The document contains multiple patient cases and questions related to psychotropic medications. Some key details include:
1) A 10-year-old boy developed gingival hyperplasia after starting anti-epileptic medication for seizures, likely caused by phenytoin.
2) A 75-year-old woman on haloperidol showed signs of akathesia like inability to sit still and purposeless movements.
3) A patient with schizophrenia on long-acting haloperidol depot may encounter issues with high dosage or need for additional medications to treat side effects.
The document asks questions related to appropriate medication selection, dosing, and management of side effects for various psychiatric conditions
The document contains multiple patient cases and questions related to psychotropic medications. Some key details include:
1) A 10-year-old boy developed gingival hyperplasia after starting anti-epileptic medication for seizures, likely caused by phenytoin.
2) A 75-year-old woman on haloperidol showed signs of akathesia like inability to sit still and purposeless movements.
3) A patient with schizophrenia on long-acting haloperidol depot may encounter issues with high dosage or need for additional medications to treat side effects.
The document asks questions related to appropriate medication selection, dosing, and management of side effects for various psychiatric conditions
The document contains multiple patient cases and questions related to psychotropic medications. Some key details include:
1) A 10-year-old boy developed gingival hyperplasia after starting anti-epileptic medication for seizures, likely caused by phenytoin.
2) A 75-year-old woman on haloperidol showed signs of akathesia like inability to sit still and purposeless movements.
3) A patient with schizophrenia on long-acting haloperidol depot may encounter issues with high dosage or need for additional medications to treat side effects.
The document asks questions related to appropriate medication selection, dosing, and management of side effects for various psychiatric conditions
The document contains multiple patient cases and questions related to psychotropic medications. Some key details include:
1) A 10-year-old boy developed gingival hyperplasia after starting anti-epileptic medication for seizures, likely caused by phenytoin.
2) A 75-year-old woman on haloperidol showed signs of akathesia like inability to sit still and purposeless movements.
3) A patient with schizophrenia on long-acting haloperidol depot may encounter issues with high dosage or need for additional medications to treat side effects.
The document asks questions related to appropriate medication selection, dosing, and management of side effects for various psychiatric conditions
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1.
A 10-year-old boy has been taking anti-epileptic medication
for the treatment of generalized tonic-clonic seizures that he had developed a year ago. After starting anti-epileptic medication, he exhibited moderate gingival hyperplasia resulting in poor oral hygiene and halitosis. Which anti-epileptic medication was responsible for gingival hyperplasia? A. Carbamazepine B. Phenobarbital C. Lamotrigine D. Phenytoin 2. A 75-years-old female schizophrenia patient has been taking Haloperidol 10mg PO for the last two weeks. On return for follow-up at psychiatry clinic, her sister reported that she is not able to sit stable during meal and/or coffee time. She moves here and there without any purpose. As clinical pharmacy service provider, you suspected drug induced adverse effect from the current regimen. What type adverse effects for the patient,? a. Tardive dyskinesia b. Dystonia c. Pseudoparkisonism d. Akathesia 3. A 23-year-old male patient who is diagnosed with Schizophrenia cannot memorize whether he took his medication every day. Due to poor adherence to his medication and follow up, the physician prescribed him Haloperidol 50mg in the form of depot preparation. The patient is also advised to come after four weeks to refill his next dose. What potential drug therapy problem will encounter this patient? (A) Haloperidol depot is ineffective (B) Dosage of Haloperidol is too high (C) Depot formulation is not indicated (D) Additional drug needed for Side Effect 4. A 55-year-old teacher was diagnosed with depression. After 6 weeks of therapy with fluoxetine, his symptoms improved, but he complains of sexual dysfunction. Which of the following drugs might be useful for management of depression in this patient? A. Sertraline B. Citalopram C. Mirtazapine D. Lithium 5. A 25-year-old woman has a long history of depressive symptoms accompanied by body aches and pain secondary to a car accident. Which of the following drugs might be useful in this patient? a. Fluoxetine b. Sertraline c. Phenelzine d. Duloxetine. 6. A 51-year-old woman with symptoms of major depression also has angle-closure glaucoma. Which antidepressant should be avoided in this patient? A. Amitriptyline B. Bupropion C. Mirtazapine D. Fluvoxamine 7. A 36-year-old man presents with symptoms of compulsive behavior. He realizes that his behavior is interfering with his ability to accomplish his daily tasks but cannot seem to stop himself. Which drug would be most helpful to this patient? a. Desipramine b. Paroxetine c. Amitriptyline d. Selegiline 8. A 36-year-old man presents with symptoms of compulsive behavior. If anything is out of order, he feels that "work will not be accomplished effectively or efficiently." He realizes that his behavior is interfering with his ability to accomplish his daily tasks but cannot seem to stop himself. Which of the following drugs would be most helpful to this patient? a. Imipramine. b. Fluvoxamine. c. Amitriptyline. d. Tranylcypromine. e. Lithium. 9. Which antidepressant is the most sedating? a. Bupropion b. Duloxetine c. Doxepin d. Venlafaxine 10. Which antidepressant is the most sedating? a. Fluoxetine. b. Duloxetine. c. Nortriptyline. d. Citalopram 11. Which antidepressant has, as its two principal mechanisms of action, 5-HT2A receptor antagonism and α2 receptor antagonism? a. Fluoxetine b. Doxepin c. Maprotiline d. Mirtazapine 12. Which mood-stabilizing agent is most likely to decrease the thyroid function? a. Carbamazepine b. Lithium c. Valproic acid d. Chlorpromazine 13. Which antidepressant agent has significant α1 receptor antagonism and, thus, is a poor choice in an elderly female with depressive symptoms due to a higher risk of falls related to orthostatic hypotension? a. Venlafaxine b. Bupropion c. Escitalopram d. Amitriptyline 14. Which agent would be a poor choice in a 70-yearold elderly female with depressive symptoms due to the drug having significant α1 receptor antagonism and thus a higher risk for falls due to orthostatic hypotension? a. Lithium. b. Bupropion. c. Escitalopram. d. Imipramine. e. Sertraline. 15. 45-year-old woman with sleep apnea, hypertension,type 2 diabetes mellitus, and chronic pain. She is being seen in the clinic today for an assessment of her depressive symptoms and medication evaluation. She endorses sad mood, poor appetite (lost 15 lb), poor concentration, and feelings of hopelessness and worthlessness for the past 3 weeks. She has also stopped going to her book club because she does not have any motivation to get out of the house, and she has frequent mid-nocturnal awakening. She denies suicidal/homicidal ideation. She denies any use of alcohol, tobacco, or illicit drugs. She is currently taking hydrochlorothiazide, metformin,hydrocodone/acetaminophen (APAP), and aspirin. You decide that A.Z. should receive an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class to treat herdepressive symptoms. Which SSRI would most likely interact with her current medications? A. Citalopram. B. Fluvoxamine. C. Paroxetine. D. Sertraline. 16. Which antidepressant would be most appropriate for the pt depressive symptoms? A. Bupropion. B. Fluoxetine. C. Mirtazapine. D. Venlafaxine. 17. It has been 4 weeks since the pt initial visit with you, and she has been treated with citalopram 20 mg/day in the morning. She still presents with sad mood, but her insomnia, concentration, and appetite have improved. She still has feelings of hopelessness and worthlessness, lack of motivation, and anhedonia. At this point, which is the best recommendation to optimize her therapy? a. Continue at current dose of 20 mg/day. b. Increase the current dose to 40 mg/day. c. Add bupropion 150 mg twice daily d. Switch to a different SSRI. 18. Six months later, A.Z. reports that although her depression symptoms have resolved, she has "trouble" during intercourse, which is quite disturbing to her. You determine that she has anorgasmia caused by citalopram treatment. Which is the most appropriate recommendation at this time? a. Discontinue citalopram. b. Add bupropion c. Switch to d/t SSRI. d. Switch to mirtazapine 19. 26-year-old man with a history of bipolar disorder, type I, who presents to the inpatient unit with delusions that the FBI is tracking his movements and that his thoughts are being recorded in a secret governmental database. He believes he has special powers to hide from the FBI by making himself invisible. He is hyperverbal and has not slept in the past 48 hours. He is placed on a 72-hour hold for control of his manic symptoms. He has a history of nonadherence to medications and is currently not taking any medications. Pt last hospitalization was 2 months ago, when he had significant depressive symptoms and suicidal ideation. He has three or four hospitalizations per year, and his history of medication trials includes carbamazepine, olanzapine, and lamotrigine (may be helpful but uncertainbecause of nonadherence). He has also received a diagnosis of hepatitis C. Which statement is most applicable regarding selecting the patient 's mood stabilizer at this time? A. Carbamazepine should be tried again because it is effective for preventing rehospitalization. B. Divalproex should be tried because it is good for maintenance treatment. C. Lithium should be tried because it can effectively treat the manic phase and prevent future episodes. D. Lamotrigine should be tried again because it is effective for bipolar maintenance. 20. Which adverse effects would be of most concern and would require immediate evaluation if the patient prescribed lithium? a. Hyperthyroidism. b. Coarse tremor. c. Severe acne. d. Weight gain
21. It is 3 months later, and the patient has been stable on
lithium 900 mg/day. During a clinic visit, you find that pt is confused and slurring his words. His other medications include lisinopril, ibuprofen, atorvastatin, and zolpidem. Which is best to recommend immediately? A. Discontinue lisinopril because it interacts with lithium. B. Discontinue zolpidem because it may increase confusion. C. Obtain a lithium level because pt may have supratherapeutic levels. D. Discontinue ibuprofen because it interacts with lithium. 22. L.M. is a 25-year-old man recently given a diagnosis of schizophrenia, paranoid type. He often hears voices telling him that he is "stupid and worthless" and that he should "just jump off his apartment building." His parents became very concerned about his isolative behavior and brought him to the hospital. He was given haloperidol in the psychiatry unit and now presents with neck stiffness and feelings of extreme restlessness. Until now, he has not taken medications because he felt that he could control his symptoms on his own with vitamins and Red Bull drinks. Which is the most appropriate treatment of L.M.'s symptoms at this time? a. Benztropine. b. Haloperidol. c. Olanzapine. d. Quetiapine. 23. You and the psychiatric team decide to recommend risperidone for L.M. Which is the most likely reason for this selection? A. Risperidone has less risk of causing EPS than haloperidol. B. Risperidone is available in a long-acting injection for increasing adherence. C. Risperidone is effective for decreasing L.M.'s negative symptoms. D. Risperidone can be dosed once daily after titration to target dose. 24. Which adverse effect of risperidone would be of most concern in L.M.? a. Sedation. b. Anticholinergic effects. c. EPS. d. Corrected QT (QTc) prolongation. 25. One year later, L.M. is no longer responding to risperidone, and you decide to switch him to another medication. L.M. is only interested in oral medications. On the basis of his history, which agent is most appropriate at this time? a. Clozapine. b. Fluphenazine. c. Olanzapine. d. Quetiapine 26. Which recommendation is most appropriate at this time? A. Continue paroxetine because it treats both PTSD and major depression. B. Discontinue paroxetine and initiate sertraline, which treats both PTSD and major depression. C. Continue paroxetine and add lorazepam for the anxiety symptoms. D. Discontinue paroxetine and initiate buspirone for the anxiety symptoms. 27. C.P. has been adherent to the medication you recommended earlier, but he still feels very irritable and has been aggressive at times at work toward others. Which adjunctive medication is most appropriate in this patient? a. Buspirone. b. Clonazepam. c. Divalproex. d. Lithium 28. After 8 months of treatment, C.P. is not responding to the medication you recommended. Having heard a lot about buspirone, he wonders whether this medication might be helpful for his conditions. Which is the most accurate statement for this patient? a. Buspirone may be helpful for the nightmares. b. Buspirone may work as quickly as 3 days. c. Buspirone is convenient because of its once-daily dosing. d. Buspirone does not have much dependence potential. 29. C.P. returns to the clinic and states that his depressive and anxiety symptoms have much improved. However, he is concerned that his girlfriend, who has obsessive- compulsive disorder, is not doing well on her treatment with lorazepam. If you were also treating the girlfriend, which is the most appropriate medication you would initiate? a. Clomipramine. b. Amitriptyline. c. Imipramine. d. Nortriptyline 30. 52-year-old woman (body mass index [BMI] 35 kg/m2 ) with schizophrenia presents for a routine follow-up. She is noted to have abnormal repetitive chewing type movements in her jaw, which she seems unable to control. She states that they are bothersome and interfere with her ability to eat, and she stays home because she is ashamed to be seen in public. She has taken perphenazine for the past 8 years with good control of her symptoms. She is able to live independently and care for herself. She did not respond to therapeutic trials of aripiprazole, ziprasidone, or haloperidol. She has gained 22.7 kg (50 lb) and developed type 2 diabetes while taking olanzapine. The diabetes resolved off olanzapine. Which would be the best treatment? a. Add benztropine. b. Add lorazepam. c. Change to quetiapine. d. Add valbenazine. 31. A 36-year-old man presents with a 16-year history of schizophrenia and alcohol use disorder. His medication was recently changed from haloperidol to aripiprazole because of gynecomastia and impotence. Today, he is pacing in your office and seems anxious and agitated. He has not been sleeping well and feels uncomfortable in his skin. Which medication would be most appropriate to help relieve this patient's symptoms? a. Benztropine. b. Dantrolene. c. Lorazepam. d. Propranolol. 32. 67-year-old man is admitted for new-onset tonic-clonic seizures. His medical history is negative for seizure disorders but positive for prediabetes and schizophrenia. His schizophrenia has been stabilized on clozapine 900 mg daily for many years. He also takes diphenhydramine 50 mg at bedtime, metformin 1000 mg twice daily, and bupropion extended release (ER) 300 mg daily (for 2 months). His social history is negative for alcohol and illicit drug use but positive for a 25 pack-year history, which he stopped 2 weeks ago. Which medication is most likely responsible for his seizures? a. Bupropion. b. Clozapine. c. Diphenhydramine. d. Metformin. 33. A 56-year-old woman presents with a medical history significant for recurrent major depression and type 2 diabetes with newly diagnosed neuropathy, obesity, and coronary artery disease. She takes citalopram 40 mg daily, carvedilol 25 mg twice daily, lisinopril 40 mg daily, and metformin 1000 mg twice daily. She is tearful during her appointment and continues to have symptoms of depression despite initial improvement with citalopram. She wants to change antidepressants. Which would be most beneficial? a. Bupropion. b. Duloxetine. c. Nortriptyline. d. Sertraline. 34. A 45-year-old man presents with agitation and diaphoresis and an oral temperature of 38.5°C (101.3°F). His right eyelid began twitching about an hour ago, and he cannot make it stop. He developed cold symptoms 2 days ago and began taking dextromethorphan and pseudoephedrine around the- clock. His medical history includes depression, hypertension, and dyslipidemia. He takes cetirizine 10 mg at bedtime, paroxetine 40 mg at bedtime, diltiazem extended release (XR)240 mg daily, and rosuvastatin 10 mg daily. Which combination of medications is most likely contributing to his current symptoms? a. Cetirizine and paroxetine. b. Dextromethorphan and pseudoephedrine. c. Diltiazem and pseudoephedrine. d. Paroxetine and dextromethorphan. 35. A 31-year-old man presents with a 5-year history of type I bipolar disorder, for which he takes lithium 300 mg twice daily. He has been adherent to treatment. His lithium serum concentration, obtained yesterday before his morning lithium dose, is 1.0 mEq/L. He has been without manic symptoms for the past few years. He is admitted for a suicide attempt using acetaminophen. For the past few weeks, he has lost interest in his job and isolated himself from other people. Which medication would best help his acute symptoms? a. Aripiprazole. b. Lamotrigine. c. Quetiapine. d. Venlafaxine. 36. A 28-year-old woman (height 61 inches, weight 74.8 kg [165 lb], up from 68 kg [150 lb] 2 months ago) presents with a history of type I bipolar disorder. She has taken lithium 450 mg twice daily for the past 6 months. Her last serum concentration (3 months ago) was 0.7 mEq/L. She presents today for an annual examination. Her laboratory test results include sodium (Na) 138 mEq/L, potassium (K) 4.7 mEq/L, serum creatinine (SCr) 0.9 mg/dL, glucose 124 mg/dL, and TSH 24 mIU/mL. Additional medications include olanzapine 10 mg at bedtime (for 1 year), ethinyl estradiol/drospirenone (Yasmin) daily, and a multivitamin. Which laboratory finding is most closely associated with her current medication regimen? a. Glucose. b. SCr. c. Na. d. TSH. 37. A 43-year-old woman presents with right upper quadrant abdominal pain with rebound tenderness, nausea, and vomiting. Her medical history is significant for rapid-cycling bipolar disorder, hypertension, obesity, and asthma. She takes divalproex sodium 500 mg twice daily, lamotrigine 150 mg twice daily, aripiprazole 30 mg daily, ramipril 10 mg daily, albuterol hydrofluoroalkane (HFA) 2 puffs every 6 hours, and fluticasone/salmeterol dry powder inhaler 250/50 twice daily. She started a prednisone taper 3 days ago for an asthma exacerbation. Laboratory test results include sodium 141 mEq/L, potassium 3.3 mEq/L, chloride 95 mEq/L, carbon dioxide 26 mmol/L, SCr 1.0 mg/dL, glucose 72 mg/ dL, total cholesterol 165 mg/dL, triglycerides 188 mg/dL, aspartate aminotransferase (AST) 27 U/L, alanine aminotransferase (ALT) 21 U/L, amylase 456 U/L, lipase 387 U/L, and valproic acid trough concentration 56 mg/dL. Which medication is most likely responsible for her current clinical picture? a. Aripiprazole. b. Divalproex sodium. c. Lamotrigine. d. Prednisone 38. A 20-year-old woman presents to the emergency department after experiencing trembling, sweating, chest pain, and shortness of breath accompanied by intense fear. A myocardial infarction has been ruled out. She has been given a diagnosis of panic disorder. In addition to a medication for her acute symptoms, which medication would provide the best long-term control? a. Alprazolam. b. Buspirone. c. Hydroxyzine. d. Paroxetine. 39. A 55-year-old woman presents with uncontrolled generalized anxiety disorder (GAD). Concomitant medical conditions include a history of breast cancer, dyslipidemia, osteoarthritis, vasomotor symptoms, and osteopenia. She takes tamoxifen, simvastatin, ibuprofen, lorazepam, and alendronate. Her physician would like her to have better control of her anxiety symptoms. He would also like to taper off lorazepam. Her GAD has not been controlled with paroxetine, sertraline, or duloxetine. Which agent would be best? a. Bupropion. b. Fluoxetine. c. Pregabalin. d. Venlafaxine. 40. A 74-year-old woman has difficulty getting to sleep. Once she falls asleep, she rests comfortably throughout the night. She has struggled with keeping a consistent bedtime for the past few months. She has no identifiable contributing factors. Concomitant medical conditions include hypertension, arthritis, and mild cognitive impairment. She has tried diphenhydramine but states that it helped for only a few nights and "made me loopy." She would like a medication with the least risk of hangover effect. Which medication is best? a. Eszopiclone. b. Ramelteon. c. Suvorexant. d. Zolpidem. 41. A 23-year-old man has a history of heroin addiction. He has successfully been maintained on methadone 40 mg daily for 1 year. He would like an option that does not require him to go to a daily opioid treatment program to get his methadone dose. He is not taking other medications, nor does he abuse other substances. Which treatment regimen is most appropriate? A. Initiate supervised buprenorphine/naloxone. B. Change to buprenorphine × 2 days; then take buprenorphine/naloxone. C. Change to naltrexone. D. Taper to methadone 30 mg; then change to buprenorphine 42. A 55-year-old man has a 30-year history of alcohol dependence. He drinks 1 pint of vodka daily. He has tried several times to quit without success. He recently reconciled with his estranged son and wants to be sober so that he can be present in his son's life. His medical history includes heroin use, depression, and posttraumatic stress disorder (PTSD). Concomitant medications include methadone maintenance (which he wishes to continue) and sertraline (currently nonadherent). His liver function test results include AST 143 U/L, ALT 74 U/L, albumin 4.0 g/dL, alkaline phosphatase 75 U/L, total bilirubin 0.3 mg/dL, prothrombin time 15.1 seconds, international normalized ratio 0.9, platelet count 370,000/ mm3 , and creatinine clearance (CrCl) 40 mL/minute/1.73 m2 .After alcohol detoxification, which maintenance treatment is most appropriate? a. Acamprosate 333 mg three times daily. b. Chlordiazepoxide 25 mg four times daily. c. Disulfiram 500mg daily. d. Naltrexone 50 mg daily 43. A 44-year-old man is preparing to be discharged from the hospital after a myocardial infarction. He has a 25 pack-year history of smoking cigarettes and smokes 1½ packs/day. He has unsuccessfully tried to quit twice. He tried quitting "cold turkey" the first time about 5 years ago. He resumed smoking 6 months later when he lost his job. He tried again about 6 months ago using the 2-mg strength of nicotine gum. To save money, he chewed 7 pieces daily. He has just been given a diagnosis of depression. Which regimen would be best? a. Bupropion suspended release (SR). b. Nicotine gum. c. Nicotine patch. d. Varenicline. 44. A 4-year-old child exhibits severe hyperactivity at preschool and is asked to leave preschool due to aggression, impulsivity, and not following directions. Which of the following statements describes an additional diagnostic criterion needed for a diagnosis of ADHD? a. The symptom duration would need to be 6 weeks. b. These impairing symptoms are also present at home. c. The patient must be at least 6 years old. d. Learning disability needs to be ruled out. 45. A teacher's aide asks about the most likely cause of new onset tics (throat clearing) in a 9-year old with ADHD and Tourette disorder treated with Quillivant 20 mg daily and clonidine 0.1 mg at bedtime (same doses for 3 months)? The best answer is: a. Too much sugar in the diet. b. Quillivant dose is too high. c. Clonidine dose is too low. d. Natural course of tic disorder. 46. A deficiency in this substance has been shown to contribute to ADHD symptoms: a. Ferritin b. Cyanocobalamin c. Folate d. Omega-3 fatty acids 47. Which statement should be included when counseling a family on the risks and benefits of stimulant therapy? a. The risk of an adverse cardiac event for a child with ADHD taking a stimulant is two times greater than an untreated child. b. Stimulant therapy for ADHD can increase the risk of severe brain injury. c. The risk of decreased growth and insomnia is greater with immediate release stimulants for ADHD. d. Atomoxetine is less likely associated with liver injury compared to stimulant. 48. Which of the following statements most accurately describes the clinical presentation of adult ADHD? a. Hyperactivity and impulsivity are the most prominent symptoms. b. Adults frequently report racing thoughts, mood swings, and insomnia. c. Disorganization increases in frequency and severity over the adult life span. d. Distractibility and difficulty with sustained mental effort are most common. 49. What structural brain changes are thought to correlate with persistence of ADHD into adulthood? a. Enlarged ventricles and diminished basal ganglia b. Underdevelopment of the locus coeruleus c. Overgrown lateral lobe of the amygdala d. Cortical thinning and decreased brain volume. 50. Which of the following is an example of an obsession that a patient with obsessive compulsive disorder may complain about? a. Repeated hand washing b. Repeating words silently c. Counting pencils and pens d. Repeated thoughts of doubt 51. Which of the following agents has the most evidence to support use as an augmenting agent in patients with post- traumatic stress disorder who are on antidepressant therapy and continue to complain of nightmares? a. Prazosin b. Zolpidem c. Lorazepam d. Olanzapine 52. A 39-year-old patient is being treated for treatment- resistant GAD with escitalopram 30 mg daily and quetiapine XR 100 mg at bedtime. Which of the following are the most appropriate monitoring parameters for this patient? a. Liebowitz Social Anxiety Scale, weight, complete blood count b. Hamilton Anxiety Scale, body mass index, fasting blood sugar c. Fall risk, weight, complete blood count, basic metabolic panel d. Suicidality risk, ophthalmic examination every 6 months, blood pressure 53. A 35-year-old patient with panic disorder has been well maintained on sertraline 150 mg daily and clonazepam 1 mg twice daily for 2 years. As a result of a recent hospitalization, several medications have been added to the regimen, and the patient is experiencing significant breakthrough anxiety. Which of the following new medications is most likely to interact with the clonazepam and result in increased anxiety? a. Pantoprazole b. Carbamazepine c. Lithium carbonate d. Warfarin sodium
54. A 58-year-old male with obstructive sleep apnea and
daytime sleepiness. What is the best therapy for him? a. Tracheostomy b. Modafinil c. Uvulopalatopharyngoplasty d. Oral appliances E. Continuous positive airway pressure 55. Which of the following non-pharmacologic treatments has been found to be the most effective in the management of post-traumatic stress disorder? a. Psychoeducation b. Deep brain stimulation c. Transcranial magnetic stimulation d. Trauma-focused cognitive behavioral therapy 56. A patient with panic disorder has been treated successfully with paroxetine 60 mg daily for 6 months. The patient inquires about discontinuation of therapy. Which of the following is the most appropriate plan for discontinuation of paroxetine? a. Continue therapy for 6 more months, and then attempt to taper the paroxetine over 4 to 6 months. b. Add clonazepam to the regimen and attempt to taper paroxetine over 2 months. c. Continue therapy for 3 more months, and then attempt to taper paroxetine by decreasing the dose 25% weekly. d. Convert paroxetine to fluoxetine, and then taper the fluoxetine after 6 months of therapy. 57. A 27-year-old female has trouble with waking up in the middle of the night. What is the best way to avoid tolerance and dependence in this patient? a. Use high-dose BZDRA therapy for as long as possible. b. Use high-dose BZDRA therapy for as short as possible. c. Use low-dose BZDRA therapy for as long as possible. d. Use low-dose BZDRA therapy for as short as possible. 58. A patient with newly diagnosed obsessive-compulsive disorder has been on escitalopram 20 mg daily for the past 6 months with a 50% reduction of symptoms based on the Yale-Brown Obsessive-Compulsive Disorder Scale. The patient inquires as to how much longer it is recommended to stay on this medication. What is the most appropriate response? a. 5 to 7 more days b. 3 to 4 more weeks c. 6 to 12 more months d. 4 to 5 more years 59. A 27-year-old patient with a history of substance abuse is being treated for panic disorder. Which of the following medications is associated with the risk of dependence with chronic and prolonged use? a. Buspirone b. Clonazepam c. Venlafaxine d. Gabapentin 60. A 19-year-old patient presents with panic attacks occurring two to three times weekly. Symptoms that occur during the attacks include shortness of breath, tachycardia, paresthesias, dizziness, and palpitations. On further questioning, the patient states that the attacks occur during times of fear of talking with strangers, writing a check in front of someone, or in any situation that the patient feels scrutinized by others or likelihood of humiliation. Based on clinical presentation, the panic attacks this patient is experiencing are most likely associated with which of the following anxiety disorders? a. Panic disorder b. Social anxiety disorder c. Generalized anxiety disorder d. Obsessive-compulsive disorder 61. stic criteria for post-traumatic stress disorder, a patient has to have symptoms for longer than which of the following durations? A. 1 day B. 1 week C. 1 month D. 1 year 62. A 54-year-old male patient has been having difficulty maintaining sleep. He sleeps fine until around 1 am when he wakes up. He would like to sleep until 6:30 am. Which of the following would be the most appropriate? a. Diazepam 5 mg orally at bedtime b. Eszopiclone 3 mg orally when he awakens at 1 am c. Zolpidem 3.5 mg SL when he awakens at 1 am d. Flurazepam 30 mg orally at bedtime 63. The experience of two years of hypomania symptoms that do not meet the criteria for a manic episode is known as: a. Dysthymic Disorder. b. Dissociative disorder. c. Cyclothymic Disorder. d. Personality disorder. 64. 64) An 8-year-old boy is brought by an ambulance to the ER. His mother says he had fallen to the ground and began twitching and jerking both arms and legs. The jerking lasted for about 2 to 3 minutes, after which he would wake up, but have no memory of the event. This pattern of events recurred for what seemed like an hour before the ambulance arrived. His mother said he had a fever with upper respiratory tract symptoms a day or two ago. She relayed he does not have epilepsy but does have asthma. He takes Flonase (fluticasone), Singular (montelukast) daily, and albuterol as needed. As you are taking the history, the child begins to convulse again. Which of the following is true? A. He has non-convulsive status epilepticus B. He has cluster seizures C. He has partial status epilepticus D. He has generalized convulsive status epilepticus 65. As part of the above patient’s work up, which test would be the least helpful in evaluating his seizure etiology? A. Toxicology screen B. Blood cultures C. Chest X-ray D. Blood electrolytes 66. Responsiveness to anticonvulsive treatment in GCSE is affected by which of the following? A. Patient age B. History of epilepsy C. Patient adherence D. Duration of seizure 67. One of the major drug therapies for Bipolar disorder is: a) Chlorpromazine. b) Lithium carbonate. c) Clozapine. d) Benzodiazepine. 68. Which of the following may be given by IV push? A. Phenytoin B. Fosphenytoin C. Phenobarbital D. Midazolam 69. Which patient is most likely going to have successful discontinuation of his AED(s)? A. Patient with a seizure-free period for 1 to 2 years B. An onset of seizures after 35 years of age C. Seizure control within 1 year of onset D. Patient with complex partial seizures as opposed to GTC seizures E. Patient with an abnormal EEG only when he is asleep 70. Which AED has the longest elimination half-life? A. Lacosamide B. Oxcarbazepine C. Tiagabine D. Clobazam E. Topiramate 71. Which AED is not used for refractory complex partial seizures? A. Vigabatrin B. Lacosamide C. Levetiracetam D. Valproic acid E. Rufinamide