, Question 1
A patient with treatment-resistant depression is prescribed phenelzine. Which
dietary component most specifically necessitates strict avoidance due to a
dose-dependent hypertensive crisis risk?
A. Tyramine
B. Tryptophan
C. Caffeine
D. Histamine
Correct Answer: A - Tyramine
RATIONALE
Tyramine, found in aged cheeses and cured meats, is normally
metabolized by MAO-A; phenelzine irreversibly inhibits MAO-A,
allowing tyramine to trigger massive norepinephrine release and
hypertensive crisis. Tryptophan and caffeine do not cause this specific
reaction, and histamine is not the primary dietary amine implicated.
Question 2
Which laboratory parameter is most critical to monitor in a patient initiated on
clozapine, given its potential to cause a rare but life-threatening adverse effect?
A. Absolute neutrophil count
B. Serum creatinine
C. Liver function tests
D. Fasting lipid panel
Correct Answer: A - Absolute neutrophil count
RATIONALE
Clozapine carries a boxed warning for severe
neutropenia/agranulocytosis, requiring regular ANC monitoring per
REMS. While clozapine can affect liver enzymes and lipids, the most
critical and uniquely mandated monitoring is ANC. Renal function is
not the primary concern.
Page 2
, Question 3
A patient on lithium therapy presents with coarse hand tremor, ataxia, and
confusion. Which condition most likely explains these findings?
A. Lithium toxicity
B. Serotonin syndrome
C. Neuroleptic malignant syndrome
D. Acute dystonia
Correct Answer: A - Lithium toxicity
RATIONALE
Coarse tremor, ataxia, and confusion are classic signs of lithium
toxicity, often precipitated by dehydration or drug interactions.
Serotonin syndrome presents with clonus and hyperreflexia; NMS
includes rigidity and fever; acute dystonia involves sustained muscle
contractions.
Question 4
Which cytochrome P450 enzyme is primarily responsible for the metabolism
of fluoxetine, and what is the clinical implication when co-administered with
codeine?
A. CYP2D6; reduced conversion of codeine to morphine, decreasing
analgesia
B. CYP3A4; increased codeine levels, risking toxicity
C. CYP1A2; decreased fluoxetine levels, reducing efficacy
D. CYP2C19; increased fluoxetine levels, causing toxicity
Correct Answer: A - CYP2D6; reduced conversion of codeine to
morphine, decreasing analgesia
Page 3
A patient with treatment-resistant depression is prescribed phenelzine. Which
dietary component most specifically necessitates strict avoidance due to a
dose-dependent hypertensive crisis risk?
A. Tyramine
B. Tryptophan
C. Caffeine
D. Histamine
Correct Answer: A - Tyramine
RATIONALE
Tyramine, found in aged cheeses and cured meats, is normally
metabolized by MAO-A; phenelzine irreversibly inhibits MAO-A,
allowing tyramine to trigger massive norepinephrine release and
hypertensive crisis. Tryptophan and caffeine do not cause this specific
reaction, and histamine is not the primary dietary amine implicated.
Question 2
Which laboratory parameter is most critical to monitor in a patient initiated on
clozapine, given its potential to cause a rare but life-threatening adverse effect?
A. Absolute neutrophil count
B. Serum creatinine
C. Liver function tests
D. Fasting lipid panel
Correct Answer: A - Absolute neutrophil count
RATIONALE
Clozapine carries a boxed warning for severe
neutropenia/agranulocytosis, requiring regular ANC monitoring per
REMS. While clozapine can affect liver enzymes and lipids, the most
critical and uniquely mandated monitoring is ANC. Renal function is
not the primary concern.
Page 2
, Question 3
A patient on lithium therapy presents with coarse hand tremor, ataxia, and
confusion. Which condition most likely explains these findings?
A. Lithium toxicity
B. Serotonin syndrome
C. Neuroleptic malignant syndrome
D. Acute dystonia
Correct Answer: A - Lithium toxicity
RATIONALE
Coarse tremor, ataxia, and confusion are classic signs of lithium
toxicity, often precipitated by dehydration or drug interactions.
Serotonin syndrome presents with clonus and hyperreflexia; NMS
includes rigidity and fever; acute dystonia involves sustained muscle
contractions.
Question 4
Which cytochrome P450 enzyme is primarily responsible for the metabolism
of fluoxetine, and what is the clinical implication when co-administered with
codeine?
A. CYP2D6; reduced conversion of codeine to morphine, decreasing
analgesia
B. CYP3A4; increased codeine levels, risking toxicity
C. CYP1A2; decreased fluoxetine levels, reducing efficacy
D. CYP2C19; increased fluoxetine levels, causing toxicity
Correct Answer: A - CYP2D6; reduced conversion of codeine to
morphine, decreasing analgesia
Page 3
