NURS660 Psychopharmacology Exam 4 - ADHD, Dementia, Impulsivity/Compulsivity, And Addiction. Q&A Exam

NURS660 Psychopharmacology
Exam 4 - ADHD, Dementia,
Impulsivity/Compulsivity, And
Addiction. Q&A
EXAM
Q1: The cortico-striatal-thalamic (CSTC) loop modulates motor
activity through connections from the prefrontal motor cortex to
which structure?

 A. Caudate nucleus
 B. Putamen (lateral striatum)
 C. Globus pallidus interna
 D. Subthalamic nucleus

A1: B. Putamen (lateral striatum).

 Rationale: The CSTC loop involved in motor activity
(hyperactivity) connects the prefrontal motor cortex to the
putamen, then to the thalamus, and back to the cortex.

Q2: A 9-year-old boy is constantly fidgeting, leaves his seat in
class, runs excessively, and has trouble playing quietly. These
symptoms are primarily mediated by dysfunction in which brain
pathway?

 A. Cortico-striatal-thalamic loop
 B. Mesolimbic dopamine pathway
 C. Mesocortical pathway
 D. Nigrostriatal pathway

,A2: A. Cortico-striatal-thalamic loop.

 Rationale: Hyperactivity symptoms in ADHD are modulated
by the CSTC loop from the prefrontal motor cortex to the
putamen.

Q3: A child with ADHD has significant issues with distractibility,
forgetfulness, and fatigue. This presentation is most associated
with deficiency of which neurotransmitters?

 A. Serotonin and GABA
 B. Norepinephrine and dopamine
 C. Acetylcholine and histamine
 D. Glutamate and glycine

A3: B. Norepinephrine and dopamine.

 Rationale: ADHD involves dysregulation of dopamine and
norepinephrine. Low levels contribute to inattention and
fatigue.

Q4: The pathophysiology of ADHD is best described as:

 A. Excessive dopamine in the nucleus accumbens
 B. Overactivity of the default mode network
 C. Inefficient tuning of the prefrontal cortex by dysregulation
of dopamine and norepinephrine
 D. Decreased serotonin transmission in the raphe nuclei

A4: C. Inefficient tuning of the prefrontal cortex by dysregulation
of dopamine and norepinephrine.

,  Rationale: ADHD results from inefficient prefrontal cortex
modulation due to dysregulation of dopamine and
norepinephrine, leading to inattention, hyperactivity, and
impulsivity.

Q5: Which medication for ADHD is a non-stimulant that inhibits
the norepinephrine transporter (NET) in the prefrontal cortex?

 A. Methylphenidate
 B. Dextroamphetamine
 C. Atomoxetine
 D. Guanfacine

A5: C. Atomoxetine.

 Rationale: Atomoxetine (Strattera) is a selective
norepinephrine reuptake inhibitor (NRI).

Q6: A patient with ADHD and comorbid anxiety would benefit
most from which non-stimulant that also reduces blood pressure?

 A. Bupropion
 B. Atomoxetine
 C. Guanfacine extended-release
 D. Modafinil

A6: C. Guanfacine extended-release.

 Rationale: Guanfacine (Intuniv) is an alpha-2A agonist
approved for ADHD that also lowers blood pressure and may
reduce anxiety.

, Q7: Which statement accurately distinguishes the mechanism of
amphetamine from methylphenidate? (Select all that apply)

 A. Amphetamine promotes the release of dopamine and
norepinephrine.
 B. Methylphenidate only blocks the reuptake of
norepinephrine and dopamine.
 C. Both amphetamine and methylphenidate only block
reuptake.
 D. Methylphenidate promotes the release of dopamine.

A7: A & B.

 Rationale: Amphetamines promote release and inhibit
reuptake of dopamine and norepinephrine. Methylphenidate
primarily blocks the reuptake of these neurotransmitters. This
distinction is key for understanding their pharmacology.

Q8: A 7-year-old with ADHD cannot swallow pills. Which
formulation of methylphenidate can be opened and sprinkled on
food?

 A. Ritalin (immediate-release)
 B. Concerta
 C. Ritalin LA (long-acting capsules)
 D. Daytrana patch

A8: C. Ritalin LA (long-acting capsules).

 Rationale: Ritalin LA and other long-acting methylphenidate
capsules contain beads that can be sprinkled on soft foods
for patients who have difficulty swallowing pills. Concerta
tablets must be swallowed whole.