NCMHCE Psychopharmacology and Co-occurring Disorders 3 — Questions and Answers
Question 1: A client with major depression and type 2 diabetes is starting an antidepressant. Which medication warrants the MOST caution due to metabolic side effects?
- Sertraline
- Bupropion
- Mirtazapine (Correct answer)
- Venlafaxine
Correct answer: Mirtazapine
Mirtazapine is associated with significant weight gain and increased appetite, which can worsen glycemic control in clients with type 2 diabetes.
Question 2: Which benzodiazepine is considered SAFEST for older adults with co-occurring anxiety and alcohol use disorder due to its lack of active metabolites?
- Diazepam
- Chlordiazepoxide
- Lorazepam (Correct answer)
- Clonazepam
Correct answer: Lorazepam
Lorazepam (Ativan) has no active metabolites and is metabolized by glucuronidation, making it safer in older adults and those with liver impairment from alcohol use.
Question 3: A client with bipolar I disorder and stimulant use disorder is in a manic episode. Which medication class is CONTRAINDICATED in this situation?
- Atypical antipsychotics
- Mood stabilizers like valproate
- Antidepressants as monotherapy (Correct answer)
- Short-term benzodiazepines for agitation
Correct answer: Antidepressants as monotherapy
Antidepressants as monotherapy in bipolar I disorder can precipitate or worsen mania and are contraindicated during acute manic episodes.
Question 4: Acamprosate (Campral) is thought to reduce alcohol cravings by acting on which neurotransmitter system?
- Dopamine reward pathway
- Opioid mu receptors
- Glutamate/GABA balance (Correct answer)
- Serotonin 5-HT3 receptors
Correct answer: Glutamate/GABA balance
Acamprosate modulates glutamate and GABA activity, restoring the neurochemical balance disrupted by chronic alcohol use and reducing protracted withdrawal symptoms.
Question 5: A counselor is reviewing a client's medication list and notices they are taking both an SSRI and tramadol prescribed by their PCP. What risk should the counselor flag?
- Reduced analgesic efficacy of tramadol
- Serotonin syndrome due to dual serotonergic activity (Correct answer)
- Increased risk of SSRI discontinuation syndrome
- Tramadol blocks SSRI absorption
Correct answer: Serotonin syndrome due to dual serotonergic activity
Tramadol has serotonergic properties; combined with an SSRI, it raises the risk of serotonin syndrome, characterized by hyperthermia, agitation, and autonomic instability.
Question 6: Which medication used for alcohol use disorder is an opioid antagonist that works by blocking the reinforcing effects of alcohol?
- Acamprosate
- Disulfiram
- Naltrexone (Correct answer)
- Topiramate
Correct answer: Naltrexone
Naltrexone blocks mu-opioid receptors, reducing alcohol's rewarding effects and decreasing the urge to drink after the first sip.
Question 7: A client with depression and chronic pain is prescribed duloxetine. What is the mechanism that makes this medication useful for BOTH conditions?
- It is an opioid receptor partial agonist
- It inhibits serotonin and norepinephrine reuptake, affecting both mood and pain pathways (Correct answer)
- It blocks substance P in the dorsal horn only
- It acts as a GABA-A receptor positive allosteric modulator
Correct answer: It inhibits serotonin and norepinephrine reuptake, affecting both mood and pain pathways
Duloxetine (Cymbalta) is an SNRI that enhances both serotonin and norepinephrine, which are involved in mood regulation and descending pain inhibition.
NCMHCE Psychopharmacology and Co-occurring Disorders 3
A client with major depression and type 2 diabetes is starting an antidepressant.
Which medication warrants the MOST caution due to metabolic side effects?