NURS660 Psychopharmacology Exam 4 - ADHD,
Dementia, Impulsivity/Compulsivity, And Addiction.
Q&A
**1. A 9-year-old is started on methylphenidate ER. What is the most
common initial adverse effect?**
- **A.** Bradycardia
- **B.** Insomnia and decreased appetite
- **C.** Hepatotoxicity
- **D.** Rash
- **Answer: B**
- **Rationale:** Methylphenidate is a CNS stimulant; appetite
suppression and sleep onset insomnia are very common, especially
early in treatment.
**2. Which non-stimulant is FDA-approved for ADHD and also treats
hypertension?**
- **A.** Bupropion
- **B.** Clonidine
- **C.** Atomoxetine
- **D.** Modafinil
- **Answer: B**
- **Rationale:** Extended-release clonidine (Kapvay) is FDA-approved
for ADHD and has antihypertensive effects.
,**3. Atomoxetine’s black box warning is for:**
- **A.** Seizures
- **B.** Hepatic failure
- **C.** Suicidal ideation in children/adolescents
- **D.** Cardiomyopathy
- **Answer: C**
- **Rationale:** Atomoxetine increases risk of suicidal thinking in
youth, similar to some antidepressants.
**4. A patient on guanfacine ER presents with hypotension and
bradycardia. The most appropriate action is:**
- **A.** Increase dose
- **B.** Monitor and consider dose reduction or discontinuation
- **C.** Add a stimulant
- **D.** Give IV fluids
- **Answer: B**
- **Rationale:** Guanfacine is an alpha-2 agonist;
hypotension/bradycardia are dose-related adverse effects.
**5. First-line pharmacotherapy for preschool ADHD (4–5 years) is:**
- **A.** Methylphenidate
- **B.** Parent training in behavior management (non-pharm)
,- **C.** Atomoxetine
- **D.** Clonidine
- **Answer: B**
- **Rationale:** Guidelines recommend behavior therapy first;
medication only if moderate-severe and behavior therapy insufficient.
**6. Which CYP enzyme is primarily responsible for metabolizing
atomoxetine?**
- **A.** CYP2D6
- **B.** CYP3A4
- **C.** CYP1A2
- **D.** CYP2C9
- **Answer: A**
- **Rationale:** Atomoxetine is a CYP2D6 substrate; poor metabolizers
have higher exposure.
**7. A child on amphetamine/dextroamphetamine develops new-onset
psychosis. Next step?**
- **A.** Add an antipsychotic
- **B.** Discontinue stimulant and reassess
- **C.** Increase dose to overcome psychosis
- **D.** Continue and monitor
- **Answer: B**
, - **Rationale:** Stimulants can unmask or worsen psychotic
symptoms; they should be stopped.
**8. Long-acting stimulants are preferred over short-acting primarily
because:**
- **A.** Lower abuse potential
- **B.** Once-daily dosing improves adherence and symptom coverage
- **C.** Fewer cardiovascular effects
- **D.** No growth suppression
- **Answer: B**
- **Rationale:** Once-daily dosing avoids midday rebound and need
for in-school doses.
**9. Which medication for ADHD carries a risk of chemical hepatitis?**
- **A.** Lisdexamfetamine
- **B.** Atomoxetine
- **C.** Methylphenidate
- **D.** Guanfacine
- **Answer: B**
- **Rationale:** Rare but serious hepatotoxicity reported with
atomoxetine.
Dementia, Impulsivity/Compulsivity, And Addiction.
Q&A
**1. A 9-year-old is started on methylphenidate ER. What is the most
common initial adverse effect?**
- **A.** Bradycardia
- **B.** Insomnia and decreased appetite
- **C.** Hepatotoxicity
- **D.** Rash
- **Answer: B**
- **Rationale:** Methylphenidate is a CNS stimulant; appetite
suppression and sleep onset insomnia are very common, especially
early in treatment.
**2. Which non-stimulant is FDA-approved for ADHD and also treats
hypertension?**
- **A.** Bupropion
- **B.** Clonidine
- **C.** Atomoxetine
- **D.** Modafinil
- **Answer: B**
- **Rationale:** Extended-release clonidine (Kapvay) is FDA-approved
for ADHD and has antihypertensive effects.
,**3. Atomoxetine’s black box warning is for:**
- **A.** Seizures
- **B.** Hepatic failure
- **C.** Suicidal ideation in children/adolescents
- **D.** Cardiomyopathy
- **Answer: C**
- **Rationale:** Atomoxetine increases risk of suicidal thinking in
youth, similar to some antidepressants.
**4. A patient on guanfacine ER presents with hypotension and
bradycardia. The most appropriate action is:**
- **A.** Increase dose
- **B.** Monitor and consider dose reduction or discontinuation
- **C.** Add a stimulant
- **D.** Give IV fluids
- **Answer: B**
- **Rationale:** Guanfacine is an alpha-2 agonist;
hypotension/bradycardia are dose-related adverse effects.
**5. First-line pharmacotherapy for preschool ADHD (4–5 years) is:**
- **A.** Methylphenidate
- **B.** Parent training in behavior management (non-pharm)
,- **C.** Atomoxetine
- **D.** Clonidine
- **Answer: B**
- **Rationale:** Guidelines recommend behavior therapy first;
medication only if moderate-severe and behavior therapy insufficient.
**6. Which CYP enzyme is primarily responsible for metabolizing
atomoxetine?**
- **A.** CYP2D6
- **B.** CYP3A4
- **C.** CYP1A2
- **D.** CYP2C9
- **Answer: A**
- **Rationale:** Atomoxetine is a CYP2D6 substrate; poor metabolizers
have higher exposure.
**7. A child on amphetamine/dextroamphetamine develops new-onset
psychosis. Next step?**
- **A.** Add an antipsychotic
- **B.** Discontinue stimulant and reassess
- **C.** Increase dose to overcome psychosis
- **D.** Continue and monitor
- **Answer: B**
, - **Rationale:** Stimulants can unmask or worsen psychotic
symptoms; they should be stopped.
**8. Long-acting stimulants are preferred over short-acting primarily
because:**
- **A.** Lower abuse potential
- **B.** Once-daily dosing improves adherence and symptom coverage
- **C.** Fewer cardiovascular effects
- **D.** No growth suppression
- **Answer: B**
- **Rationale:** Once-daily dosing avoids midday rebound and need
for in-school doses.
**9. Which medication for ADHD carries a risk of chemical hepatitis?**
- **A.** Lisdexamfetamine
- **B.** Atomoxetine
- **C.** Methylphenidate
- **D.** Guanfacine
- **Answer: B**
- **Rationale:** Rare but serious hepatotoxicity reported with
atomoxetine.
