PEBC Part I (MCQ) · Competency 1A Clinical Care (about 50% of Part I)
Neurology & Mental Health
Neuro-psych items cover depression (CANMAT 2023), anxiety, bipolar disorder and lithium, antipsychotic safety and clozapine, ADHD, insomnia, opioid and alcohol use disorder, epilepsy, Parkinson disease, dementia and migraine, with many safety-critical interactions.
1A Clinical Care·2 min read·7 sections
✓Checked against the CANMAT 2023 MDD update (Can J Psychiatry 2024;69:641); CANMAT/ISBD 2018 bipolar guidelines; CADDRA 2020; CRISM OUD (CMAJ 2018) and AUD (CMAJ 2023) guidelines; Canadian Parkinson guideline (CMAJ 2019); Canadian Headache Society guidelines; Health Canada product monographs; checked 13 Oct 2026. Not affiliated with or endorsed by The Pharmacy Examining Board of Canada (PEBC).
★
Must-know for the exam
✓Citalopram maximum is 20 mg/day over age 65 (QT); escitalopram maximum is 20 mg/day.
✓Assess antidepressant response after 2-4 weeks at an adequate dose; switch or augment for partial response after 4-8 weeks.
✓Thiazides, ACE inhibitors, ARBs, NSAIDs and dehydration raise lithium levels; hold lithium during vomiting and diarrhea.
✓Clozapine needs weekly ANC for 26 weeks; watch for constipation and myocarditis; quitting smoking raises levels.
✓Valproate should not be used in people who can become pregnant without a pregnancy prevention plan.
✓Buprenorphine/naloxone is preferred first line for opioid use disorder; induce in moderate withdrawal.
✓Naltrexone is contraindicated with opioid use; acamprosate suits patients on opioids if kidney function allows.
✓Screen for HLA-B*15:02 before carbamazepine in people of Southeast Asian or Han Chinese ancestry.
✓Avoid metoclopramide and typical antipsychotics in Parkinson disease; use domperidone or ondansetron for nausea.
✓Triptans are contraindicated in coronary and cerebrovascular disease; overuse on 10+ days a month causes rebound headache.
▸On this page · 7 sections
⚠
Traps that cost marks
→Exceeding the 20 mg citalopram limit in adults over 65.
→Judging an antidepressant ineffective after 10 days.
→Mistaking discontinuation symptoms for relapse or serotonin toxicity.
→Missing linezolid as a serotonergic interacting drug.
→Not anticipating a rise in lithium with thiazides.
→Continuing lithium during a dehydrating illness.
→Confusing the initial weekly schedule with later intervals.
→Not monitoring metabolic risk after starting olanzapine.
Educational practice material for exam preparation only. Not medical advice and not a substitute for current product monographs, clinical guidelines or professional judgement. Questions have not yet been reviewed by a licensed pharmacist.
