Practice Test GeeksBCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test
← All BCACP Flashcard Decks

Mental Health and Substance Use Disorders Flashcards

7 cards from real BCACP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Mental Health and Substance Use Disorders flashcards as text

  1. A patient with bipolar I disorder is stable on lithium 900 mg/day. She reports she is 8 weeks pregnant. What is the most appropriate next step regarding her lithium therapy?

    Answer: Continue lithium with close monitoring and folic acid supplementation, discussing risks and benefits

    Lithium carries teratogenic risk (Ebstein's anomaly) but abrupt discontinuation risks severe relapse; a shared decision-making approach with continued therapy and enhanced monitoring is generally preferred.

  2. Which opioid use disorder (OUD) medication is the ONLY one approved by the FDA that can be prescribed in an office-based setting without a special waiver historically required under the DATA 2000 Act?

    Answer: Extended-release naltrexone (Vivitrol)

    Extended-release naltrexone (injectable) has no special prescribing restrictions and can be prescribed by any licensed provider, unlike methadone for OUD (OTP only) or buprenorphine (which historically required a waiver).

  3. A 55-year-old patient with schizophrenia is non-adherent to oral antipsychotics. Which long-acting injectable (LAI) antipsychotic requires an oral overlap period of at least 3 weeks before the first injection to ensure adequate plasma levels?

    Answer: Risperidone microspheres (Risperdal Consta)

    Risperidone microspheres (Risperdal Consta) has a 3-week lag before therapeutic drug release, requiring oral antipsychotic overlap for the first 3 weeks after initiation.

  4. A patient on clozapine develops an ANC of 1,200 cells/mm³. According to REMS monitoring requirements, what is the correct action?

    Answer: Interrupt clozapine and resume only when ANC ≥ 1,500

    An ANC of 1,000–1,499 (moderate neutropenia) requires interruption of clozapine; therapy may resume when ANC returns to ≥ 1,500 cells/mm³ with more frequent monitoring.

  5. A pharmacist is counseling a patient starting disulfiram for alcohol use disorder. Which of the following interactions is MOST clinically significant to warn the patient about?

    Answer: Metronidazole (Flagyl)

    Metronidazole combined with disulfiram can cause acute psychosis and confusion; this combination is contraindicated.

  6. A patient with generalized anxiety disorder (GAD) has failed two SSRIs. Which agent is FDA-approved for GAD and has a mechanism of action as a partial agonist at 5-HT1A receptors?

    Answer: Buspirone

    Buspirone is FDA-approved for GAD and acts as a partial agonist at serotonin 5-HT1A receptors, with no dependence potential or sedation.

  7. A 40-year-old patient with major depressive disorder (MDD) and insomnia is started on mirtazapine. At which dose does mirtazapine typically have the MOST sedating effect?

    Answer: 7.5–15 mg

    Mirtazapine's sedation is paradoxically more pronounced at lower doses (7.5–15 mg) due to greater antihistamine H1 blockade relative to noradrenergic activity at higher doses.