Stephanie is a 36-year-old female who presents to the clinic with a history of anxiety. Social history is unremarkable. For the last 4 years, she has been well controlled on paroxetine, however she feels “it just doesn’t work anymore.” You have decided to change her medication regimen to vortioxetine 5mg, titrating up to a max dose of 20mg per day based on tolerability. The patient asks, “When can I expect this to start kicking in?” The best response is: a. 3 or 4 days b. 1 or 2 weeks c. 3 or 4 weeks d. 10 weeks 3.75 points Question 2 Which of the following medications, when given intramuscularly, is most likely to cause severe postural hypotension? a. haloperidol b. lorazepam c. benztropine d. chlorpromazine 3.75 points Question 3 Sam is a 48-year-old male who presents to the clinic with signs and symptoms consistent with GAD & MDD. Which of the following medications would be the LEAST appropriate choice when initiating pharmacotherapy? a. duloxetine b. sertraline c. mirtazapine d. buproprion 3.75 points Question 4 Jason is a 6-year-old child whose mother presents to the clinic with him. The mother says that “he’s not himself lately.” After a thorough workup, you diagnose the patient as having GAD. Which of the following medications would be the LEAST appropriate to prescribe to this child? a. Sertraline b. Paroxetine c. Venlafaxine d. Buspirone 3.75 points Question 5 Mirza is a 75-year-old patient with a long history of schizophrenia. During the past 5 years, she has shown significant cognitive decline consistent with dementia. The patient has been well controlled on a regimen of risperidone 1mg BID. As the PMHNP, the most appropriate course of action for this patient is: a. Increase the risperidone to 1mg QAM, 2mg QPM b. Discontinue risperidone and prescribe a long-acting injectable such as Invega Sustenna. c. Discontinue risperidone and initiate therapy with clozapine. d. Augment the patient’s risperidone with brexpiprazole. 3.75 points Question 6 Amber is a 26-year-old female who presents to the clinic 6 weeks postpartum. The patient states that she has been “feeling down” since the birth of her son. She is currently breastfeeding her infant. You diagnose the patient with Postpartum depression. Which of the following is the LEAST appropriate option in treating her PPD? a. paroxetine b. escitalopram c. citalopram d. sertraline 3.75 points Question 7 Jordyn is a 27-year-old patient who presents to the clinic with GAD. She is 30 weeks pregnant and has been well controlled on a regimen of sertraline 50mg daily. Jordyn says that “about once or twice a week my husband really gets on my nerves and I can’t take it.” She is opposed to having the sertraline dose increased due to the risk of further weight gain. You have decided to prescribe the patient a short-term course of benzodiazepines for breakthrough anxiety. Which of the following is the LEAST appropriate benzodiazepines to prescribe to this patient? a. diazepam b. alprazolam c. clonazepam d. lorazepam 3.75 points Question 8 Steve is a 35-year-old male who presents to the primary care office complaining of anxiety secondary to quitting smoking cold turkey 2 weeks ago. The patient has a 14-year history of smoking two packs per day. The patient has an unremarkable social history other than a recent divorce from his wife, Brittany. Which of the following would be the LEAST effective medication to treat Steve’s anxiety? a. Buproprion b. Sertraline c. Varenicline …
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