NSG 533 Advanced Pharmacology Test 1
Questions With All Correct Answers
1. Which of the following SSRIs requires up to a 5-week washout
period because of the long half-life of its potent active metabolite?
A. Escitalopram
B. Fluvoxamine
C. Fluoxetine
D. Sertraline
Correct Answer: C. Fluoxetine
Explanation: Fluoxetine has a long half-life and an active metabolite
(norfluoxetine) that extends its duration of action, requiring a 5-
week washout before starting an MAOI to avoid serotonin syndrome.
2. Which of the following symptoms is most likely to improve within
approximately 1 week of starting treatment?
A. Depressed mood
B. Suicidal thoughts
C. Anhedonia
D. Sleep
Correct Answer: D. Sleep
Explanation: Sleep disturbances often improve within the first week
of antidepressant therapy, while mood and anhedonia may take 4-6
weeks to improve.
,3. Of the following combinations of medications, which one would you
want to avoid?
A. Fluoxetine-lithium
B. Fluoxetine-phenelzine
C. Citalopram-valproic acid
D. Citalopram-aripiprazole
Correct Answer: B. Fluoxetine-phenelzine
Explanation: Combining an SSRI (fluoxetine) with an MAOI
(phenelzine) can cause serotonin syndrome, a potentially fatal
condition.
4. A 26-year-old man with a history of depression has been taking
sertraline 200 mg/day for 12 weeks with no response. The patient
has no other complications. The physician asks for your
recommendation. The most reasonable recommendation would be to:
A. Increase sertraline
B. Add fluoxetine
C. Switch to amitriptyline
D. Change to venlafaxine
E. Decrease sertraline
Correct Answer: D. Change to venlafaxine
Explanation: If a patient fails to respond to an adequate trial of an
SSRI, switching to a different class of antidepressant (e.g., SNRI like
venlafaxine) is recommended.
,5. Which of the following is a dangerous combination?
A. MAOI-lorazepam
B. MAOI-acetaminophen
C. MAOI-meperidine
D. MAOI-ziprasidone
Correct Answer: C. MAOI-meperidine
Explanation: Combining an MAOI with meperidine can cause
serotonin syndrome and is contraindicated.
6. A 23-year-old married white woman comes to the outpatient
psychiatric clinic complaining of decreased sleep, decreased
appetite, decreased concentration, depressed mood, thoughts of
death, and lack of interest in activities for 6 weeks' duration. She
has no history of psychiatric illness and takes no medications
except for Ortho-Tri Cyclen Lo daily. Based upon the patient's
symptoms, choose the best medication to treat this patient.
A. Nefazodone 100 mg po twice daily
B. Paroxetine 20 mg po daily
C. St. John's wort 300 mg po three times daily
D. Amitriptyline 25 mg at bedtime
Correct Answer: B. Paroxetine 20 mg po daily
Explanation: Paroxetine is an SSRI and is a first-line treatment for
major depressive disorder. It is generally well-tolerated and
effective.
, 7. A 36-year-old man is admitted to the hospital for a severe
methicillin-resistant Staphylococcus aureus diabetic foot infection
and is started on linezolid 600 mg IV every 12 hours. His medication
profile includes paroxetine 40 mg every morning, trazodone 100 mg
at bedtime as needed for sleep, and metformin 1000 mg po twice
daily. After 3 days on these medications, the patient becomes
agitated, confused, and diaphoretic and develops myoclonic jerks.
Which of the following is the most likely diagnosis?
A. Overdose of metformin
B. Bacterial meningitis
C. Neuroleptic malignant syndrome
D. Serotonin syndrome
Correct Answer: D. Serotonin syndrome
Explanation: Linezolid is a weak MAOI and can interact with SSRIs like
paroxetine to cause serotonin syndrome.
8. A 46-year-old woman presents to the psychiatric outpatient clinic
for follow-up treatment of major depression. She is currently on
paroxetine 10 mg at bedtime, which she started taking 2 months ago
when admitted to the psychiatric hospital for suicidal ideation.
During the interview, she says that she does not think the
medication is working because she is just as depressed as she was
before taking the medication and has recently started drinking eight
to 10 beers daily to alleviate the depression. Before this episode, she
was sober for 4 years. Which of the following treatment strategies
Questions With All Correct Answers
1. Which of the following SSRIs requires up to a 5-week washout
period because of the long half-life of its potent active metabolite?
A. Escitalopram
B. Fluvoxamine
C. Fluoxetine
D. Sertraline
Correct Answer: C. Fluoxetine
Explanation: Fluoxetine has a long half-life and an active metabolite
(norfluoxetine) that extends its duration of action, requiring a 5-
week washout before starting an MAOI to avoid serotonin syndrome.
2. Which of the following symptoms is most likely to improve within
approximately 1 week of starting treatment?
A. Depressed mood
B. Suicidal thoughts
C. Anhedonia
D. Sleep
Correct Answer: D. Sleep
Explanation: Sleep disturbances often improve within the first week
of antidepressant therapy, while mood and anhedonia may take 4-6
weeks to improve.
,3. Of the following combinations of medications, which one would you
want to avoid?
A. Fluoxetine-lithium
B. Fluoxetine-phenelzine
C. Citalopram-valproic acid
D. Citalopram-aripiprazole
Correct Answer: B. Fluoxetine-phenelzine
Explanation: Combining an SSRI (fluoxetine) with an MAOI
(phenelzine) can cause serotonin syndrome, a potentially fatal
condition.
4. A 26-year-old man with a history of depression has been taking
sertraline 200 mg/day for 12 weeks with no response. The patient
has no other complications. The physician asks for your
recommendation. The most reasonable recommendation would be to:
A. Increase sertraline
B. Add fluoxetine
C. Switch to amitriptyline
D. Change to venlafaxine
E. Decrease sertraline
Correct Answer: D. Change to venlafaxine
Explanation: If a patient fails to respond to an adequate trial of an
SSRI, switching to a different class of antidepressant (e.g., SNRI like
venlafaxine) is recommended.
,5. Which of the following is a dangerous combination?
A. MAOI-lorazepam
B. MAOI-acetaminophen
C. MAOI-meperidine
D. MAOI-ziprasidone
Correct Answer: C. MAOI-meperidine
Explanation: Combining an MAOI with meperidine can cause
serotonin syndrome and is contraindicated.
6. A 23-year-old married white woman comes to the outpatient
psychiatric clinic complaining of decreased sleep, decreased
appetite, decreased concentration, depressed mood, thoughts of
death, and lack of interest in activities for 6 weeks' duration. She
has no history of psychiatric illness and takes no medications
except for Ortho-Tri Cyclen Lo daily. Based upon the patient's
symptoms, choose the best medication to treat this patient.
A. Nefazodone 100 mg po twice daily
B. Paroxetine 20 mg po daily
C. St. John's wort 300 mg po three times daily
D. Amitriptyline 25 mg at bedtime
Correct Answer: B. Paroxetine 20 mg po daily
Explanation: Paroxetine is an SSRI and is a first-line treatment for
major depressive disorder. It is generally well-tolerated and
effective.
, 7. A 36-year-old man is admitted to the hospital for a severe
methicillin-resistant Staphylococcus aureus diabetic foot infection
and is started on linezolid 600 mg IV every 12 hours. His medication
profile includes paroxetine 40 mg every morning, trazodone 100 mg
at bedtime as needed for sleep, and metformin 1000 mg po twice
daily. After 3 days on these medications, the patient becomes
agitated, confused, and diaphoretic and develops myoclonic jerks.
Which of the following is the most likely diagnosis?
A. Overdose of metformin
B. Bacterial meningitis
C. Neuroleptic malignant syndrome
D. Serotonin syndrome
Correct Answer: D. Serotonin syndrome
Explanation: Linezolid is a weak MAOI and can interact with SSRIs like
paroxetine to cause serotonin syndrome.
8. A 46-year-old woman presents to the psychiatric outpatient clinic
for follow-up treatment of major depression. She is currently on
paroxetine 10 mg at bedtime, which she started taking 2 months ago
when admitted to the psychiatric hospital for suicidal ideation.
During the interview, she says that she does not think the
medication is working because she is just as depressed as she was
before taking the medication and has recently started drinking eight
to 10 beers daily to alleviate the depression. Before this episode, she
was sober for 4 years. Which of the following treatment strategies
