NSG 552 Exam 3 Psychopharmacology (2026/2027) | Wilkes University | 150 Q&A with Rationales | TRD, Schizophrenia, Dementia, Insomnia, Special Populations

Complete NSG 552 Exam 3 Study Guide – Psychopharmacology – Wilkes University (2026/2027 Academic Year) This digital download is a comprehensive 150-question practice exam for NSG 552 Psychopharmacology – Exam 3 at Wilkes University. Designed for graduate nursing students (PMHNP, FNP, AGNP) mastering advanced psychopharmacology for treatment-resistant conditions, schizophrenia spectrum disorders, dementia, insomnia, and special populations. What's included: 150 multiple-choice questions with detailed rationales 5 organized sections covering all exam topics Answers with evidence-based rationales – learn the "why," not just the "what" Section 1: Treatment-Resistant Depression (TRD) – Q1–30 Definition of TRD: failure of ≥2 adequate antidepressant trials Augmentation strategies: atypical antipsychotics (aripiprazole 2–5 mg, brexpiprazole, quetiapine XR 150–300 mg, olanzapine-fluoxetine combination) Aripiprazole: D2/5-HT1A partial agonist, 5-HT2A antagonist; akathisia management (dose reduction or propranolol) Brexpiprazole (Rexulti): lower intrinsic D2 activity (less akathisia) Esketamine (Spravato): NMDA antagonist, intranasal REMS program, dissociation/sedation/hypertension, twice weekly ×4 weeks then weekly ×4 weeks, must be on oral antidepressant TMS: non-invasive magnetic stimulation of dorsolateral prefrontal cortex ECT: gold standard for severe TRD, catatonia, suicidality; transient cognitive side effects (RUL placement minimizes), hold lithium 24–48 hours before VNS: chronic TRD (≥4 failed trials), delayed response (months) DBS: subcallosal cingulate (BA25) or ventral capsule/ventral striatum Stimulants/modafinil for fatigue/apathy; trazodone/mirtazapine for insomnia/anxiety T3 (liothyronine) augmentation: best evidence with TCAs, monitor for hyperthyroidism STAR*D: remission rates decline with each failure (37% → 30% → 14% → 13%) Section 2: Schizophrenia Spectrum & Antipsychotic Management – Q31–65 First-episode psychosis: lower SGA doses, "start low, go slow," maintain ≥1–2 years after remission Clozapine: only agent for treatment-resistant schizophrenia (failure of ≥2 antipsychotics); also FDA-approved for suicidal behavior; REMS ANC monitoring (weekly ×6 mo → q2wk ×6 mo → monthly) Clozapine adverse effects: agranulocytosis (fever/sore throat → hold + STAT ANC), myocarditis (first 2 months – tachycardia, chest pain, dyspnea), sialorrhea (glycopyrrolate), severe constipation/ileus (fatal – hold + imaging), seizures (dose-dependent, 600 mg/day high risk) CATIE trial: 74% discontinuation rate; olanzapine slightly superior but metabolic burden LAIs: reduce relapse 20–30%, offer to all patients (not just non-adherent); risperidone LAI needs oral overlap 3–4 weeks; aripiprazole LAI and paliperidone LAI loading doses achieve levels without prolonged overlap Tardive dyskinesia: VMAT2 inhibitors (valbenazine/Ingrezza, deutetrabenazine/Austedo) or switch to clozapine Negative symptoms: cariprazine (D3-preferring partial agonist), aripiprazole, lurasidone Hyperprolactinemia: switch to prolactin-sparing agent (aripiprazole, clozapine, quetiapine, olanzapine) or add aripiprazole Metabolic monitoring: weight/BMI, waist circumference, BP, fasting glucose/HbA1c, lipids Metformin off-label for antipsychotic-induced weight gain Smoking (CYP1A2 inducer): reduces clozapine/olanzapine levels; smoking cessation → levels rise 50–70% → dose reduction required NMS: after recovery, rechallenge after ≥2 weeks with low-potency agent or clozapine Section 3: Dementia, Delirium & Cognitive Disorders – Q66–95 Alzheimer's disease: cholinesterase inhibitors first-line (donepezil, rivastigmine patch reduces GI side effects, galantamine); memantine (NMDA antagonist) for moderate-severe, renally dosed BPSD: non-pharmacologic first-line; antipsychotics black box warning (↑ mortality, CVA events), use low-dose SGAs (risperidone 0.25–1 mg, olanzapine, quetiapine) only when severe Benzodiazepines: avoid in elderly (falls, cognitive worsening, Beers Criteria) Delirium: treat underlying cause; haloperidol or low-dose SGA if severe agitation; benzodiazepines for alcohol/benzodiazepine withdrawal Lewy Body Dementia: extreme antipsychotic sensitivity; pimavanserin (Nuplazid – 5-HT2A inverse agonist) FDA-approved for Parkinson's disease psychosis, preferred; avoid haloperidol Frontotemporal Dementia: SSRIs for disinhibition/compulsions; cholinesterase inhibitors ineffective Anti-amyloid monoclonal antibodies (aducanumab, lecanemab): for MCI/mild AD with amyloid confirmation; ARIA (edema/hemorrhage) requires serial MRI monitoring; APOE ε4 increases risk Brexpiprazole: FDA-approved for agitation in Alzheimer's dementia Section 4: Sleep-Wake Disorders – Q96–120 CBT-I: first-line for chronic insomnia (stimulus control, sleep restriction) DORAs (suvorexant/Belsomra, lemborexant/Dayvigo, daridorexant/Quviviq): orexin receptor antagonists, no respiratory depression, lower abuse potential, contraindicated in narcolepsy Z-drugs (zolpidem, eszopiclone): GABA-A positive modulators; complex sleep behaviors (sleep-driving) – discontinue immediately Ramelteon (Rozerem): melatonin agonist, no abuse potential (non-controlled), for sleep onset insomnia Low-dose doxepin (3–6 mg/Silenor): H1 antagonist, for sleep maintenance Trazodone 25–100 mg off-label for insomnia; morning grogginess – take earlier or reduce dose OTC antihistamines (diphenhydramine, doxylamine): Beers Criteria (anticholinergic burden in elderly) RLS: dopamine agonists (ropinirole, pramipexole) or alpha-2-delta ligands (gabapentin encarbil, pregabalin); augmentation with long-term dopamine agonists Benzodiazepine/Z-drugs + opioids: fatal respiratory depression risk COPD/sleep apnea: avoid benzodiazepines/Z-drugs; ramelteon/DORAs safer Section 5: Comprehensive & Special Populations – Q121–150 Pregnancy: lithium – Ebstein's anomaly absolute risk ~0.1–0.2%; hold 24–48 hours before delivery (fluid shifts); valproate/carbamazepine highly teratogenic; lamotrigine/atypical antipsychotics preferred mood stabilizers Breastfeeding: sertraline preferred (low infant exposure) Geriatrics: "start low, go slow" (1/4–1/2 adult dose); Beers Criteria (benzodiazepines, anticholinergics); Anticholinergic Cognitive Burden (ACB) scale Pediatrics: SSRI black box warning (suicidal ideation); stimulants – monitor growth (height/weight), appetite suppression, insomnia Polypharmacy: increased adverse events, interactions, non-adherence Serotonin syndrome vs NMS: hyperreflexia/clonus (serotonin) vs lead pipe rigidity/hyporeflexia (NMS) Key drug interactions: lithium + thiazides ↑ toxicity; carbamazepine + OCPs ↓ efficacy (CYP3A4 induction); clozapine + smoking cessation ↑ levels (CYP1A2); warfarin + SSRIs ↑ INR; aripiprazole + CYP2D6 poor metabolizer → 50% dose reduction Pharmacogenomics: CYP2D6 poor metabolizers (7–10% of Caucasians) require aripiprazole dose reduction Hepatic impairment: dose reduction for most psychotropics Renal impairment: adjust lithium, gabapentin, pregabalin, memantine, paliperidone Rating scales: AIMS (tardive dyskinesia), SAS (parkinsonism), BARS (akathisia), CGI (global improvement) Shared decision-making: incorporate patient preferences (e.g., weight-neutral agents) Why this guide works: 150 unique questions – comprehensive coverage of Exam 3 content Detailed rationales – understand complex mechanisms, adverse effects, drug interactions, and clinical decision-making Clinically relevant – prepare for managing TRD, clozapine monitoring, dementia care, insomnia treatment Exam-ready – mirrors the difficulty and style of Wilkes University NSG 552 Format: PDF (150 questions + answer key + rationales) Institution: Wilkes University Course: NSG 552 – Psychopharmacology Term: 2026/2027 Exam: 3 of 3 (TRD, Schizophrenia, Dementia, Insomnia, Special Populations) Instant download – study on any device or print for offline use.