Quiz 5

Chapter 54 Parkinson Disease

1. HPI: CH is a 70 year-old male who presents to the clinic on 9/10 for a follow up of his Parkinson
disease and COPD. He currently has symptoms of tremor on his right side, slow movement and
poor balance. He also complains of dry mouth. He confirms use of all medications noted in the
order history…. The following plan is implemented for CH: dis continue Reglan, Increase Sinemet
25/100 TID, add entacapone 200mg TID, continue Requip at current dose, follow up in 3
months… in 3 months, CH presents to clinic and laboratory values show a low hemoglobin. A
Coombs test is positive. What is the most likely cause?
a. Sinemet
2. CH’s healthcare provider wants to start Cogentin 1 mg BID. Choose the correct statement:
a. This drug will worsen his constipation
3. CH is still having symptoms of Parkinson Disease despite starting Sinemet 3 months ago. Which
of the following is true:
a. The dose of carbidopa is too low for initial treatment
4. Choose the medication that is most likely making CH’s movement disorder worse:
a. Reglan
5. What is the generic substitution for the Parkinson Disease drug started on 8/10?
a. Ropinirole
6. A patient takes carbidopa-levodopa 25/250 TID. It began to wear off and the prescriber added
on entacapone 200 mg daily. Is this addition correct?
a. No, the dosing regimen is incorrect; it should be 200 mg with each dose of levodopa.
7. A patient is taking fluoxetine, pramipexole, carbidopa/levodopa and clonidine. After some time
on these three medications, he began to imagine that his wife was trying to poison his food. He
also noticed that the weather was getting worse and felt that he would eventually be washed
out into the ocean. What would be contributing to the development of the patient’s psychosis?
a. His Parkinson disease is becoming more advanced
b. Pramipexole
c. Carbidopa/levodopa
8. What is the mechanism of action of entacapone?
a. COMT inhibitor
9. BB is a 72 year-old male who presents to the clinic with bilateral tremor. He reports that the
tremor began on his right side only, and now his writing is so “shaky” that he is having trouble
keeping his checkbook. He is scared that the tremor has spread to both sides and he states he
doesn’t want that “Parkinson’s thing.” Which of the following symptoms would lead to a
diagnosis of Parkinson disease?
a. Tremor
b. Falling
c. Problems walking
d. Feeling “stiff”
e. Moving slowly
10. AC is a patient with a long history of psychosis and anxiety who is presenting to the physician’s
office with a swinging, rolling motion in her neck that is causing her pain and embarrassment.
Which of AC’s medications could be contributing to the movement disorder?
a. Chlorpromazine
11. BD is a patient who has been diagnosed with Parkinson disease. What is the cause of this
condition?
a. Impairment of dopamine-producing cells in the substantia nigra of the brain
12. All of the following are side effects associated with Sinemet therapy except
a. Erectile dysfunction
13. Select the correct statement regarding use of Mirapex for Parkinson disease:
a. It should be titrated slowly (no more than weekly)
14. A patient who requires wound treatment has been transferred to a hospital from a skilled
nursing facility. He is receiving the following medications: carbidopa-levodopa, ropinirole,
amlodipine, and acetaminophen-hydrocodone, as needed. He was given two doses of
ondansetron in the past few hours, due to gagging/vomiting. The patient suffers from extreme
hypomobility. A feeding tube has been inserted and the medicine team has requested a
pharmacist consult for medication administration. The physician inquires if the patient can be
given an injection of apomorphine so they can provide rescue from an “off” period and better
communicate with him at the bedside. The pharmacist should inform the team that:
a. Apomorphine is currently contraindicated in this patient due to the recent use of
ondansetron
15. A patient has been prescribed amantadine for Parkinson disease. Which of the following is true?
a. A common side effect is dizziness
b. Amantadine is also indicated for the treatment of influenza A
16. A patient is using rasagiline for early-onset Parkinson disease. The patient should be counseled
to avoid certain foods while using this medicine. These foods include:
a. Air-dried or cured meats
b. Aged cheeses
c. Some red wines and some beers
17. A patient is prescribed selegiline 5 mg PO BID for Parkinson disease tremor. Which of the
following statements is incorrect?
a. Selegiline is effective for treating tremor because it works by breaking down dopamine
and decreasing dopaminergic activity
18. MH has Parkinson disease and uses Sinemet and Mirapex to help control symptoms. Last night
at the bridge club she accused her old friend of cheating. The friend’s new boyfriend got upset
and knocked the card table over. This unfortunate event resulted in the police being called in
and poor MH was taken to the hospital for observation. The medical resident decides that she
should receive and antipsychotic. Which medication would carry the lowest risk of worsening
her Parkinson symptoms?
a. Quetiapine
19. JG is a 78 year old female resident of a skilled nursing facility. She has developed rash with
pruritus on both forearms. The skin on her arms is dry and scaly with slightly raised, red bumps.
JG has developed a similar rash before; the cause remain unknow. Her chronic medical
conditions include Parkinson disease and moderate dementia of the Alzheimer’s type. JG has
 had two hospitalizations in the past 6 months for aspiration pneumonia. She required antibiotics
during each admission….. JG is unable to eat solid food and her history of aspiration pneumonia
suggests she has difficulty swallowing. Which of the following statements about her Rytary
prescription is correct?
a. The active ingredients are carbidopa and levodopa
b. This is an ER capsule that can be opened and sprinkled on a small amount of applesauce
20. At the skilled nursing facility, all of the medications are listed on the medication administration
record (MAR) by generic name. which of the following will be present on JG’s MAR?
a. Entacapone
21. One of JG’s medications is a patch formulation. Which of the following statements concerning
the patch is/are correct?
a. JG may experience skin reactions at the application site
b. The generic name of the patch is rotigotine
c. It is FDA approved for both Parkinson disease and restless leg syndrome

Chapter 55 Alzheimer’s disease

1. A caregiver is picking up a new prescription for Namenda ER capsules. What are possible side
effects of this medication?
a. Dizziness and headache
2. AO is a 70 year old male who takes benztropine for Parkinson Disease. What possible side
effects might AO experience from the use of this medication?
a. Confusion
3. A patient with dementia takes rivastigmine 3 mg PO BID with breakfast and dinner. He is
experiencing a lot of nausea and his wife asks the pharmacist for assistance. What medication/s
would be useful for this patient?
a. Donepezil ODT
b. An Exelon patch
4. Memantine can be used:
a. For moderate to severe Alzheimer’s disease in combination with donepezil
5. A patient gave the pharmacist a prescription for Exelon 1.5 mg BID # 60. Which of the following
is an appropriate generic for Exelon?
a. Rivastigmine
6. Which of the following treatment regimens can be used in a patient with severe Alzheimer’s
disease?
a. Namenda + Aricept
b. Namenda monotherapy
c. High dose (23 mg) Aricept
7. A patient will begin therapy with the Exelon patch. Which of the following are correct counseling
statements?
a. Apply the patch on the back, upper arm or chest, and always change the site from day to
day so that the skin does not become irritated
 b. Remove the patch after 24 hours and fold it in half with sticky sides together for safe
disposal
8. MO is a 75 year old African American male who had a stroke 12 months ago. His other medical
conditions include heart failure and mild memory impairment. MO’s medications include
clopidogrel, enalapril, Toprol XL, bumetanide, potassium supplements, Aleve and ginkgo biloba.
He presents to the emergency room with a nosebleed and blood in the urine. Choose the agents
that MO is taking that can increase that risk of bleeding:
a. Cloidogrel
b. Ginkgo biloba
c. Aleve
9. A patient gave the pharmacist a prescription for Namenda 5 mg twice daily #60. Which of the
following is an appropriate generic substitution for Namenda?
a. Memantine
10. A patient receives a score of 20 on an MMSE. Which medication is likely to be initiated?
a. Donepezil
11. Select the mechanism of action of memantine
a. NMDA-receptor antagonist
12. Why are patients instructed to take donepezil in the evening?
a. Donepezil causes nausea
13. Select the mechanism of action of donepezil
a. Acetylcholinesterase inhibitor
14. JY is a 72 year old female who comes into the clinic on 1/18 for a follow-up on her depression
medications. Her husband is with her and states that she is having trouble finding the right
words to say in conversation and becomes easily frustrated when she can’t remember simple
things, which is happening quite often. Her MMSE score today is 21… what medication is the
best choice to start JY on at this time based on her MMSE score and diagnosis?
a. Aricept
15. At a follow up visit one year later, JY’s symptoms have progressed to moderate disease. She is
now taking donepezil 10 mg QHS. Which of the following treatment changes is appropriate?
a. Discontinue donepezil and start namzaric
16. Of the medications that JY is currently taking, which can worsen dementia?
a. Ativan
b. Diphenhydramine
c. Ditropan xl
17. JY is started on donepezil 5 mg QHS. Which of the following counseling point is/are appropriate?
a. This medication can cause your heart rate to slow down. Tell your healthcare provider if
you are taking any other medications that slow down heart rate
b. This medication can cause difficulty with falling or staying asleep. If this occurs, you can
take the medication in the morning
c. This medication can cause nausea; taking it with food may help
d. If you have difficulty swallowing tablets, this medication comes in a tablet that dissolves
rapidly in the mouth
Chapter 63 depression

1. PR has been prescribed amitriptyline for depression. PR should be counseled on the following
possible side effects:
a. Urinary retention
b. Dry mouth
c. Orthostasis/dizziness
d. Blurry vision
2. JN has had depression most of her adult life. She used doxepin when she was a teenager and
stopped taking this medication in her twenties. She had a recurrence of the depression later
that year and began using paroxetine. She has been successfully treated with paroxetine for five
years. She would like to have a child and is asking the pharmacist if it is safe to stop the
paroxetine. Which of the following statements are correct?
a. Paroxetine is not a preferred agent in pregnancy; it has been associated with cardiac
abnormalities.
b. If she wishes to try and stop the paroxetine, she will need to have it discontinued with a
slow, gradual taper.
c. SSRI use in pregnancy carries the potential risk of persistent pulmonary hypertension of
the newborn.
3. Which of the following are side effects/possible adverse reactions of bupropion?
a. Insomnia
b. Tremors/risk of seizures
c. Dry mouth
4. A patient with allergic rhinitis and hypothyroidism is using Wellbutrin xl for seasonal affective
disorder (SAD). The prescriber instructed the patient to start early in the spring at 150 mg BID
and continue until late summer. He said that the pharmacist would instruct the patient how to
use the drug. Which statement below is correct?
a. The doing instructions and the timing of initiation are both incorrect
5. Paroxetine comes in various formulations. Which of the following are brand names of
paroxetine? Select all that apply
a. Pexeva
b. Brisdelle
c. Paxil
6. A patient has treatment-resistant depression. He has failed reasonable doses, with reasonable
trial periods of doxepin, escitalopram, fluoxetine and venlafaxine. Which of the following
statements apply to treatment resistant depression? Select all that apply
a. Abilify can be used as an augmentation agent, in addition to the antidepressant
b. Olanzapine carries significant risk of weight gain, and metabolic issues, such as elevated
blood glucose
c. Olanzapine is sedating and fluoxetine is stimulating; when used together they are doses
QHS
7. HB is an 82 year old male with end stage renal disease who has been using venlafaxine.
Recently, he had a hematoma that put him in the hospital and was nearly fatal. His daily
medications are venlafaxine, warfarin, metoprolol and PHosLo. Choose the risky problem
present with this combination
 a. Increased bleeding risk due to combination of warfarin and an SNRI
8. Select the correct primary mechanism of action for Elavil
a. Norepinephrine and serotonin (5-HT) reuptake inhibitor
9. MR has been using tranylcypromine for depression for thirty years. He was recently admitted to
the hospital and underwent coronary artery bypass surgery. After surgery, the tranylcypromine
was stopped and he was switched to duloxetine. The physician thought it was a better choice
because it might also treat his neuropathic pain and would have less troublesome interactions.
Choose the correct statement
a. Stop the duloxetine immediately
10. Several of the antidepressants, including all the SSRIs and SNRIs, have warnings not to initiate in
patients being treated with the following agents:
a. Methylene blue
b. Zyvox
c. Linezolid
11. What is the mechanism of action of paroxetine?
a. Selective serotonin reuptake inhibitor
12. A patient will begin therapy with bupropion. The pharmacist should check that the patient does
not have any contraindications to use of this medication. Which of the following are
contraindications to the use of bupropion?
a. Seizure disorder
b. Bulimia
c. Anorexia nervosa
13. A patient gave the pharmacist a prescription for Trintellix. Which of the following is the correct
generic name for Trintellix?
a. Vortioxetine
14. NM has been using Pristiq for a few days. Her other medications include Prilosec OTC and
occasional Advil PM. She returns to the pharmacy to report that the new medication is not
getting into her body. She saw it in the toilet after she had a bowel movement. NM should be
provided with the following information:
a. She should be informed that the drug has been absorbed
15. What are likely rationales behind using Remeron SolTab when given to thin, elderly patients or
in patients receiving chemotherapy?
a. Patients using mirtazapine may have dysphagia
b. Patients using mirtazapine may have nausea
16. What are the indications for Cymbalta?
a. Generalized anxiety disorder (GAD)
b. Fibromyalgia
c. Depression
d. Diabetic neuropathic pain
17. A pharmacist will counsel a male patient beginning therapy with trazodone to help treat the
patient’s depressed mood. Which of the following statements concerning trazodone are
correct?
a. The use of trazodone can put a frail patient at risk for falls and injury
18. A female patient suffers from severe depression prior to the onset of menses. After the period
begins, her mood appears brighter and the depression dissipates. This pattern occurs monthly
and causes significant distress to her routine functioning. She has been diagnosed with
premenstrual dysphoric disorder (PMDD). Which medication/s are indicated for this condition?
a. Yaz
b. Sarafem
c. Zoloft
19. MJ is using citalopram. Choose possible side effects from the use of citalopram.
a. Dizziness
b. Decreased libido
c. Risk of QT prolongation
20. Select the correct mechanism of action for vilazodone
a. SSRI and 5-HT1a (serotonin-1a) partial agonist
21. A patient gave the pharmacist a prescription for Lexapro 10 mg daily #30. Which of the following
statements concerning Lexapro is incorrect?
a. Lexapro does not cause sexual concerns which can be present with other SSRIs
22. MD wishes to begin therapy with an antidepressant. The physician is considering either
desvenlafaxine or sertraline. Which of the following statements are correct?
a. SSRIs and SNRIs can cause hyponatremia
b. Physical symptoms, such as energy and sleep, usually improve prior to an improvement
in emotional symptoms, such as feeling better
c. Both of these medications carry a boxed warning for risk of suicidal thoughts or actions
in younger patients
23. A 51 year old female gave the pharmacist a prescription for doxepin 75 mg daily for depression
#30. She currently takes Irbesartan for hypertension, cetirizine for nasal allergies, Silenor nightly
for insomnia and occasional use of diphenhydramine. The patient mentions to the pharmacist
that she is very sleepy most mornings and has even been concerned that she might fall asleep
while driving to work. Select the correct statement
a. The prescriber should be called regarding duplication of therapy
24. Many of the antidepressants increase serotonin and avoidance of excessive serotonin is
required. Methylene blue, which is used in diagnostic procedures and to treat a few medical
conditions has monoamine oxidase inhibitor properties. Linezolid is a weak monoamine oxidase
inhibitor. The use of either will generally require temporary discontinuation of the
antidepressant medication. In addition, other drugs increase serotonin and can cause risk with
concurrent antidepressant use. Which of the following drugs will contribute to additive
serotonergic risk
a. Ultram
b. Methadone
c. Lithobid
d. St. John’s wort
25. Forfivo xl is a formulation of bupropion 450 mg, taken once daily. It is available only in this dose.
Forfivo is not approved for smoking cessation. It has the same suicidality warning as all other
antidepressants. Which of the following contraindications would rule out the use of Forfivo in a
patient being treated for depresson?
 a. Seizure disorder, using other forms of bupropion, bulimia, anorexia, or MAO inhibitor
use within the past 14 days
26. BG has suffered with depression for years, which she describes as “coming on every year, once
or twice, lasting a few months, and making me miserable. I don’t want to live when I’m that
low.” Her medications are listed below. Which medications could be contributing to her
depressive symptoms?
a. Pegasys, for hepatitis C
b. Oral contraceptives
c. Varenicline, for smoking cessation
27. Seroquel XR has been prescribed as adjunctive treatment for a patient receiving drug treatment
for depression who has not had a satisfactory response to several antidepressant medications.
The Seroquel XR is being added to his current medication regimen. Which of the following
represent boxed warnings for this use of Seroquel XR and will necessitate counseling by the
pharmacist.
a. Increased mortality in elderly patients with dementia-related psychosis
b. Suicidal thoughts and behavior
28. JJ is admitted to a skilled nursing after experiencing a stroke. She is clinically depressed and
cannot get to sleep at night due to excessive worry. JJ is not eating much at all and does not like
the food at the facility. She has a BMI of 17.2. Her blood pressure is 100/65 mmHg and her
potassium is 3.4 mEq/L. The physician has started mirtazapine 15 mg QHS. Choose benefits that
this medication may provide to the patient.
a. Help with sleeping at night
b. Positive benefit in mood
c. Increased appetite and weight gain
29. A patient is using the selegiline patch at 12 mg/day. The patient asks the pharmacist: “I was told
to avoid foods rich in tyramine, but I don’t know what foods I should stop eating. Do you?” the
pharmacist should counsel the patient to avoid the following foods:
a. Aged cheese, air-dried meats
b. Soy sauce
c. Sauerkraut
30. EK is using fluoxetine 20 mg QHS. She is having difficulty sleeping and has asked her pharmacist
for advice. Choose the most reasonable initial response
a. Move the fluoxetine to the morning
31. SK has been prescribed doxepin 200 mg daily for depression. He has failed trials with other
agents. SK suffers from severe depression and has tried to commit suicide in the past. His other
medications include furosemide, potassium extended-release, carvedilol and fosinopril. Which
of the following safety concerns should the pharmacist relay to the physician?
a. QT prolongation risk
b. Suicide risk with tricyclic antidepressants
32. FL is a 45 year old male who recently lost his job. This has caused significant anxiety and
depression. At first, he tried to just “be happy” but he is very low and has felt low for so long
that he is having difficulty applying for work. He has asked for an antidepressant. His height is
5’10”, and weight is 199 pounds, blood pressure 155/92 mmHg, pulse 86 BPM. Current
medications are Adderall XR and a multivitamin. Choose the safest option for FL
 a. Escitalopram
33. An increased risk of teratogenic effects, including cardiovascular defects, are linked to use of
SSRIs during pregnancy. Choose a specific type of problem identified with the newborn that is
linked with SSRI use during pregnancy
a. Persistent pulmonary hypertension of the newborn (PPHN)
34. SR is a 34 year old male lawyer who has been recently diagnosed with a relapse of major
depression. He feels unmotivated to go to work, complains of lack of energy and feelings of guilt
that constantly plague him, and has noticed he sleeps much more than he normally does. He has
tried Lexapro 10 mg daily in the past for several months but without much success or
improvement in symptoms. “Many years ago I tried Zoloft too and that did nothing except make
me feel worse!” which medication might be a reasonable option in this patient at this time?
a. Wellbutrin XL
35. A patient is using Wellbutrin SR 150 mg BID for depression. He told his doctor that he has
improved, but the doctor assesses that he is not in full remission. The prescriber enters and
electronic prescription for Wellbutrin SR 200 mg TID. The pharmacist should relay the following
information to the prescriber?
a. This exceeds the maximum daily dose
b. The maximum dose/day is 450 mg (Wellbutrin SR and generics)
36. A mother brought in a prescription for fluoxetine for her teenage son. The boy has not been
participating in his usual sports, is eating poorly and is having difficulty getting to sleep at
bedtime. She tells the pharmacist that the boy was found trying to slit his wrists. After a directed
intervention, he is better but is still high risk for suicide. The following counseling must be
relayed to the parent
a. Initially, he will be at heightened risk for suicide
37. Which of the following neurotransmitters is not believed to be involved in depression?
a. Melatonin
38. Select the side effects common to the class of drugs that includes venlafaxine, duloxetine and
desvenlafaxine?
a. Diaphoresis
b. Sexual dysfunction
c. Elevated blood pressure and heart rate
39. A patient gave the pharmacist a prescription for Viibryd. Which of the following is the correct
generic name for Viibryd?
a. Vilazodone
40. A patient is using the following medications daily: amlodipine 10 mg and chlorthalidone 25 mg
for hypertension, atorvastatin 40 mg and fenofibrate 130 mg for cholesterol, Wellbutrin Xl 300
mg daily for depression. He also uses lorazepam 1 mg as needed for anxiety. The patient is a
smoker and has been unable to quit. The prescriber calls in a prescription for Zyban 150 mg BID
to the pharmacy. Select the correct statement
a. The patient is already taking the same active ingredient in Zyban; the prescription
cannot be filled
41. Which of the following items are contraindicated in a patient taking phenelzine or
tranylcypromine?
 a. Foods rich in tyramine, including many foods that are smoked, aged, pickled or
fermented
b. Tricyclic antidepressants
c. Venlafaxine and desvenlafaxine
d. Fluoxetine and paroxetine
42. Which of the following are brand formulations that contain bupropion?
a. Contrive
b. Zyban
c. Aplenzin
d. Wellbutrin SR
43. A pharmacist receives a prescription for Viibryd. Select the appropriate generic name for this
antidepressant medication
a. Vilazodone
44. A patient has been treated at the community hospital for osteomyelitis in the lower left
extremity. The other medications that the patient uses chronically include Levitra, trazodone,
symbyax, Novolin N, glyburide, Fortamet and Cozaar. The hospital infectious disease team has
discharged the patient with a prescription for Zyvox 600 mg PO BID, to continue as an
outpatient for 4 weeks. Zyvox cannot be filled in this patient due to the concurrent use of the
following medications
a. Trazodone, symbyax
45. There is an FDA warning not to prescribe citalopram above this maximum daily dose, due to the
risk of QT prolongation
a. 40 mg daily
46. BL is a 39 year old female who comes into the outpatient clinic visibly upset and anxious. She is a
single mother who works as a paralegal and takes care of her 14 year old daughter. BL
complains that over the past month or two she has had more frequent fights with her daughter,
and has been having difficutly concentrating at work, trouble staying asleep at night……………
which condition is most likely to contribute to a depressed state in BL?
a. Hypothyroidism
47. Of the following medications BL is using chronically, which can contribute to a depressed mood?
a. Cyclessa
b. Cyclosporine
48. Which recommendation would best address BL’s issues with her therapy for depression?
a. Switch to bupropion
49. AB is a 38 year old female who has stopped enjoying her normal activities. She is easily tearful.
AB is hesitant to ask for help as she feels worthless and does not wish to burden her family or
friends because they already get annoyed that she leaves a mess around the house and has
done this since childhood……. What symptoms of depression, according to the DSM criteria, are
present in this patient?
a. Anhedonia (diminished pleasure/interest)
b. Feelings of worthlessness or guilt
c. Changes in appetite
d. Changes in sleep pattern
50. Which medication/s could be contributing to AB’s depression symptoms?
 a. Catapres
b. Inderal LA

Chapter 64 Schizophrenia/psychosis

1. Doris Brass is a 72 year old female caregiver for her husband Edward brass, who is suffering
from dementia. Recently, to Ms. Brass’s very sad surprise, her husband struck her while she was
helping him eat. She asked the physician for help and he prescribed risperidone 1 mg BID. The
pharmacist should inform Ms. Brass of the risk of using this medicine ( and the mild, if any,
benefit). The pharmacist should inform her that there may be a slightly increased risk of serious,
possibly fatal, side effects when this medication is used in older adults with dementia primarily
due to an increased risk of the following
a. Myocardial infarction
b. Cerebrovascular accident
c. Infection
2. Charlene Fitzpatrick is a 74 year old female who has a unilateral tremor in her right hand. She
may have parkinson’s disease. The physician needs to choose a second generation antipsychotic
for Ms. Fitzpatrick. Among the following second generation agents, which agents have a high
risk for movement disorders and should not be chosen for this patient?
a. Paliperidone
b. Risperidone
3. Select the correct chemical class for chlorpromazine
a. Phenothiazine
4. Brian McGough is a 24 year old male who has failed trials with olanzapine and ziprasidone. The
psychiatrist plans to initiate clozapine therapy and sends the patient to have a CBC drawn. The
patient cannot be started on clozapine therapy if the absolute neutrophil count (ANC) is below
a. 1500/mm^3
5. A 28 year old female patient experienced high prolactin levels while using the atypical agent
risperidone. She experienced decreased, irregular menstrual periods. She found this very
bothersome and discontinued the drug. Which of the following agents would put her at
repeated risk for the same adverse reaction?
a. Paliperidone
6. Which of the following prescription drug classes may induce or exacerbate psychotic symptoms?
a. Systemic steroids
b. Sinemet
c. Adderall
d. Mirapex
7. Phenylalanine must be avoided in patients with PKU. Which of the following formulations may
contain phenylalanine?
a. ODTs or sublingual formulations
b. Chewable formulations
c. Granules
8. Byron Grey is a 34 year old male diagnosed with schizophrenia. He presents to the clinic for
routine follow up ad for his monthly injection Invega sustenna, which he has been taking for 11
 months. His past medical history includes obesity, hypertension, hyperlipidemia and two suicide
attempts. His medications include amlodipine 10 mg po daily and atorvastatin 40 mg po at hs.
He smokes ½ pack of cigarettes per day. Which of the following medications can be given
monthly or less frequently than monthly?
a. Haloperidol decanoate
b. Invega trinza
c. Ability maintena
9. A pharmacist will counsel a patient beginning therapy with Saphris. Which of the following are
correct counseling statements?
a. Place the tablet under the tongue and allow it to dissolve completely
b. The medicine can make the tongue numb
c. If the patient has any uncontrollable movements of the mouth, tongue, cheeks, jaw, or
arms or legs, please contact a healthcare provider right away
10. A physician has a patient who is forgetful and does not take her antipsychotic on a regular basis.
The physician wishes to use one of the newer, atypical or “second generation” agents. He has
heard that one of them is available in a two week formulation. Which agent comes in a 2-week
intramuscular injection?
a. Risperidone
11. A pharmacist will counsel a patient beginning therapy with Zyprexa. Which of the following are
correct counseling statements? (select all)
a. The other name for this medication is olanzapine
b. This medication can cause the patient to gain weight and can increase blood sugar and
cholesterol. It is important to try to get regular exercise, such as walking, and to eat
healthy foods.
12. A patient gave the pharmacist a prescription for abilify 10 mg PO daily #30. Which of the
following is an appropriate generic substitution for abilify?
a. Aripiprazole
13. Rosie McDonald is a 52 year-old female patient with schizophrenia, depression, elevated
cholesterol, pre-diabetes and hypothyroidism. The physician is considering a trial with
olanzapine. Choose the correct statements
a. Olanzapine is sedating and is generally taken at bedtime
b. Olanzapine can increase her blood glucose and weight
c. Olanzapine can increase her weight and cholesterol
14. SJ has failed several trials of antipsychotics. He continues to respond to “voices” that constantly
torment him. He has tried to commit suicide several times. His other medical conditions include
poorly controlled seizures since childhood, phenytoin-induced gingival hyperplasia and
thickening of facial features, depression, anxiety, elevated cholesterol and pre-diabetes.
Fortunately, since a second-anticonvulsant was added to the phenytoin, he has not had a
seizure in the past six months. His WBC is 5,500 cells/mm^3 and ANC is 1890/mm^3. Choose the
correct statements. Select all
a. If he has poor adherence clozapine comes in an ODT formulation called FazaClo
b. Clozapine can be tried as he has failed several trials of antipsychotics
c. The patient’s ANC permits clozapine therapy
d. Clozapine use could result in loss of seizure control
15. Jessica krazny is a 72 year-old female with a variety of medical conditions. Two years ago, her
family reported that ms. Krazny was displaying paranoid delusions, including the belief that her
daughter was trying to kill her by poisoning her food. The physician prescribed risperidone,
which has been helpful. At clinic today ms. Krazny is darting her tongue in and out and blinking
in an involuntary manner. She is displaying the following adverse effect from the use of an
antipsychotic:
a. Tardive dyskinesia
16. What is the rationale behind the production of several different formulations of orally
disintegrating tablets for schizophrenia?
a. The patient will not be able to “cheek” the medicine and spit it out later
17. Select the correct chemical class for Haldol
a. Butyrophenone
18. Rudy Reynolds is a 17 year-old high school junior who no longer wishes to socialize with her
former friends. Ms. Reynolds is speaking little and has little desire for social interaction. When
asked by her mother if she is interested in seeing her former friends, she states she does not
care. Choose the response that best describes these symptoms of schizophrenia displayed by
ruby Reynolds
a. Negative symptoms
19. Benjamin yavel is an elderly gentleman with advanced parkinson’s disease. He has lived in a
skilled nursing facility for about one year since he became unable to feed himself. Mr. yavel
tried to hit his roommate with a butter knife. He explained to the nurse that roommate was
planning to attack him when he was sleeping in order to take his eyes out and sell them. Which
of the following medications are possible contributing to mr. yavels’ psychosis?
a. Requip
b. Sinemet
20. A patient gave the pharmacist a prescription for Geodon 60 mg PO BID #60. Which of the
following is an appropriate generic substitution for Geodon?
a. Ziprasidone
21. Haloperidol comes in the following formulations?
a. Fast-acting injection
b. Four-week depot injection
c. Oral tablet
22. Carol Devry presents to the pharmacy with a prescription for cariprazine with instructions to
take 1.5 mg po daily on day 1, then increase to 3 mg po daily. What is an appropriate substitute?
a. Vraylar
23. A patient gave the pharmacist a prescription for Seroquel 25 mg BID #60. Generic substitution
for Seroquel?
a. Quetiapine
24. Antipsychotics such as chlorpromazine and haloperidol exert their mechanism of action by
blocking this receptor?
a. Dopamine
25. Ruby Reynolds is a 17 year-old high school junior who is seen mumbling to herself repeatedly in
class. When confronted, it is apparent that ms. Reynolds believes she is talking to someone.
 Choose the response that best describes the symptom of schizophrenia displayed by ruby
Reynolds:
a. Hallucination
26. In a recent epidemiologic study that included 6,988 patients, patients exposed to olanzapine for
45 days or more had increased risk of diabetes (HR 1.71, 95%CI, 1.12-2.61) compared to patients
receiving typical (first-generation) antipsychotics. Choose the statement below that best reflects
the meaning of this statistical parameter.
a. Patients in the olanzapine group had a 71% higher risk of diabetes, which was
statistically significant
27. A patient gave the pharmacist a prescription for Zyprexa 5 mg po QHS #30. Generic
substitution?
a. Olanzapine
28. Charlene Theron had never used drugs but was “talked into” trying methamphetamine by a
friend. Ms. Theron took the drug and began to believe that she had to have sexual relations with
the boy next to her in order to prove her dedication to God. Charlene experienced drug-induced
psychosis. Other drugs that can cause drug-induced psychosis include?
a. Phencyclidein(PCP)/MDPV(bath salts)
b. Dextromethorphan
c. Amphetamines, include methamphetamine
d. Lysergic acid diethylamide
29. Antipsychotics can cause cardiovascular side effects, including dizziness and orthostasis. Proper
counseling points for antipsychotics should include?
a. All of the above
30. A 23 year-old male was picked up by the police for acting erratically and threatening patrons at
a subway stop. He was placed into the acute lock-down ward of the psychiatric hospital and
given an injection of haloperidol and lorazepam. He quickly developed a very painful sustained
contraction of his neck and trunk. Choose the correct statements concerning this adverse drug
reaction?
a. He can be treated with a centrally-acting anticholinergic, such as diphenhydramine
b. He is higher risk and should have received prophylaxis for his reaction
c. He is likely experiencing a dystonic reaction due to haloperidol
31. Ruby Reynolds has been diagnosed with schizophrenia and has been prescribed risperidone. Her
heart rate becomes tachycardic and the physician wishes to use an agent with the lowest
cardiovascular risk. Choose the agent on the patient’s formulary that is not considered to be
among the higher risk options
a. Lurasidone
32. Ruby Reynolds has been diagnosed with schizophrenia and has been prescribed risperidone. She
is sleeping almost all day. Choose the agent on the patient’s formulary that is least sedating?
a. Aripiprazole
33. A female patient has been taking haloperidol 1 mg BID. Her family noticed an unusual
“smacking” motion made with her lips and unusual eye movements. Choose the correct
statements
a. The haloperidol should be discontinued; she will have to try an alternative antipsychotic
 b. If the haloperidol is not discontinued quickly there is a risk that the abnormal movement
will become permanent
34. A patient is going to begin Invega sustenna. Choose the correct statements concerning this
medication
a. Invega sustenna is a once-monthly formulation of paliperidone
35. A patient gave the pharmacist a prescription for Risperal 1 mg PO TID #90. Generic name?
a. Risperidone
36. Which of the following drugs requires prescribers, pharmacists and patients to participate in a
REMS program?
a. Clozapine
37. Angelica Bryson has been taking an atypical antipsychotic as an adjunctive agent to treat
resistant depression. After beginning the antipsychotic as an adjunctive agent to treat resistant
depression. After beginning the antipsychotic she began to feel that she had a feeling of
restlessness and an urge to move. She stated that she feels that she cannot keep her legs still.
Ms. Bryson is displaying the following adverse effect from the use of an antispsychotic
a. Akathisia
38. A pharmacist has instructed a patient’s caregiver to draw up the medication in the oral syringe
she has supplied and administered directly down the patient’s feeding tube. Which medication
is the pharmacist dispensing?
a. Risperidone
39. A pharmacist will counsel a patient beginning therapy with Seroquel xr. Which of the following
are correct counseling statements?
a. This medication can cause weight gain and can increase blood sugar and cholesterol. It
is important to try and get regular exercise, such as walking, and to eat healthy foods
b. Take at night without food, or with a light meal that is not over 300 kcals (calories)
40. A pharmacist will counsel a patient on the proper use of abilify discmelt. Choose the correct
counseling points.
a. Immediately upon opening the foil blister, remove tablet and place in mouth; do not
push the tablet through the foil because it may crumble
b. The patient dose not need water to take this medicine; use water only if desirable .
c. Do not open with wet fingers

Chapter 65 bipolar disorder

1. A pharmacist will counsel a patient beginning lithium therapy for bipolar disorder. Which of the
following statements regarding lithium are correct?
a. Patients should drink plenty of water and other fluids to avoid dehydration, as this can
increase lithium side effects
b. This medication can cause a light tremor in the hands; if the patient notices the tremor
looks worse (much more noticeable), it can mean the level of drug in the body is too
high and the user should see a healthcare provider right away
c. The patient will need to have his/her blood checked occasionally while taking his
medicine
 d. The patient should not become pregnant while taking this medicine, as it can harm the
baby; if the patient become pregnant, contact a healthcare provider right away
2. Which of the following medications is not used as a mood stabilizer in treatment of bipolar
disease?
a. Paroxetine
3. PG is a 42 year old male with a new diagnosis of bipolar disorder. He is currently experiencing
mania. Which of the following would not be a good choice for this initial therapy?
a. Lamictal XR
4. Select the correct name for the resource used to correlate symptoms to a diagnosis in patients
with psychiatric illness?
a. The diagnostic and statistical manual of mental disorders, fifth edition(DSM-5)
5. Which of the following does not require a medGuide to be dispensed each time the prescription
is filled?
a. Lithium
6. DN has used lithium for many years. Normally, she has a fine hand tremor. Today, her hand is
visibly shaking. She is nauseated, and vomited the little she ate this morning. Her speech is
slurred and confused. She appears to have difficulty walking into the examination room. DN is
found to have lithium toxicity. Which of the following can contribute to lithium toxicity?
a. Decreased intake of NaCl
b. Reduced renal function
7. What are the indications for symbyax?
a. Treatment -resistant depression
b. Bipolar depression
8. LT has been using lithium for most of her adult life. She cannot afford air conditioning and has
been living in an apartment where the temperature has been over 90 degrees for the past five
days. She succumbed to the heat and has been brought into the hospital with dehydration,
acute renal failure and lithium toxicity. The lithium level is taken and found to be 3.2 mEq/l. the
following adverse effects may be present when the lithium concentration is at this level?
a. Seizure
b. Severe CNS sedation
c. Coma, death could occur
d. Arrhythmias
9. A patient has been diagnosed with bipolar I disorder. Which of the following statement
concerning bipolar disorder is correct?
a. In bipolar I, mania and psychosis can require hospitalization
10. JN is a 43 year-old black female with bipolar disorder who has been using lithium for 4 ½ years.
She presents to the clinic on 8/8 to complain about nausea…..which of the following represents
a reasonable option for JN at this time?
a. Change to lithium extended-release 450 mg PO BID, recommend eating some breakfast
11. HL is a 50 year old female who has been using lithium as a mood stabilizer for bipolar disorder
for three years. HL presents to the clinic for her six-month follow up. She complains of fatigue,
constipation, dry skin and mental sluggishness. Which of the following lab tests are most
appropriate to find the probable cause of these symptoms?
a. TSH and FT4
 12. GL is a known patient at the local pharmacy. She states that she is depressed due to her
husband’s gambling streaks in which he has racked up high credit card debts. She states that he
is either engaging in risky behavior or “moping around the house”. GL says that her husband
finally went to see a doctor, who diagnosed her spouse with “bipolar II disorder”. She asked the
pharmacist what this means. Pick the most reasonable explanation
a. This is a disease where the person has periods of elevated or irritable mood, which
alternates with periods of very sad mood
13. Choose the correct statement concerning treatment of bipolar disorder in pregnancy?
a. Lurasidone has more favorable safety profile in pregnancy and is approved for bipolar
depression
14. TN is a 27 year old male with bipolar disorder who is intubated in the medical ICU and needs his
lithium to be given via feeding tube. He takes 1350 mg daily, divided TID. The hospital has
available a lithium solution that contains 300 mg (8 meq) per 5 ml. what volume of lithium
solution should be receive per dose?
a. 7.5
15. A patient gave the pharmacist a prescription for depakene 150 mg BID #60. Which of the
following is an appropriate generic substitution of depakene?
a. Valproic acid
16. Choose the correct statement/s concerning lithium and drug interactions?
a. Caution should be utilized when used with other serotonergic drugs, such as tramadol
b. Lithium is not metabolized; it is excreted renally
17. What is the correct serum trough range for monitoring lithium therapy?
a. 0.6-1.2 mEq/l
18. Lithium must be kept within a “narrow therapeutic range”. What signs and symptoms may be
present if the lithium concentration is elevated?
a. Ataxia, coarse hand tremor, diarrhea
19. A pharmacist will counsel a patient beginning lithium therapy for bipolar disorder. Which of the
following statements regarding lithium are correct?
a. Patients should avoid becoming pregnant while using this medicine. If the patient
become pregnant, see a healthcare provider right away
b. This medicine can make the user feel thirsty, and patients may need to use the
bathroom more often. In order to prevent becoming dehydrated, users should drink
water often and take a water bottle with them when they go out
c. If the patient feels very nauseated , or has diarrhea (loose and watery stools), and if the
patient feels confused with slurring speech , or have trouble walking, it could mean the
amount of medicine in the body is too high, see a healthcare provider right away

Chapter 66 ADHD

1. Which of the following ADHD medications is a long acting suspension?

a. Quillivant XR
2. The American association of pediatrics does not recommend use of which stimulant medication
in children 5 years and younger?
a. Dextroamphetamine IR
3. Which of the following stimulant medications is available as a chewable tablet?
a. Quillichew ER
4. Stimulants used for ADHD are scheduled by the DEA in the following controlled category?
a. C-II
5. The pharmacist is counseling the parent of an 11-year old boy who has received an ADHD
diagnosis and will begin therapy with concerta. All of the following counseling points should be
conveyed to the parent except?
a. When stopping this medication, it is important to slowly taper the dose under the care
of a healthcare provider
6. Choose the correct counseling statement/s for the Daytrana patch?
a. When removing the patch, fold it in half and put it down the toilet or in a lidded trash
can
b. Place on the right hip one morning, then alternate hips daily
c. Wash your hands immediately after applying the patch
7. An eight year old boy is impolite to his mother and barely responds to her requests to do his
schoolwork or clean up messes. However, he is relatively well behaved at school and the teacher
does not consider him to possess behavioral problems. The parents reported that the symptoms
started about 6 months ago and he has become very difficult to manage. They have requested
that the physician prescribe and ADHD drug. They were provided with a prescription for
concerta. Select the correct statement
a. The use of concerta does not meet recommended criteria
8. Which of the following ADHD medications releases the medication as immediate-release and
extended-release in an OROS delivery system?
a. Concerta
9. Choose the correct brand name for the long-acting formulation of clonidine approved for
ADHD?
a. Kapvay
10. JG is an 11 year old girl who presents on 2/2 with difficulty focusing, inattention, and inability to
sit still, which has been occurring for over a year according to her mother. She has just finished
treatment yesterday with an antibiotic for MRSA community acquired pneumonia? ….what
treatment plan can be implemented today if JG is to be started on a medication for ADHD?
a. Wait 14 days, then start Vyvanse 30 mg daily
11. A patient was using methylphenidate extended-release for ADHD. It helps somewhat but the
psychiatrist felt that an addition of intuniv might be useful. Which of the following statements
concerning intuniv is correct?
a. Intuniv contains extended-release guanfacine
12. A patient gave the pharmacist a prescription for Daytrana. Which of the following should be
dispensed?
a. Methylphenidate transdermal patch
13. A patient gave the pharmacist a prescription for Strattera. Choose the correct statements
concerning Strattera?
a. The generic name is atomoxetine
b. It has a boxed warning for risk of suicidal ideation
c. A two week wash-out period is required between atomoxetine and MAO inhibitors
 d. It is a selective norepinephrine reuptake inhibitor approved for use in patients 6 years of
age and older
14. A patient gave the pharmacist a prescription for Vyvanse 30 mg daily #30. Vyvanse contains the
following compound?
a. Lisdexamfetamine
15. Stimulant medications used for ADHD included the following warnings?
a. Risk of psychiatric problems
b. Risk of heart-related problems
c. Risk of abuse and dependence
16. PH is 7 year old boy who is experiencing outbursts at his school, inability to sit through dinner,
and loss of focus. His physician would like to initiate a medication to treat these symptoms of
ADHD. Which of the following statements is correct?
a. Ritalin is a first-line medication for ADHD; the starting dose is 5 mg BID
17. A pharmacist is dispensing atomoxetine to an adult patient who has a history of alcohol and
drug abuse. The pharmacist should include which of the following counseling statements?
a. If nausea occurs with a decrease in appetite, weakness, abdominal pain, or yellowed
skin, see a healthcare provider quickly
18. Stimulant medications used for ADHD in children are filled monthly. During each visit (or
sometimes less frequently) the following should be monitored
a. Height and weight
b. Heart rate
c. Blood pressure
d. ADHD symptoms, and the child’s mood
19. A patient gave the pharmacist a prescription for focalin 5 mg BID. Which of the following is an
appropriate generic substitution for focalin?
a. Dexmethylphenidate
20. Which of the following ADHD medications contains both dextroamphetamine and
amphetamine?
a. Adderall
21. A patient was using methylphenidate extended-release for ADHD. It helps somewhat but the
psychiatrist felt that and addition of Kapvay might be useful. Which of the following statements
concerning Kapvay is correct?
a. If stopped suddenly, the patient’s blood pressure could shoot up quickly; titrate off if
discontinuation is required
22. Which of the following formulations of methylphenidate is not available?
a. Immediate-release sublingual tablet
23. A mother reports that her child, who started methylphenidate BID approximately two weeks
ago, is having trouble sleeping since beginning the medication. Which of the following
statements are correct?
a. Diphenhydramine, taken QHS, may be helpful
b. Clonidine, taken QHS, may be helpful
c. Taking a long-acting formulation that is dosed once daily in the morning may be helpful,
since a dose is not taken later in the day
 24. A patient gave the pharmacist a prescription for Ritalin 2.5 mg BID. Choose the correct name for
the generic component in Ritalin?
a. Methylphenidate
25. Choose the correct brand name for long acting formulation of guanfacine approved for ADHD?
a. Intuniv
26. Which of the following drugs is considered to have a lower risk of abuse since the drug requires
conversion to an active stimulant and a quick “high” is averted?
a. Vyvanse
27. A pharmacist is dispensing Vyvanse to a patient who is beginning therapy for ADHD. Correct
counseling statements include the following?
a. It is important to eat a healthy breakfast before the medication kicks in; it can decrease
appetite during the day
b. The capsule contents can be opened and mixed in water
c. This medication has a Medication Guide that describes the most important safety
considerations; please take the time to read it
d. Nausea is possible, especially when the medication is being started or the dose is being
increased by the physician
28. DG is a fifth grade student who was recently diagnosed with ADHD and given a prescription for
Concerta 54 mg daily. The first day he took the medication, he complained of nausea and
abdominal pain. That afternoon, the smell of his teacher made him complain vocally which
earned the child detention. Select the correct statement
a. The starting dose was too high
29. MJ s an 8 year old boy who is visiting his psychiatrist for a follow up. He has been
experiencing….which medication can MJ be switched to for treatment of ADHD?
a. Intuniv
30. MJ’s concerta was discontinued and he was started on intuniv 1 mg daily and titrated up to 3 mg
daily after three weeks. Soon after, he developed a skin rash with exfoliation. What is the most
appropriate course of action to take at this time?
a. Discontinue the drug and do not restart

Chapter 67 anxiety disorder

1. Ly is a 45 year old female who presents to her PCP on August 1st for a follow-up of multiple
health problems, including a recent asthma exacerbation. She complains of stress and
constantly worrying for the past year. She expresses fear about managing her finances and her
health, though there have been no major changes in her life recently to contribute to this. She
obtains prescriptions from her PCP, but is often resistant to suggestions and advice from
healthcare providers…of all of the medications that have been prescribed for LY, which is
considered first line to treat a chronic anxiety disorder?
a. Zoloft
2. Which of the following may be contributing to LY’s anxiety?
a. Incorrect use or overuse of albuterol
b. Use of theophylline
c. Use of a systemic steroid
 d. Use of a decongestant
3. In reviewing LY’s medication history, you find a note from 4/25 that says “Zoloft 50 mg has not
improved anxiety, switch to valium”. What is the most likely reason that Zoloft was not
effective?
a. The duration of use may have been too short, and the dose too low
4. What is the generic name of the medication prescribed for LY on 4/25?
a. Diazepam
5. What is the generic name of the benzodiazepine prescribed for LY on 3/15?
a. Alprazolam
6. Based on Ly’s lab results, what undiagnosed condition does she have that could present with
symptoms of anxiety (e.g..,tachycardia, shortness of breath, insomnia)?
a. Hyperthyroidism
7. A patient gave the pharmacist a prescription for Klonopin 0.25 mg BID as-needed #60. Which of
the following is an appropriate generic substitution for klonopin?
a. Clonazepam
8. Which of the following statements correctly describes the anxiolytic buspirone?
a. If switching from a benzodiazepine to buspirone, it is still necessary to slowly taper the
benzodiazepine off
b. It may take 2-4 weeks for the patient to notice the maximum effect from this drug
c. Buspirone works via serotonin receptors; there is a risk for serotonin syndrome when
used with other serotonergic drugs
9. A patient gave the pharmacist a prescription for Ativan 1 mg TID, take one tablet as needed #20.
Which of the following is an appropriate generic substitution for Ativan?
a. Lorazepam
10. Which of the following medications should be avoided with benzodiazepines according to the
boxed warning for this class of medications?
a. Oxycontin
11. When dispensing a benzodiazepine, auxiliary labels containing which of the following
information should be placed on the bottle?
a. This drug may impair your ability to drive or operate machinery
b. Controlled substance dangerous unless used as directed
12. Which of the following patient scenarios is not consistent with a diagnosis of anxiety disorder?
a. Has a temporary period of stress due to marital discord (e.g a divorce)
13. A middle-aged man was in a motor vehicle accident and was out of work for about twelve
months. Eventually he returned to work but during the time he was recuperating at home, he
lost his usual enjoyment of living and felt sad most of the time. He is able to function at work,
but he has anxiety about losing his job, being in another auto accident and other (largely
baseless) fears. What resource would help determine if this patient has depression or an anxiety
disorder?
a. Dsm-5
14. MK found that the lorazepam he was prescribed for anxiety was effective, but after about 4
months it was no longer working as well as it had previously. He initially used 0.5 or 1 mg. he
increased his dose to 2 mg, and this worked for a while. He eventually was using 4 mg to get the
same effect. What has most likely happened to MK?
 a. He has developed tolerance
15. Which of the following natural products can be used to help anxiety?
a. Valerian
16. What is the mechanism of action of the benzodiazepines?
a. They potentiate GABA, an inhibitory neurotransmitter, resulting in CNS depression
17. A patient comes to the pharmacy counter with a bottle of St. John’s wort. He is also picking up
multiple prescriptions for his chronic conditions, including Cymbalta, tramadol, warfarin,
lisinopril, furosemide and coreg. Which of the following safety concerns would prompt you to
counsel the patient about the use of ST. john’s wort?
a. It could increase the risk of serotonin syndrome
b. It can decrease the effects of his other medications
c. It may take him sensitive to the sun
18. A patient is preparing for a solo piano performance with the local symphony orchestra. He is
very anxious and wants to know what he can take to calm his nerves. Which of the following
could be recommended?
a. Propranolol
19. CL is a 76 year old female who experienced the loss of her spouse this past week. She has not
been able to sleep and is acting erratic. Her family is coming for a gathering and CL is worried
about behaving properly. Choose the best benzodiazepine for CL to use during the day that will
calm her and help her cope during the family gathering?
a. Lorazepam
20. BG is an older gentleman who was in a motor vehicle accident. Previously, BG’s daily
medications included nifedipine, simvastatin, aspirin and tramadol (for generalized arthritis
pain). Cyclobenzaprine was added at the time of the accident. Due to the accident and injury, BG
has experienced anxiety and was given a prescription for lorazepam to use as-needed. He has
one drink of whiskey at bedtime. The patient is facing significant risk of the following additive
drug interaction problem.
a. Central nervous system depression

Chapter 68 sleep disorders: Insomnia, Restless Legs syndrome(RLS)& Narcolepsy

1. Select the class of drugs used most commonly to treat restless legs syndrome (RLS):
a. Dopamine agonists
2. BH is a 46 year old female who has been using Lunesta for sleep. Her other medications include
lisinopril and a calcium plus vitamin D supplement. At a follow up visit, she states that her
spouse complained that she had eaten his leftover birthday cake. She does not recall doing so
although a plate with cake crumbs was found in the kitchen a few mornings in a row. Which of
the following assessments can me made?
a. BH has experienced a parasomnia due to the use of Lunesta
3. HG is a 61 year old male patient who has come in for his routine annual physical. He reports that
he has developed an urge to move his legs when he tries to sleep at night, and the only way to
stop it is to get up and move. If he stops moving, the feeling comes back. HG states that this has
occurred during the day a few times (when he was resting in his easy-chair) but it almost always
 happens when he first goes to bed. He describes it as “unpleasant, uncomfortable and creepy.”
Which condition is most likely causing HG’s symptoms?
a. Restless Legs Syndrome
4. Which of the following best describes the rationale for avoiding benzodiazepines in elderly
patients with insomnia?
a. There is a risk of falls and injury due to excessive CNS depression
5. Which of the following drug/s increase GABA leading to an inhibitory effect by binding to
benzodiazepine receptor subtypes specific for sedation?
a. Ambien
b. Sonata
c. Eszopiclone
6. A pharmacist is discussing the use of sleep agents on medical rounds. He is asked about the
usefulness of the drug rozerem. Which of the following statements are correct?
a. It is a melatonin receptor agonist
7. Which of the following drugs are used in the treatment of restless legs syndrome (RLS)
a. Requip
b. Horizant
c. Mirapex
d. Neupro
8. Which of the following insomnia medications requires a 14-day wash out period in someone
who had been using phenelzine?
a. Silenor
9. A patient arrives at the pharmacy with a prescription for new-onset Restless legs syndrome
(RLS). Which of the following statements is true regarding treatment of RLS?
a. Pramipexole immediate-release formulation should be taken 1-3 hours before bedtime
10. Which of the following statements is not correct regarding xyrem?
a. It is a C-V drug
11. Which of the following medications can be used for narcolepsy?
a. Methylphenidate
12. Benzodiazepines are considered unsafe to use in elderly patients, and in many younger patients
as well. Although all benzodiazepines carry health risks, select the agents below that are
considered less harmful for elderly patients if a benzodiazepine must be used:
a. Lorazepam, oxazepam, temazepam
13. Select the correct characterization of the drugs modafinil and armodafinil
a. These are stimulants for wakefulness
14. EC is a 55 year old female who has been prescribed Ambien for sleep. She has one or two glass
of wine at dinner almost daily. EC should receive the following counseling:
a. It is best not to use alcohol with zolpidem or any other sleep medication
15. JF is using Tamsulosin, psyllium, atenolol, sertraline and latanoprost. He wishes to purchase over
the counter diphenhydramine for sleep. Which of JF’s medications should indicate to the
pharmacist that diphenhydramine is not a good choice?
a. Latanoprost
b. Tamsulosin
c. Psyllium
 16. JL is a 70 year old female who is having difficulty sleeping since her cat died. She is not clinically
depressed. The physician wishes to prescribe a hypnotic. From the choices below select the
most appropriate option:
a. Zolpidem
17. A patient arrives at the pharmacy with a prescription for Horizant, a brand of gabapentin
approved for restless legs syndrome (RLS). Select the correct statement regarding this drug
a. It is also indicated for postherpetic neuralgia
18. A pharmacist will instruct a medical resident about the medication zolpidem. Which of the
following statements regarding zolpidem are correct?
a. This medication comes in an oral spray; the brand name is Zolpimist
b. This medication comes as a SL tablet; the brand names are edluar and intermezzo
c. This medication comes as a tablet (IR and CR); the brand name is Ambien
19. Nuvigil and Provigil require a medguide and careful pharmacist counseling due to this risk
a. Severe rash which can be life-threatening
20. A patient gave the pharmacist a prescription for Lunesta 1 mg, take one tablet as needed for
sleep. Which of the following is an appropriate generic substitution for Lunesta?
a. Eszopiclone
21. Select common side effects of the narcolepsy stimulants modafinil and armodafinil:
a. Headache, dizziness, anxiety, agitation
22. JY is a 72 year old female who comes into the clinic on 1/18 for a follow-up on her depression
medications. Her husband is with her and states that she is having trouble finding the right
words to say in conversation and becomes easily frustrated when she can’t remember simple
things, which is happening quite often. Her MMSE score today is 21…. Which of the following is
a true statement regarding JY’s medication profile?
a. Her medications are likely making her dementia worse
b. Fluoxetine can cause insomnia if taken too late in the day
c. Diphenhydramine should be avoided if possible in patients >65 years of age
23. SM is a 39 year old female who recently became involved in a sexual relationship. She comes to
the clinic for an oral contraceptive and to get advice on safe sex practices. Specifically, she wants
to know whether she and her partner should be screened for sexually transmitted diseases
before becoming intimate. MS has some documented chronic health conditions but believes in
natural healing and so takes a handful of supplements daily. She did not bring her medications
to clinic so there are limited details on dosing and manufacturer brands she is using…which of
the medications on SM’s profile is potentially being used for insomnia?
a. St. john’s wort and melatonin

Chapter 69 seizures/epilepsy

1. A young woman has been using Topamax for migraine prophylaxis. She may be interested to
know that the FDA has issued a warning regarding the risk for this type of birth defect in
children born to women taking Topamax during pregnancy. The warning concerned the
following birth defect
a. Cleft lip and/or palate
2. Which statements concerning status epilepticus are accurate?
 a. Patients in status epilepticus should be rolled on their side
b. The first line agents for treating status epilepticus include lorazepam or diazepam
c. Seizures that last longer than 5 minutes are considered status epilepticus
d. This condition is a medical emergency
3. Which of the following side effects/adverse drug reactions are possible with the use of
zonisamide?
a. Contraindicated in sulfa allergy
b. Kidney stones
c. Weight loss
d. Decreased sweating
4. What is the maximum infusion rate for fosphenytoin?
a. 150 mg PE/min
5. Which anticonvulsant requires genetic testing prior to use in persons of Asian descent?
a. Carbamazepine
6. Which of the following best describes the kinetics of phenytoin?
a. Phenytoin exhibits first order, then zero order kinetics
7. A 28 year old male has been diagnosed with seizures. He continues to have seizures despite
receiving multiple antiepileptic drugs. His doctor has prescribed a specific diet that can help
reduce seizures in patients who are refractory. Which of the following diets is used for this
purpose?
a. Ketogenic
8. Which of the following medications are known to cause seizures?
a. Demerol
b. Primaxin
c. Ultram
d. Zyban
9. Claire Biao, a thirteen year old Asian female, has been prescribed carbamazepine. Which allele
should be tested prior to initiation of therapy?
a. 1502
10. A patient had several seizures when she was a young child. She is now 13 years old and has been
seizure free for at least 5 years while taking carbamazepine. Choose the correct statement
a. Carbamazepine should be tapered gradually to minimize the risk of seizures
11. Choose the correct trade-generic match
a. Oxcarbazepine- Trileptal
12. Which of the following patient counseling points apply to all anticonvulsants?
a. Risk of suicidal ideation
13. CR recently experienced a seizure and requires an anticonvulsant…which anticonvulsant would
have minimal impact on CR’s current medication regimen?
a. Keppra
14. RT presents with a new prescription for Lamictal 250 mg BID #60. Choose the correct statements
a. Lamictal concentration can become markedly increased if the patient is taking valproate
b. The patient should be counseled on the risk of serious rash
c. The prescription cannot be filled until the prescriber is contacted to correct the dose
15. DK is a 47 year old male with epilepsy….which of the following anticonvulsants would be
contraindicated in DK?
a. Zonegran
16. An 8 year old girl is prescribed zarontin. She has 2 to 3 Hertz spiking wave discharge on her EEG.
Zarontin is primarily used for this type of seizure
a. Absence seizures
17. Side effects of divalproex sodium may include the following:
a. Hair loss
b. Thrombocytopenia
c. Weight pain
18. PY is a 32 year old male who is in status epilepticus. Phenytoin is ordered to be given by IV
infusion. What is the maximum infusion rate of phenytoin?
a. 50 mg/min
19. Which of the following formulations dissolves rapidly with a sip of liquid?
a. Spritam
20. A 25 year old male with recent head trauma is started on Dilantin for seizure prevention. Which
of the following statements concerning Dilantin is correct?
a. Serious skin rashes, including SJS and TEN, can occur with the use of this drug
21. A 42 year old female patient with partial onset seizures has several other medical conditions
including GERD, hypertension and diabetes type 2. She is currently prescribed omeprazole,
amlodipine and metformin. The physician has begun her on levetiracetam. Choose the correct
statement:
a. Levetiracetam may cause fatigue, somnolence and psychotic symptoms
22. JC, who has controlled partial seizures, has been experiencing at least 4 headaches per month
for the past 4 months. Which of the following anticonvulsants is indicated for migraine
prophylaxis?
a. Topamax
23. A 34 year old woman with a long history of epilepsy has been using phenobarbital 100 mg TID
for many years. She has not had a seizure in the past year. Choose the correct statement:
a. The therapeutic range for adults is 20-40 mcg/ml
24. JM has been taking primidone for many years. Primidone is similar in side effect profile to this
drug
a. Phenobarbital
25. A patient gave the pharmacist a prescription for Neurotin 300 mg TID #90. Which of the
following is an appropriate generic substitution for Neurontin?
a. Gabapentin
26. Which of the following pairs of terms is not correctly matched?
a. Focal aware seizure- previously called generalized partial seizure
27. Which of the following statements concerning oxcarbazepine is correct?
a. Serum sodium levels need to be monitored for the first 3 months of therapy
28. A patient is beginning Topamax therapy for new onset seizures. He brought in a prescription for
Topamax 25 mg BID #60. Which of the following statements is correct?
a. This drug is associated with decreased appetite and weight loss
29. Which of the following anticonvulsants are associated with oligohydrosis?
 a. Topiramate
30. TD is a 3 year old boy who was prescribed Diastat AcuDial. Which of the following statements
are correct regarding Diastat AcuDial
a. The mediation should be dialed to the correct dose and locked by the pharmacist before
giving to the patient
31. Which of the following is true of the mechanism of action for antiepileptic drugs?
a. Phenytoin is a sodium channel blocker
32. HT was in a motor vehicle accident with a head injury and suffered a seizure in the emergency
room. He has stabilized, and will released from the hospital on phenytoin 100 mg TID.
Discharged counseling on the use phenytoin should include a discussion of the following
symptom of acute drug toxicity
a. Ataxia
33. JW comes to pick up her seizure mediation, Lamictal. Which of the following statements
concerning Lamictal is true?
a. This medication requires a slow dose titration
34. Which of the following are boxed warnings for valproate and divalproex?
a. Hepatic failure
b. Teratogenicity
c. Pancreatitis
35. A 12 year old girl with refractory Lennox-Gastaut syndrome is prescribed felbamate. A
medication informed consent needs to be completed before starting therapy. The neurologis
asks the pharmacist to educate the patient and her family on the boxed warnings of felbamate
which include:
a. Hepatic failure and aplastic anemia
36. A hospital pharmacist is preparing a phenytoin injection. The pharmacist should use the
following diluent
a. NS
37. A pharmacist will counsel a patient on the possible side effects of oxcarbazepine. The most likely
side effects from the use of oxcarbazepine are
a. Sleepiness, ataxia, visual disturbances
38. Choose the correct statement below that best describes phenytoin
a. It is an enzyme inducer and can lower the concentration of other drugs
39. A patient has been admitted in the hospital with symptoms of acute phenytoin toxicity. Initial
lab reports include a total phenytoin level of 12.6 mcg/ml and an albumin level of 1.5 g/dl.
Which of the following statements is accurate?
a. The true phenytoin level is expected to be higher than reported
40. A child with epilepsy presents with a new prescription for Keppra 250 mg BID #60 . which of the
following is an appropriate generic substitution for Keppra?
a. Levetiracetam
41. TN, a 40 year old male patient who is starting carbamazepine. Choose the correct statement
concerning carbamazepine therapy
a. Carbamazepine is a potent inducer and can lower the concentration of many other
drugs
42. Choose the correct statement concerning fosphenytoin
 a. Fosphenytoin can be given by intramuscular injection
43. A patient who started taking antiepileptic drugs 2 years ago commented to her prescriber that
she has seen an increase in body hair. Which antiepileptic drug is associated with this effect?
a. Phenytoin
44. VC is a 34 year old female (height: 5’6”, weight: 156 lbs) who is admitted to the hospital with
seizure activity… based on the laboratory results on 4/14, what is VC’s corrected phenytoin
level?
a. 14.4 mcg/ml
45. VC is not tolerating orals. What is the equivalent total daily dose of Phenytek if given
intravenous?
a. 300 mg
46. What is the therapeutic range for tegretol?
a. 4-12 mcg/ml
47. Which of VC’s medications has a boxed warning related to her laboratory results on 6/17?
a. Depakote ER
48. Besides the labs obtained on 6/17, what other laboratory values should be monitored since VC is
taking tegretol?
a. CBC with differential
49. Which of VC’s medications is most likely causing the laboratory results on 4/14?
a. Tegretol