Which of the following pairs of drugs would be most appropriate as a therapeutic regimen for the 37-year-old woman with acute psychotic state and history of seizures?

Correct Answer: A

Rationale: The correct answer is A: Haloperidol and clonazepam. Haloperidol is an antipsychotic medication used to treat acute psychotic states, while clonazepam is a benzodiazepine commonly used to manage seizures. The combination is appropriate as it addresses both the acute psychotic symptoms and the history of seizures in the patient. Explanation for incorrect choices: B: Chlorpromazine and lamotrigine - Chlorpromazine is an antipsychotic, but lamotrigine is primarily used for mood disorders, not seizures. C: Clozapine and ethosuximide - Clozapine is an antipsychotic, but ethosuximide is used to treat absence seizures, not generalized seizures. D: Thioridazine and ethosuximide - Thioridazine is an antipsychotic, but ethosuximide is not commonly used for seizures in adults.

Correct Answer: C

Rationale: The correct answer is C: Inhibition of serotonin transporter. This mechanism of action would be appropriate for this patient as it increases serotonin levels in the synaptic cleft, which can help alleviate symptoms of depression. Monoamine oxidase A inhibition (Choice A) is used for atypical depression. Serotonergic receptor blockade (Choice B) can worsen depression symptoms. Blockade of β receptors (Choice D) is used for conditions like hypertension, not depression. In summary, choice C is the most suitable for treating depression by increasing serotonin levels, while the other choices are either ineffective or potentially harmful for this condition.

Correct Answer: D

Rationale: The correct answer is D: Chlorpromazine. The patient reported symptoms are likely extrapyramidal side effects, such as tremors, muscle rigidity, and akathisia, which are common with typical antipsychotics like chlorpromazine. Lithium (A) is used for bipolar disorder, not associated with these side effects. Amitriptyline (B) is a tricyclic antidepressant, known for sedation and anticholinergic effects. Fluoxetine (C) is a selective serotonin reuptake inhibitor, not known for causing extrapyramidal symptoms. Therefore, based on the symptoms described, chlorpromazine is the most likely culprit.

Correct Answer: A

Rationale: The correct answer is A: Amitriptyline. Metoclopramide interacts with amitriptyline by inhibiting its metabolism, leading to increased levels of amitriptyline in the body. This can result in adverse effects such as sedation, confusion, and potential serotonin syndrome. Explanation: 1. Metoclopramide is known to inhibit CYP2D6 enzyme, which is responsible for metabolizing amitriptyline. 2. Increased amitriptyline levels can lead to enhanced sedative effects and central nervous system depression. 3. The combination can also increase the risk of serotonin syndrome due to the additive serotonergic effects of both drugs. Summary: B: Lithium - Lithium does not have a significant metabolic interaction with metoclopramide. C: Zolpidem - Zolpidem is primarily metabolized by different enzymes and does not interact significantly with metoclopramide. D: Paroxetine - Although both

Correct Answer: C

Rationale: The correct answer is C: Insomnia. During the first days of lithium therapy, individuals are more likely to experience insomnia due to the stimulating effects of lithium on the central nervous system. This can disrupt sleep patterns and cause difficulty falling or staying asleep. Choice A (Constipation) is less likely to occur as lithium is not known to have a significant impact on gastrointestinal motility. Choice B (Weight loss) is also less likely as weight gain is a more common side effect of lithium therapy. Choice D (Hypertension) is not typically seen in the initial days of lithium therapy, as lithium is more commonly associated with long-term kidney-related issues leading to hypertension.