NAPLEX EXAM PRACTICE QUESTIONS AND ANSWERS
What is the range for acute manic episode treatment with lithium? ✔ Ans - 0.8-1.2 mEq/L
higher than maintenance treatment
Which medication may potentially interact with and raise lithium levels?
A. metoprolol
B. lisinopril
C. Tenormin
D. APAP ✔ Ans - lisinopril affects the kidneys!!
Which is a side effect of lithium that commonly occurs in patients taking long term?
A. ataxia
B. constipation
C. hypothyroidism
D. neuropathy ✔ Ans - C. hypothyroidism sometimes, diabetes insipidius
which of following is true regarding MAO inhibitors for depression?
A. potential for severe side effects of hypertensive crisis precipitated by certain foods
B. considered 1st line C. good choice because few drug interactions ✔ Ans - A. tyramine -
containing foods can precipitate Serotonin syndrome and hypertensive crises
Which of the following agents may be considered 1st line for treatment of major depression?
A. Buspar
B. lithium
C. fluoxetine (Prozac) D. Doxepin (Silenor) ✔ Ans - C fluoxetine SSRIs and SNRIs are first line for depression. Silenor = insomnia
What is an advantage of using bupropion for tx of MDD?
A. action is specific to serotonin unlike SSRIs
B. fairly sedating so can also treat insomnia
C. free from effect of lowering seizure threshold
D. free from sexual side effects unlike many SSRIs ✔ Ans - free from sexual side effects unlike many SSRIs
**can lower seizure threshold
another benefit: wellbutrin approved for smoking cessation
Which of the following are counseling points for patient switching from SSRI --
> SNRI for depression?
A. same SE as SSRIs, except maybe more HTN
B. should be stopped abruptly if any side effects
C. may require therapeutic drug monitoring ✔ Ans - - Same SE as SSRIs - may include HTN - do not stop abruptly without talking to Dr. - no drug monitoring
JS, age 56 takes tamoxifen for breast cancer remission. Starting SSRI for MDD. What is BEST initial choice?
A. fluoxetine
B. phenelzine
C. Paxil
D. Zoloft ✔ Ans - D. Zoloft
fluoxetine and paroxetine can lower tamoxifen levels in the blood.
What are the goals of therapy for treating anxiety disorders?
A. alleviate all symptoms
B. improve functioning in society
C. reduce anxious symptoms or prevent recurrence D. improve overall quality of mood and sleep ✔ Ans - C. reduce symptoms and prevent recurrence
Which of the following would be 1st line for 35yo patient newly diagnosed with anxiety (no other meds)?
A. Celexa
B. Olanzapine
C. Buspirone
D. Ativan ✔ Ans - Celexa (SSRI are first line)
What is the role of benzos in tx of anxiety?
A. first line for newly diagnosed
B. short term for initial period of SSRI
C. PRN breakthrough for all pts being treated with meds
D. tx of choice for patients with SUD ✔ Ans - B. short term for initial period of SSRI
MU is a 38, F w/ anxiety disorder. She tried and failed 2 SSRIs, but was still having significant anxiety symptoms. MU has a history of drug abuse and dependence. She would like to resume treatment for her anxiety today. Which of the following treatment options would be most appropriate for treating MU's anxiety?
a. Lorazepam b. Paroxetine c. Ziprasidone d. Buspirone ✔ Ans - D. buspirone
A - no because hx of drug abuse
B. no because SSRIs have failed her
C. Ziprasidone only indicated for BPD and schizophrenia
For which symptoms of schizophrenia might anti-psychotic meds be most effective?
A. apathy
B. social withdrawal
C. hallucinations
D. flat affect ✔ Ans - C. hallucinations
antipsychotic meds only treat POSITIVE sx, not negative How do side effect profiles of 2nd gen antipsychs compare to 1st gen?
A. 2nd gen agents tend to have less EPS than 1st gen agents. B. 2nd gen >>EPS than 1st gen
C. 2nd gen <<weight gain than 1st gen d. 2nd gen >>TD than 1st gen ✔ Ans - 2nd gen (risperidone, ziprasidone, quetiapine, olanzapine, abilify) :
- less EPS
- less TD
- more weight gain/metabolic syndrome
1st gen (haldol):
- more EPS/ TD
- less weight gain
Which of the following medications carries an FDA warnings about hyperglycemia and diabetes risk associated with use? a. Olanzapine b. Haloperidol c. Perphenazine d. Fluphenazine ✔ Ans - A. Olanzapine (Zyprexa) = 2nd gen
Which of the following is true regarding the use of clozapine for schizophrenia? a. It requires initial and periodic monitoring of WBC. b. It has been shown to be equally effective as other antipsychotics. c. It is considered a first generation antipsychotic. d. It works best on the "negative" symptoms of schizophrenia. ✔ Ans - Agranulocytosis can occur = complete wipe out of immune system. need to be in REMS program and get blood work before dispensing meds
Hallmark features of Parkinson's Disease (PD) include: a. tremor at rest and bradykinesia b. shortness of breath and facial paralysis c. depression and insomnia d. postural instability and dizziness ✔ Ans - tremor at rest bradykinesia reduced speech volume
postural instability (but not dizziness)
What is the range for acute manic episode treatment with lithium? ✔ Ans - 0.8-1.2 mEq/L
higher than maintenance treatment
Which medication may potentially interact with and raise lithium levels?
A. metoprolol
B. lisinopril
C. Tenormin
D. APAP ✔ Ans - lisinopril affects the kidneys!!
Which is a side effect of lithium that commonly occurs in patients taking long term?
A. ataxia
B. constipation
C. hypothyroidism
D. neuropathy ✔ Ans - C. hypothyroidism sometimes, diabetes insipidius
which of following is true regarding MAO inhibitors for depression?
A. potential for severe side effects of hypertensive crisis precipitated by certain foods
B. considered 1st line C. good choice because few drug interactions ✔ Ans - A. tyramine -
containing foods can precipitate Serotonin syndrome and hypertensive crises
Which of the following agents may be considered 1st line for treatment of major depression?
A. Buspar
B. lithium
C. fluoxetine (Prozac) D. Doxepin (Silenor) ✔ Ans - C fluoxetine SSRIs and SNRIs are first line for depression. Silenor = insomnia
What is an advantage of using bupropion for tx of MDD?
A. action is specific to serotonin unlike SSRIs
B. fairly sedating so can also treat insomnia
C. free from effect of lowering seizure threshold
D. free from sexual side effects unlike many SSRIs ✔ Ans - free from sexual side effects unlike many SSRIs
**can lower seizure threshold
another benefit: wellbutrin approved for smoking cessation
Which of the following are counseling points for patient switching from SSRI --
> SNRI for depression?
A. same SE as SSRIs, except maybe more HTN
B. should be stopped abruptly if any side effects
C. may require therapeutic drug monitoring ✔ Ans - - Same SE as SSRIs - may include HTN - do not stop abruptly without talking to Dr. - no drug monitoring
JS, age 56 takes tamoxifen for breast cancer remission. Starting SSRI for MDD. What is BEST initial choice?
A. fluoxetine
B. phenelzine
C. Paxil
D. Zoloft ✔ Ans - D. Zoloft
fluoxetine and paroxetine can lower tamoxifen levels in the blood.
What are the goals of therapy for treating anxiety disorders?
A. alleviate all symptoms
B. improve functioning in society
C. reduce anxious symptoms or prevent recurrence D. improve overall quality of mood and sleep ✔ Ans - C. reduce symptoms and prevent recurrence
Which of the following would be 1st line for 35yo patient newly diagnosed with anxiety (no other meds)?
A. Celexa
B. Olanzapine
C. Buspirone
D. Ativan ✔ Ans - Celexa (SSRI are first line)
What is the role of benzos in tx of anxiety?
A. first line for newly diagnosed
B. short term for initial period of SSRI
C. PRN breakthrough for all pts being treated with meds
D. tx of choice for patients with SUD ✔ Ans - B. short term for initial period of SSRI
MU is a 38, F w/ anxiety disorder. She tried and failed 2 SSRIs, but was still having significant anxiety symptoms. MU has a history of drug abuse and dependence. She would like to resume treatment for her anxiety today. Which of the following treatment options would be most appropriate for treating MU's anxiety?
a. Lorazepam b. Paroxetine c. Ziprasidone d. Buspirone ✔ Ans - D. buspirone
A - no because hx of drug abuse
B. no because SSRIs have failed her
C. Ziprasidone only indicated for BPD and schizophrenia
For which symptoms of schizophrenia might anti-psychotic meds be most effective?
A. apathy
B. social withdrawal
C. hallucinations
D. flat affect ✔ Ans - C. hallucinations
antipsychotic meds only treat POSITIVE sx, not negative How do side effect profiles of 2nd gen antipsychs compare to 1st gen?
A. 2nd gen agents tend to have less EPS than 1st gen agents. B. 2nd gen >>EPS than 1st gen
C. 2nd gen <<weight gain than 1st gen d. 2nd gen >>TD than 1st gen ✔ Ans - 2nd gen (risperidone, ziprasidone, quetiapine, olanzapine, abilify) :
- less EPS
- less TD
- more weight gain/metabolic syndrome
1st gen (haldol):
- more EPS/ TD
- less weight gain
Which of the following medications carries an FDA warnings about hyperglycemia and diabetes risk associated with use? a. Olanzapine b. Haloperidol c. Perphenazine d. Fluphenazine ✔ Ans - A. Olanzapine (Zyprexa) = 2nd gen
Which of the following is true regarding the use of clozapine for schizophrenia? a. It requires initial and periodic monitoring of WBC. b. It has been shown to be equally effective as other antipsychotics. c. It is considered a first generation antipsychotic. d. It works best on the "negative" symptoms of schizophrenia. ✔ Ans - Agranulocytosis can occur = complete wipe out of immune system. need to be in REMS program and get blood work before dispensing meds
Hallmark features of Parkinson's Disease (PD) include: a. tremor at rest and bradykinesia b. shortness of breath and facial paralysis c. depression and insomnia d. postural instability and dizziness ✔ Ans - tremor at rest bradykinesia reduced speech volume
postural instability (but not dizziness)
