Medications is 35% of the scored PTCE (the PTCB exam). Answer 10 exam style questions on antidepressants, antipsychotics and CNS drugs and see exactly which concepts would cost you points on test day.
Start the 10 questions →A patient with a history of seizures brings in a new prescription for Wellbutrin XL. Why should this be brought to the pharmacist's attention?
These questions cover antidepressants: bupropion cautions, drug classes: antidepressants, antidepressants: MAOI combinations, antidepressants: boxed warning and drug classes: antipsychotics. Each one shows the correct answer and why every other option is wrong, so a miss tells you exactly what to review before the PTCE.
Prefer to read first? Every question from the practice set above, with the correct answer and why each wrong option is wrong.
Answer: B. Wellbutrin XL is bupropion. Bupropion lowers the seizure threshold, and a seizure disorder is a labeled contraindication, so the pharmacist must review the order with the prescriber.
Why not A: Constipation is not the key concern with bupropion; the seizure risk is the safety issue in this patient.
Why not C: Bupropion tablets are stored at controlled room temperature, not in the refrigerator.
Why not D: Bupropion is not a federally controlled substance.
Exam tactic: Bupropion red flags: seizure disorder and eating disorders (bulimia, anorexia).
Answer: C. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI). It blocks reuptake of both serotonin and norepinephrine, like duloxetine (Cymbalta) and desvenlafaxine.
Why not A: Selective serotonin reuptake inhibitors (SSRIs) block serotonin reuptake only; examples are sertraline, fluoxetine and escitalopram.
Why not B: Monoamine oxidase inhibitors (MAOIs) include phenelzine, tranylcypromine and selegiline; venlafaxine does not inhibit monoamine oxidase.
Why not D: Tricyclic antidepressants (TCAs) include amitriptyline and nortriptyline; venlafaxine is not a tricyclic.
Exam tactic: SNRIs to know: venlafaxine, desvenlafaxine, duloxetine.
Answer: D. Combining an MAOI with an SSRI such as sertraline greatly increases serotonin and can cause serotonin syndrome (agitation, fever, tremor, fast heart rate, possibly death). The combination is contraindicated.
Why not A: A disulfiram-like reaction is caused by alcohol with drugs such as metronidazole, not by an MAOI plus an SSRI.
Why not B: Lactic acidosis is a rare warning for metformin, not for this combination.
Why not C: Tendon rupture is a boxed warning for fluoroquinolone antibiotics.
Exam tactic: MAOI + any serotonergic drug (SSRI, SNRI, tramadol, dextromethorphan) = serotonin syndrome risk.
Answer: B. Antidepressants carry a boxed warning for increased risk of suicidal thoughts and behaviors in pediatric and young adult patients. A Medication Guide must be given with each dispensing.
Why not A: Liver failure in older adults is not the class boxed warning for antidepressants.
Why not C: A serious rash boxed warning belongs to lamotrigine, an anticonvulsant, not to all antidepressants.
Why not D: Orthostatic hypotension can occur with some drugs but is not the antidepressant class boxed warning.
Exam tactic: Antidepressant boxed warning = suicidality in young patients, plus a Medication Guide every fill.
Answer: A. Aripiprazole is an atypical (second-generation) antipsychotic used for schizophrenia, bipolar I disorder and as add-on therapy for depression, like quetiapine, olanzapine and risperidone.
Why not B: Benzodiazepines include alprazolam, lorazepam and clonazepam; aripiprazole is not one.
Why not C: Tricyclics include amitriptyline and nortriptyline; aripiprazole is not an antidepressant class drug.
Why not D: Anticonvulsant mood stabilizers include lamotrigine and divalproex; aripiprazole is an antipsychotic.
Exam tactic: Atypical antipsychotics: aripiprazole, quetiapine, olanzapine, risperidone, ziprasidone, lurasidone.
Answer: D. Atypical antipsychotics, olanzapine in particular, are linked to metabolic effects: weight gain, high blood glucose and high lipids. Weight, glucose and lipids are monitored.
Why not A: Dry cough and angioedema are ACE inhibitor effects (lisinopril).
Why not B: Tendon rupture is a fluoroquinolone boxed warning.
Why not C: Black stools and constipation are typical of oral iron supplements.
Exam tactic: Atypical antipsychotics = metabolic effects (weight, glucose, lipids).
Answer: A. Ativan is lorazepam, a benzodiazepine and a federal Schedule IV controlled substance used for anxiety and other indications.
Why not B: Alprazolam is a benzodiazepine, but its brand is Xanax, not Ativan.
Why not C: Buspirone is a non-benzodiazepine anxiolytic and is not sold as Ativan.
Why not D: Hydroxyzine is an antihistamine sometimes used for anxiety; it is not Ativan.
Exam tactic: -azepam and -zolam = benzodiazepine: lorazepam (Ativan), alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium).
Answer: C. Opioids and benzodiazepines carry a boxed warning: used together they can cause profound sedation, respiratory depression, coma and death. The pharmacist reviews the combination.
Why not A: Serotonin syndrome comes from combining serotonergic drugs, such as an MAOI with an SSRI.
Why not B: Hypertensive crisis is the risk of MAOIs with tyramine-rich foods.
Why not D: Hyperkalemia is associated with ACE inhibitors, ARBs or potassium-sparing diuretics, not this combination.
Exam tactic: Opioid + benzodiazepine (or other CNS depressant) = breathing can stop.
Answer: D. Buspirone is a non-benzodiazepine anxiolytic with low abuse potential, so it is not a controlled substance. It takes a few weeks to work and is taken on a schedule, not as needed.
Why not A: Diazepam (Valium) is a benzodiazepine in Schedule IV.
Why not B: Alprazolam (Xanax) is a benzodiazepine in Schedule IV.
Why not C: Clonazepam (Klonopin) is a benzodiazepine in Schedule IV.
Exam tactic: Buspirone is the anxiety drug without the -azepam/-zolam ending and without a schedule.
Answer: B. Zolpidem carries a boxed warning for complex sleep behaviors, such as sleepwalking and sleep-driving, which can cause serious injury or death. Zolpidem is Schedule IV.
Why not A: Tardive dyskinesia is the boxed warning for metoclopramide (Reglan).
Why not C: Lactic acidosis is a warning for metformin.
Why not D: Tooth discoloration is a concern with tetracyclines in young children.
Exam tactic: Z-drugs (zolpidem, eszopiclone, zaleplon) = complex sleep behaviors boxed warning.
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