects, but still reduce hallucinations and
delusions.
B. These new drugs eliminate the positive Schneiderian signs, but not the negative
signs. They also stabilize mood.
C. These new drugs improve the patient’s ability to think, but do not always reduce
hallucinations or delusions.
D. The new drugs also work on drug-induced psychotic episodes, they stabilize mood,
reduce depression, and freshen breath.
55. The alternative medicine field is handicapped substantially because of the lack of certain pharmacokinetic information. The lack of this information makes the entire field of
alternative medication troublesome in that:
A. There is no evidence that the drugs have any pharmacodynamic effects at all.
B. The meds may not be compatible with many peoples’ biological (racial) systems.
C. There may be too many side effects making continued use troublesome for most.
D. Without this information it is unclear how much, if any, medication is even getting
into the system, how long it stays there, best doses, and what best dose regimen is.
56. Medications can be very useful for most of the old Axis I disorders. Few medications are
much use for treating the old Axis II disorders, per se. This is because:
A. Most Axis II disorders do not reflect a known alteration of synaptic activity. There is
nothing to change in that regard
B. Axis II disorders are disorders of philosophy. Only street drugs are good for altering a
Person’s philosophy.
C. The diagnosis of Axis II disorder precludes any physiological disturbance on which
drugs would work
D. Axis II people are notoriously non-compliant with structured treatments. Drugs
never get a fair clinical trial (?)
57. For some of the psychopathologies, medications work directly but only temporarily on
the symptoms, thus alleviating much of the problem (an anxiety or sleep disorder for
example). For other problems, however, the drug’s long-term effect is not symptom relief
per se. How does the therapeutic effect come about in these cases?
A. The brain’s chemical adaptation to the drug effect underlies the therapeutic effect.
B. The client’s reaction to having to take a medication changes his or her self-concept.
C. The client’s recognition of the need for a medication is the humbling, therapeutic experience.
D. The presence of a medication enhances the client-therapist relationship. It becomes more
like the medical model – a good thing.
58. The integrity of which organ systems is necessary for complete and healthy excretion?
A. The lungs, skin, kidneys, and liver.
B. The heart, lungs, and brain.
C. Only the liver and kidneys.
D. The liver and kidneys, fried and sometimes with a little onion.
59. Which of the pharmacokinetic factors is most influenced by fever?
A. Absorption
B. Excretion
C. Consumption
D. Metabolism
60. George is required to take an antidepressant. He wants to “facilitate” therapy by
attending parties with friends. He tried to negotiate with you about how much he can
drink. You explain that:
A. Intoxication can become problematic since both medications are sedating.
B. Alcohol decreases the potency of the drug, he will have to take more of the drug.
C. Drinking interferes with therapy. Can’t he party without alcohol?
D. Drinking increases the metabolism of the drug – essentially putting him in pharmacological
withdrawal.
SHORT ANSWERS SECTION Just insert your answer between the questions. Make sure you don’t accidentally delete a question in so doing.
61. You’re working with an older, highly drug-sensitive man who has been depressed for a long
time. His psychiatrist is about to put him on an antidepressant. For what class of side
effects should he be prepared? Briefly list a few of these are and how they might be managed? (3 points).
62. The placebo effect, in both pharmacology and therapy, is usually looked down on by many
therapists and physicians. Psychotherapy can also be augmented by enhancing a placebo
effect. How might you optimize the influence of the placebo effect in your clinical work with a
client (this is not asking about the medications – rather how you can use this effect in your
clinical work). (3 points)
63. Medications with which side-effect profile should be avoided for an older person who has a
heart condition, is already slightly confused, and who is frequently constipated. Name the side
effect and explain your answer (3 points)
64. What evidence do we have that antidepressants to not make people suicidal? What might we
explain to the client who is concerned? (4 points)
