APEA PSYCH PHARM EXAM PRACTICE
QUESTIONS (UPDATED VERSION)
**1. A 32-year-old female presents with depressed mood,
anhedonia, and a 10-lb weight gain over 2 months. She sleeps 12
hours/day but still feels exhausted. Which specifier applies?**
A. Melancholic features
B. Atypical features
C. Catatonic features
D. Peripartum onset
**Correct Answer: B**
**Rationale:** Atypical features include mood reactivity,
hypersomnia, increased appetite/weight gain, and leaden paralysis .
---
**2. In the treatment of depression, the mechanism of action of
bupropion (Wellbutrin) is to:**
A. Inhibit the reuptake of serotonin and norepinephrine
B. Increase norepinephrine and serotonin levels and block
acetylcholine
,C. Inhibit the reuptake of norepinephrine and dopamine
D. Increase serum levels of monoamine oxidase
**Correct Answer: C**
**Rationale:** Bupropion is an NDRI (norepinephrine-dopamine
reuptake inhibitor). It has no significant serotonergic activity, making
it useful for patients with SSRI-induced sexual dysfunction or fatigue-
dominant depression .
---
**3. Bupropion (Wellbutrin) should NOT be administered to a patient
with:**
A. Alcoholism
B. Attention deficit disorder
C. Hypertension
D. Seizure disorder
**Correct Answer: D**
**Rationale:** Bupropion lowers the seizure threshold and is
contraindicated in patients with seizure disorders .
,---
**4. Discontinuation syndrome is MOST likely with which SSRI?**
A. Fluoxetine
B. Paroxetine
C. Escitalopram
D. Sertraline
**Correct Answer: B**
**Rationale:** Paroxetine has the shortest half-life (21 hrs) and
highest anticholinergic burden, making discontinuation syndrome
most likely .
---
**5. According to updated STAR*D meta-analysis, which first-line
SSRI has the highest 12-week remission rate in primary care?**
A. Fluoxetine
B. Paroxetine
C. Escitalopram
D. Citalopram
, **Correct Answer: C**
**Rationale:** Escitalopram shows superior tolerability and
remission rates due to minimal CYP interactions .
---
**6. A patient fails 2 SSRI trials at adequate doses/duration. Next
step?**
A. Switch to TCA
B. Add a typical antipsychotic
C. Switch to SNRI (venlafaxine XR)
D. ECT
**Correct Answer: C**
**Rationale:** Level 3 STAR*D recommends switching to venlafaxine
XR or mirtazapine before MAOIs or ECT .
---
**7. Which lab is essential before starting fluoxetine?**
A. LFTs
QUESTIONS (UPDATED VERSION)
**1. A 32-year-old female presents with depressed mood,
anhedonia, and a 10-lb weight gain over 2 months. She sleeps 12
hours/day but still feels exhausted. Which specifier applies?**
A. Melancholic features
B. Atypical features
C. Catatonic features
D. Peripartum onset
**Correct Answer: B**
**Rationale:** Atypical features include mood reactivity,
hypersomnia, increased appetite/weight gain, and leaden paralysis .
---
**2. In the treatment of depression, the mechanism of action of
bupropion (Wellbutrin) is to:**
A. Inhibit the reuptake of serotonin and norepinephrine
B. Increase norepinephrine and serotonin levels and block
acetylcholine
,C. Inhibit the reuptake of norepinephrine and dopamine
D. Increase serum levels of monoamine oxidase
**Correct Answer: C**
**Rationale:** Bupropion is an NDRI (norepinephrine-dopamine
reuptake inhibitor). It has no significant serotonergic activity, making
it useful for patients with SSRI-induced sexual dysfunction or fatigue-
dominant depression .
---
**3. Bupropion (Wellbutrin) should NOT be administered to a patient
with:**
A. Alcoholism
B. Attention deficit disorder
C. Hypertension
D. Seizure disorder
**Correct Answer: D**
**Rationale:** Bupropion lowers the seizure threshold and is
contraindicated in patients with seizure disorders .
,---
**4. Discontinuation syndrome is MOST likely with which SSRI?**
A. Fluoxetine
B. Paroxetine
C. Escitalopram
D. Sertraline
**Correct Answer: B**
**Rationale:** Paroxetine has the shortest half-life (21 hrs) and
highest anticholinergic burden, making discontinuation syndrome
most likely .
---
**5. According to updated STAR*D meta-analysis, which first-line
SSRI has the highest 12-week remission rate in primary care?**
A. Fluoxetine
B. Paroxetine
C. Escitalopram
D. Citalopram
, **Correct Answer: C**
**Rationale:** Escitalopram shows superior tolerability and
remission rates due to minimal CYP interactions .
---
**6. A patient fails 2 SSRI trials at adequate doses/duration. Next
step?**
A. Switch to TCA
B. Add a typical antipsychotic
C. Switch to SNRI (venlafaxine XR)
D. ECT
**Correct Answer: C**
**Rationale:** Level 3 STAR*D recommends switching to venlafaxine
XR or mirtazapine before MAOIs or ECT .
---
**7. Which lab is essential before starting fluoxetine?**
A. LFTs
