,Chapter Topic Subtopics
Guiding Psychopharmacology Principles;
Additional Guiding Principles; Organization and
1 Getting Started
Overview; Selected Changes and Updates in Third
Edition
Rationale for the Conceptual Framework; Group 1
Conceptual Framework for
Medications for ADHD, Anxiety, and Depression;
2 Prescribing Psychotropic
Group 2 Medications; Group 3 Medications;
Medications
References
Overview; Diagnosis of Common Disorders
(ADHD, Anxiety, Depression); Diagnosis of
Common Comorbidities; Recognizing Other
3 Making a Diagnosis
Psychiatric Disorders; Determine if Medication Is
Indicated; Recognize Need for Referral;
References
Formulation; Feedback; Nonmedication
Interventions; Informed Consent; Specific
Consent Issues; Off-label Prescribing; FDA
4 Laying the Groundwork
Boxed Warnings; Triage for Psychiatric and
Social Emergencies; Important Considerations for
Safe and Effective Prescribing; References
Group 1 Medications for General Guidance; Methylphenidate;
5 Attention-Deficit/Hyperactivity Amphetamine; Guanfacine; Clonidine;
Disorder Atomoxetine; Viloxazine; Summary; References
General Guidance; SSRIs;
Group 1 Medications for Anxiety
6 Serotonin-Noradrenergic Reuptake Inhibitor
and Depression
(Duloxetine); Summary; References
Group 2 Medications:
Rationale; Antipsychotics; The Mood Stabilizer
7 FDA-Approved Antipsychotics
Lithium; Summary; References
and Mood Stabilizers
Other Antidepressants; Other Antipsychotics;
Group 3 Medications: Others
8 Other Mood Stabilizers; Anxiolytics; Sleep Aids;
Commonly Prescribed
Future Considerations; References
Reevaluate Therapies; Reevaluate Medication;
Discontinuing Group 1 Medications; Switching
Group 1 Medications; When to Consider Group 2
9 Fine Tuning Treatment or Lithium; When to Consider Group 3
(Off-label); Drug Levels or Genetic Testing; Can
Genotyping Improve Response?; Consultation or
Second Opinion; References
Reassess Diagnoses; Complex Psychosocial
10 Managing Treatment Impasses Presentations; Expert Consultation or Referral;
References
,Chapter 1.
Q1. Which guiding principle in pediatric
psychopharmacology emphasizes minimizing total drug
exposure by using the lowest effective dose? A.
Therapeutic index optimization
B. Start low, go slow
C. Polypharmacy reduction
D. Pharmacokinetic tailoring
Correct Answer: B
Rationale: The principle “start low, go slow” refers to
initiating treatment at a low dose and titrating gradually
to minimize adverse effects and total drug exposure.
Other options describe related but distinct strategies.
Q2. Which component is NOT typically included in
informed consent for initiating psychotropic medication
in children? A. Discussion of potential benefits
B. Explanation of off-label use when applicable
C. Guarantee of symptom resolution
D. Review of common side effects
Correct Answer: C
Rationale: Informed consent covers benefits, risks
(including side effects), and off-label discussions.
,Guaranteeing resolution is neither ethical nor
evidence-based.
Q3. In integrated care, psychotropic medications are
primarily used to: A. Replace psychotherapy entirely
B. Address neurochemical contributors to psychiatric
symptoms
C. Cure underlying developmental disorders
D. Prevent need for behavioral interventions
Correct Answer: B
Rationale: Medications target neurochemical imbalances;
they complement but do not replace therapy or cure
developmental disorders.
Q4. A key update in the third edition emphasizes: A.
Universal genetic testing before prescribing
B. Family education and shared decision-making
C. First-line use of long-acting injectables in preschoolers
D. Exclusive reliance on SSRI monotherapy
Correct Answer: B
Rationale: The third edition underscores shared
decision-making and family education. Genetic testing,
injectables in preschoolers, and exclusive SSRI use are not
newly prioritized.
,Q5. Which principle helps manage variability in pediatric
drug metabolism? A. Fixed dosing schedules
B. Pharmacogenetic consideration
C. Empiric polypharmacy
D. High initial loading dose
Correct Answer: B
Rationale: Considering pharmacogenetics tailors to
metabolic differences, while fixed schedules or high
loading doses ignore individual variability.
Q6. The term “therapeutic index” refers to the ratio
between: A. Maximum and minimum plasma
concentrations
B. Therapeutic effect and side-effect threshold
C. Toxic and effective doses
D. Onset time and half-life
Correct Answer: C
Rationale: Therapeutic index is toxic dose (TD50) divided
by effective dose (ED50), indicating safety margin.
Q7. Which of the following is a core value of integrated
behavioral health in pediatrics? A. Segregated specialty
referrals
,B. Co-location of mental health professionals
C. Medication as sole treatment
D. Exclusion of family in care planning
Correct Answer: B
Rationale: Co-location fosters collaboration. Segregated
referrals and medication-only approaches contradict
integrated care, and family exclusion undermines
engagement.
Q8. Before prescribing, assessing baseline vital signs is
important because: A. Children rarely have baseline
abnormalities
B. Psychotropics never affect cardiovascular status
C. Some agents can prolong QT interval
D. It replaces need for lab monitoring
Correct Answer: C
Rationale: Drugs like antipsychotics may prolong QT;
baseline vitals identify risk. Vital signs do not replace
necessary labs.
Q9. The “additional guiding principle” that promotes
concise medication regimens is: A. Maximize daily dosing
frequency
B. Encourage polypharmacy
,C. Use monotherapy when possible
D. Rotate agents monthly
Correct Answer: C
Rationale: Monotherapy reduces interaction risk and
simplifies adherence; polypharmacy and frequent
changes increase complexity.
Q10. Informed consent should include discussion of: A.
Mechanism of action in molecular detail
B. Treatment alternatives including no treatment
C. Confidentiality breaches without reason
D. Guarantee of insurance coverage
Correct Answer: B
Rationale: Reviewing alternatives and the option of no
treatment is essential. Molecular pharmacology level
detail, unwarranted confidentiality breaches, and
insurance guarantees are inappropriate.
Q11. Which update in the third edition addresses the use
of new FDA-approved pediatric indications? A. Removal
of all off-label guidance
B. Expansion of dosing tables for ADHD medications
C. Recommendation for SSRIs only
D. Directive against use in adolescents
,Correct Answer: B
Rationale: The third edition adds updated dosing tables
for ADHD agents newly approved in pediatrics.
Q12. “Start low, go slow” is especially critical when
prescribing for children because: A. Children metabolize
drugs faster than adults
B. Adverse effects can impact growth and development
C. Tolerance develops immediately
D. Efficacy is predictable at high doses
Correct Answer: B
Rationale: Adverse events may influence
neurodevelopment; gradual titration mitigates harm.
Metabolism rates vary by drug.
Q13. Assessing patient and family readiness for
treatment reflects which principle? A. Pharmacodynamic
optimization
B. Shared decision-making
C. Universal prescription
D. Single-discipline care
Correct Answer: B
Rationale: Shared decision-making ensures readiness and
aligns treatment with family goals.
,Q14. Which factor is least relevant when evaluating
medication safety in pediatrics? A. Developmental
pharmacokinetics
B. Potential for weight gain
C. Adult half-life data alone
D. Drug-drug interaction profile
Correct Answer: C
Rationale: Adult half-life data require pediatric context;
developmental factors, side-effect profiles, and
interactions are critical.
Q15. A new third-edition feature involves: A. Case
examples illustrating dosing challenges
B. Elimination of monitoring guidelines
C. Reducing parent involvement
D. Encouraging high-dose trials
Correct Answer: A
Rationale: The edition adds real-world case vignettes.
Monitoring and parental roles remain emphasized.
Q16. Which guiding principle addresses minimizing
cumulative anticholinergic burden? A. Strategic
polypharmacy
B. Anticholinergic load awareness
, C. Empiric dose escalation
D. Fixed-interval switching
Correct Answer: B
Rationale: Awareness of anticholinergic load helps select
medications with lower burden.
Q17. Before prescribing, a clinician should review: A.
Recent growth chart percentiles
B. Family’s entertainment preferences
C. School’s sports schedule
D. Parent’s social media usage
Correct Answer: A
Rationale: Growth monitoring identifies baseline
weight/height for dosing. Other items are irrelevant.
Q18. A rationale for slow titration includes: A. Reducing
the risk of withdrawal
B. Ensuring rapid symptom resolution
C. Enhancing tolerability and adherence
D. Avoiding need for follow-up visits
Correct Answer: C
Rationale: Slow titration enhances tolerability, improving
adherence; it does not guarantee rapid resolution.
Guiding Psychopharmacology Principles;
Additional Guiding Principles; Organization and
1 Getting Started
Overview; Selected Changes and Updates in Third
Edition
Rationale for the Conceptual Framework; Group 1
Conceptual Framework for
Medications for ADHD, Anxiety, and Depression;
2 Prescribing Psychotropic
Group 2 Medications; Group 3 Medications;
Medications
References
Overview; Diagnosis of Common Disorders
(ADHD, Anxiety, Depression); Diagnosis of
Common Comorbidities; Recognizing Other
3 Making a Diagnosis
Psychiatric Disorders; Determine if Medication Is
Indicated; Recognize Need for Referral;
References
Formulation; Feedback; Nonmedication
Interventions; Informed Consent; Specific
Consent Issues; Off-label Prescribing; FDA
4 Laying the Groundwork
Boxed Warnings; Triage for Psychiatric and
Social Emergencies; Important Considerations for
Safe and Effective Prescribing; References
Group 1 Medications for General Guidance; Methylphenidate;
5 Attention-Deficit/Hyperactivity Amphetamine; Guanfacine; Clonidine;
Disorder Atomoxetine; Viloxazine; Summary; References
General Guidance; SSRIs;
Group 1 Medications for Anxiety
6 Serotonin-Noradrenergic Reuptake Inhibitor
and Depression
(Duloxetine); Summary; References
Group 2 Medications:
Rationale; Antipsychotics; The Mood Stabilizer
7 FDA-Approved Antipsychotics
Lithium; Summary; References
and Mood Stabilizers
Other Antidepressants; Other Antipsychotics;
Group 3 Medications: Others
8 Other Mood Stabilizers; Anxiolytics; Sleep Aids;
Commonly Prescribed
Future Considerations; References
Reevaluate Therapies; Reevaluate Medication;
Discontinuing Group 1 Medications; Switching
Group 1 Medications; When to Consider Group 2
9 Fine Tuning Treatment or Lithium; When to Consider Group 3
(Off-label); Drug Levels or Genetic Testing; Can
Genotyping Improve Response?; Consultation or
Second Opinion; References
Reassess Diagnoses; Complex Psychosocial
10 Managing Treatment Impasses Presentations; Expert Consultation or Referral;
References
,Chapter 1.
Q1. Which guiding principle in pediatric
psychopharmacology emphasizes minimizing total drug
exposure by using the lowest effective dose? A.
Therapeutic index optimization
B. Start low, go slow
C. Polypharmacy reduction
D. Pharmacokinetic tailoring
Correct Answer: B
Rationale: The principle “start low, go slow” refers to
initiating treatment at a low dose and titrating gradually
to minimize adverse effects and total drug exposure.
Other options describe related but distinct strategies.
Q2. Which component is NOT typically included in
informed consent for initiating psychotropic medication
in children? A. Discussion of potential benefits
B. Explanation of off-label use when applicable
C. Guarantee of symptom resolution
D. Review of common side effects
Correct Answer: C
Rationale: Informed consent covers benefits, risks
(including side effects), and off-label discussions.
,Guaranteeing resolution is neither ethical nor
evidence-based.
Q3. In integrated care, psychotropic medications are
primarily used to: A. Replace psychotherapy entirely
B. Address neurochemical contributors to psychiatric
symptoms
C. Cure underlying developmental disorders
D. Prevent need for behavioral interventions
Correct Answer: B
Rationale: Medications target neurochemical imbalances;
they complement but do not replace therapy or cure
developmental disorders.
Q4. A key update in the third edition emphasizes: A.
Universal genetic testing before prescribing
B. Family education and shared decision-making
C. First-line use of long-acting injectables in preschoolers
D. Exclusive reliance on SSRI monotherapy
Correct Answer: B
Rationale: The third edition underscores shared
decision-making and family education. Genetic testing,
injectables in preschoolers, and exclusive SSRI use are not
newly prioritized.
,Q5. Which principle helps manage variability in pediatric
drug metabolism? A. Fixed dosing schedules
B. Pharmacogenetic consideration
C. Empiric polypharmacy
D. High initial loading dose
Correct Answer: B
Rationale: Considering pharmacogenetics tailors to
metabolic differences, while fixed schedules or high
loading doses ignore individual variability.
Q6. The term “therapeutic index” refers to the ratio
between: A. Maximum and minimum plasma
concentrations
B. Therapeutic effect and side-effect threshold
C. Toxic and effective doses
D. Onset time and half-life
Correct Answer: C
Rationale: Therapeutic index is toxic dose (TD50) divided
by effective dose (ED50), indicating safety margin.
Q7. Which of the following is a core value of integrated
behavioral health in pediatrics? A. Segregated specialty
referrals
,B. Co-location of mental health professionals
C. Medication as sole treatment
D. Exclusion of family in care planning
Correct Answer: B
Rationale: Co-location fosters collaboration. Segregated
referrals and medication-only approaches contradict
integrated care, and family exclusion undermines
engagement.
Q8. Before prescribing, assessing baseline vital signs is
important because: A. Children rarely have baseline
abnormalities
B. Psychotropics never affect cardiovascular status
C. Some agents can prolong QT interval
D. It replaces need for lab monitoring
Correct Answer: C
Rationale: Drugs like antipsychotics may prolong QT;
baseline vitals identify risk. Vital signs do not replace
necessary labs.
Q9. The “additional guiding principle” that promotes
concise medication regimens is: A. Maximize daily dosing
frequency
B. Encourage polypharmacy
,C. Use monotherapy when possible
D. Rotate agents monthly
Correct Answer: C
Rationale: Monotherapy reduces interaction risk and
simplifies adherence; polypharmacy and frequent
changes increase complexity.
Q10. Informed consent should include discussion of: A.
Mechanism of action in molecular detail
B. Treatment alternatives including no treatment
C. Confidentiality breaches without reason
D. Guarantee of insurance coverage
Correct Answer: B
Rationale: Reviewing alternatives and the option of no
treatment is essential. Molecular pharmacology level
detail, unwarranted confidentiality breaches, and
insurance guarantees are inappropriate.
Q11. Which update in the third edition addresses the use
of new FDA-approved pediatric indications? A. Removal
of all off-label guidance
B. Expansion of dosing tables for ADHD medications
C. Recommendation for SSRIs only
D. Directive against use in adolescents
,Correct Answer: B
Rationale: The third edition adds updated dosing tables
for ADHD agents newly approved in pediatrics.
Q12. “Start low, go slow” is especially critical when
prescribing for children because: A. Children metabolize
drugs faster than adults
B. Adverse effects can impact growth and development
C. Tolerance develops immediately
D. Efficacy is predictable at high doses
Correct Answer: B
Rationale: Adverse events may influence
neurodevelopment; gradual titration mitigates harm.
Metabolism rates vary by drug.
Q13. Assessing patient and family readiness for
treatment reflects which principle? A. Pharmacodynamic
optimization
B. Shared decision-making
C. Universal prescription
D. Single-discipline care
Correct Answer: B
Rationale: Shared decision-making ensures readiness and
aligns treatment with family goals.
,Q14. Which factor is least relevant when evaluating
medication safety in pediatrics? A. Developmental
pharmacokinetics
B. Potential for weight gain
C. Adult half-life data alone
D. Drug-drug interaction profile
Correct Answer: C
Rationale: Adult half-life data require pediatric context;
developmental factors, side-effect profiles, and
interactions are critical.
Q15. A new third-edition feature involves: A. Case
examples illustrating dosing challenges
B. Elimination of monitoring guidelines
C. Reducing parent involvement
D. Encouraging high-dose trials
Correct Answer: A
Rationale: The edition adds real-world case vignettes.
Monitoring and parental roles remain emphasized.
Q16. Which guiding principle addresses minimizing
cumulative anticholinergic burden? A. Strategic
polypharmacy
B. Anticholinergic load awareness
, C. Empiric dose escalation
D. Fixed-interval switching
Correct Answer: B
Rationale: Awareness of anticholinergic load helps select
medications with lower burden.
Q17. Before prescribing, a clinician should review: A.
Recent growth chart percentiles
B. Family’s entertainment preferences
C. School’s sports schedule
D. Parent’s social media usage
Correct Answer: A
Rationale: Growth monitoring identifies baseline
weight/height for dosing. Other items are irrelevant.
Q18. A rationale for slow titration includes: A. Reducing
the risk of withdrawal
B. Ensuring rapid symptom resolution
C. Enhancing tolerability and adherence
D. Avoiding need for follow-up visits
Correct Answer: C
Rationale: Slow titration enhances tolerability, improving
adherence; it does not guarantee rapid resolution.
