NR546 / NR 546 Midterm Exam Study guide | 2026/2027 Edition | Advanced Pharmacology | PMHNP | Chamberlain | Practice Questions & Accurate Solutions

NR546 / NR 546 Midterm Exam Study guide | 2026/2027 Edition | Advanced Pharmacology | PMHNP | Chamberlain | Practice Questions & Accurate Solutions Q: Which of the following data is most accurate in determining a treatment plan for a patient who presents with depression? Answer The patient states that they are experiencing feelings of sadness, insomnia, and lack of appetite Q: Informed Consent Answer clients have the right to receive enough information to make decisions about their treatment. They must also be informed about the potential risks associated with medication. Clients have the right to refuse treatment and cannot be forcibly medicated in non-emergencies. Q: Which lobe is responsible for movement and intelligence and can result in personality changes if damaged? Answer Frontal Lobe Q: The PMHNP wants to prescribe olanzipine for a client with depression. However, the client currently takes amiodarone for chronic atrial fibrillation. What does the PMHNP need to do to establish efficiency of this medication? Answer Decrease the dosage of olanzipine Amiodarone is a CYP450 inhibitor which means it will stop/slow down the olanzapine from metabolizing in the body. Therefore, the olanzapine is at risk for building up in the client's system rather than being metabolized and secreted. Q: What NTM is responsible for a patient's diagnosis of Parkinson's? Answer Dopamine dopamine affects balance and coordination, low levels are found in Parkinson's. Q: A surgical patient is post-op after a hernia repair. The patient is given opioids in the OR and now has a shallow respiratory rate, pinpoint pupils, and is unresponsive to verbal stimulation. The PMHNP prescribed naloxone to reverse the effects of the opioids. Where does Naloxone fall on the agonist spectrum? Answer Antagonist Q: Medications for schizophrenia target which main neurotransmitter? Answer Dopamine dopamine causes negative and positive symptoms of schizophrenia, medication block dopamine to reduce these symptoms Q: first generation antipsychotics improve _________ symptoms, and there is a higher risk of developing _________. Answer positive, hyperprolactinemia Q: Which medication is a good option for a patient with schizophrenia who also suffers from insomnia? Answer Olanzapine Olanzapine is the best tolerated antipsychotic Q: What brain region is responsible for speech comprehension? Answer Wernicke's Area Q: Which neurotransmitter may be responsible for a client's symptoms of depression? SATA a. increased level of ACH b. decreased levels of NE c. increased levels of 5HT d. decreased levels of histamine e. increased levels of glutamate Answer a. increased levels of ACH b. decreased levels of NE d. decreased levels of histamine Q: Which pathway is associated with hyperprolactemia? Answer Tuberoinfundibular Q: True or False: Sulfonamides are an example of CYP450 inducer. Answer False, they are inhibitors Q: GABA Answer chief inhibitory neurotransmitter and targeted by BZOs Q: norepinephrine Answer NTM responsible for fight, flight, or freight Q: Dopamine NTM that affects balance and coordination. Low levels may be found in patient with Parkinson's disease. Answer NTM that affects balance and coordination. Low levels may be found in patient with Parkinson's disease. Q: Acetylcholine Answer NTM that affects arousal, motivation, attention, learning, and REM sleep Q: "happy hormone" Answer 5HT (serotonin) Q: Main excitatory NTM Answer Glutamine Q: True or False: The mesolimbic pathway is responsible for positive symptoms of schizophrenia Answer True Q: True or False: The mesocortical pathway is associated with hyperprolactinemia Answer False Q: Which antipsychotic has the highest risk for galactorrhea? Answer Risperidone Q: A patient is taking aripiprazole, a CYP 2D6 substrate, for management of their schizophrenia diagnosis. The patient is doing well on that medication, but states their depression symptoms are not well managed. What must the PMHNP keep in mind before prescribing fluoxetine? Answer Fluoxetine will cause a decrease in the metabolism of aripiprazole. Fluoxetine is an inhibitor of the CYP450 2D6 isoenzyme, this means that it will compete with aripiprazole. Therefore, the patient is at risk for medication toxicity and adverse effects. The PMHNP knows that the study of how the body absorbs, distributes, metabolizes, and excretes a medication is knows as: a. Breakdown b. Pharmacokinetics c. Pharmacodynamics d. First-pass effect Answer a. Pharmacokinetics A patient with schizophrenia was discharged from the hospital on olanzapine 5mg twice a day. He immediately resumed smoking cigarettes and escalated to one pack per day. Upon presenting for his 1-week follow-up appointment, the patient reports he is having trouble sleeping and the voices have returned. Which of the following actions should the PMHNP take? a. Send the patient to the ED for stabilization b. Change to a different antipsychotic medication c. Increase his Olanzapine dosage to 10mg twice a day d. Tell him to stop smoking and give him a nicotine patch Answer c. Increase his Olanzapine dosage to 10mg twice a day A patient who has been stable on quetiapine (Seroquel XR) for 3 months has decided to start to drink grapefruit juice twice daily because she has heard it helps with weight loss. She calls to report that since her new diet she has been feeling fatigue and difficulty waking up in the morning. What s the best response by the PMHNP? a. Lower the dose of the medication b. Stop drinking the grapefruit juice and schedule an appointment to discuss this further c. Prescribe a stimulant and follow up in 2 weeks d. Advise the patient makes an appointment with their PCP for further evaluation Answer b. Stop drinking the grapefruit juice and schedule an appointment to discuss this further A 79-year-old female patient with no past psychiatric history is admitted with new onset auditory hallucinations. The patient states her most bothersome symptom is the voices which have kept her from sleeping the past 3 weeks. Which medication should the PMHNP order for sleep to be taken at bedtime? a. Olanzapine 2.5mg PO b. Lorazepam 1mg PO c. Chlorpromazine 50mg PO d. Sertraline 50mg PO a. Olanzapine 2.5mg PO A 16-year-old male with a history of smoking cigarettes and marijuana is being evaluated at the request of the school and parents. The child states that the reason he smokes is because it helps calm him down. Which of the following medications would be the best choice? a. Fluoxetine 20mg PO daily b. Clonazepam 0.5mg PO daily c. Lorazepam 1mg PO d. Adderall ER 5mg PO a. Fluoxetine 20mg PO daily A patient has had a pharmacogenomic test which reveals he is an extensive metabolizer of CYP450 1A2, 2D6, and 3A4. The prescriber should prescribe: a. A lower dose than usual b. The usual dose c. A higher than usual dose d. A different medication b. The usual dose A patient who had previously reported feeling better on her antidepressant says the "drug seems to have stopped working" at her 6 month follow up appointment. This is known as: a. Tolerance b. Abuse c. Side effect d. Adverse effect a. Tolerance A medication that works by receptor activation to produce a biological response is an: a. Agonist b. Enzyme inhibitor c. Inverse agonist d. Antagonist a. Agonist A drug that binds to a receptor but does not fully activate it, producing a muted biological response is a(n): a. Agonist b. Enzyme inhibitor c. Partial agonist d. Antagonist c. Partial agonist A drug that binds to the same receptor as an agonist, but induces an opposite biological response is a(n): a. Antagonist b. Inverse agonist c. Agonist d. Partial agonist b. Inverse agonist A drug that block receptors, inhibiting a biological response, is known as a(n): a. Partial agonist b. Inverse agonist c. Antagonist d. Agonist c. Antagonist A patient who has been stable on his long-acting injectable medication tells the PMHNP that he would like to quit smoking. What is the best response? a. Good for you, can prescribe you a nicotine patch to help. b. Let us make an appointment as your medication dose may need to be lowered. c. I will refer you to a smoking cessation support group. d. I am glad you have decided to quit smoking. b. Let us make an appointment as your medication dose may need to be lowered. A patient has been taking valproic acid for mood stabilization from a manic episode but is still not sleeping through the night. His drug level was 50mcg/mL. The PMHNP notices the patient seems disoriented to time and in flapping his wrist. What should the PMHNP do next? a. Give the patient lactulose 20g PO b. Draw an ammonia level c. Increase the dose of valproic acid a. Augment with an atypical antipsychotic b. Draw an ammonia level A patient who has been taking paroxetine for 3 years wants to come off due to sexual side effects. He has gradually tried to wean the dose on his own, but notices feelings of dizziness, fatigue, headaches, anxiety, and electric-like shocks in his head. These findings are most consistent with SSRI discontinuation. What would be the responsible actions by the PMHNP to make? a. Reassure the patient that the symptoms will go away eventually b. Prescribe the patient fluoxetine for 1 week c. Have the patient resume the paroxetine d. Start the patient on an antipsychotic for his somatic delusions b. Prescribe the patient fluoxetine for 1 week The PMHNP is monitoring a serum drug level for a medication with a 24-hour half-life. How many hours will it take to reach steady state? a. 48 hours b. 72 hours c. 96 hours d. 120 hours d. 120 hours grey matter cerebellum, cerebrum, brain stem, and butterfly shaped portion of the central spinal cord What is grey matter associated with? Learning Frontal Lobe movement, intelligence, abstract thinking, the ability organize, personality, behavior, and emotional control hippocampus Regulates memory (specifically long term), and anxiety A patient recovering from a stroke has trouble with speech comprehension and works with a speech therapist twice a week. Which part of the patient's brain has been affected by the stroke? The Wernicke's area Broca's area speech production basal ganglia involved in voluntary motor movements, cognition, and emotion limbic system associated with emotions and learning This lobe is responsible for movement and intelligence. An injury to this lobe can result in personality changes and difficulty controlling emotions. Frontal lobe home of the somatic senses parietal lobe This lobe contains the limbic system, amygdala, and hippocampus. Disorders of this lobe include dementia and ADHD. Temporal lobe This lobe controls visual processing. Occipital Lobe Epigenetics the study of environmental influences on gene expression that occur without a DNA change - Typical antipsychotic - Used for acute and chronic management of schizophrenia and psychosis - Works by non-selectively blocking dopamine D2 receptors in the mesolimbic pathway - Improves positive symptoms - Risk of developing hyperprolactinemia and EPS - Negative symptoms are unaffected first generation antipsychotics Which pathway is associated with hyperprolactinemia? the tuberoinfundibulnar Which pathway is associated with positive symptoms? mesolimbic pathway Caused by dopamine excess. Group of symptoms related to motor control and coordination. Includes dystonia, akathisia, Parkinsonism, bradydykinesia, tremors, and traduce dyskinesia extrapyramidal symptoms tremors involuntary movements or shaking bradykinesia extreme slowness in movement Parkinsonism Having tremor, muscle rigidity, stooped posture, and a shuffling gait. Akathisia iner restlessness leading to repetitive motion Dystonia involuntary muscle contractions tardive dyskinesia a motor disorder that results from chronic use of certain antipsychotic drugs hyperprolactinemia Higher-than-normal prolactin levels, which may result in irregular menses, male gynecomastia, nipple discharge, osteoporosis, sexual dysfunction and infertility Neurolepsis a syndrome that is used to describe antipsychotic medication effects on psychotic clients with respect to cognition and behavior P E A P= psychomotor slowing E= Emotional quieting A= affective indifference adverse effects of FGA - QT prolongation - torsade's de pointes - sudden cardiac death - blood dyscrasias (neutropenia, leukopenia, and agranulocytosis) - esophageal dysmobility, aspiration - increased fall risk - imbalance of ACH resulting in anticholinergic effects - a blockage. of Alpha-1 adrenergic receptors can cause orthostatic hypotension, dizziness, and drowsiness potency concentration of the drug required to produce a defined effect commonly prescribed first generation antipsychotics - Chlorpromazine (2nd line d/t QTC) - Mesoridazide - Thioridazine (2nd line d/t QTC) - Thiothixene - Fluphenazine - Haloperidol second generation antipsychotics (atypical) serotonin-dopamine antagonists SGA "-pines" Olanzapine (zyprexa) Quetiapine (Seroquel) Asenapine (saphnis) Clozapine (clozaril) - more potently bind to 5HT than DA - sedation is common - lower risk of EPS - high risk for weight gain and metabolic abnormalities Clozapine (clozaril) - should not be used in the acute presentation of schizophrenia - needs to be held if the patient's ANC is less than 1500 Asenapine (saphnis) - available in sublingual and transdermal patch - the MOST appropriate for an overweight patient SGA "2 dones and a rone" Risperidone (risperidol) Paliperidone (Invega) Ziprasidone (geodon) Iloperidone (fanapt) Lurasidone (Latuda) - either bind more potently to 5HT than DA or bind equally - less sedating - less risk of metabolic effects/ weight gain - higher risk for EPS and hyperprolactinemia Ziprasidone (geodon) - needs to be monitored for the development of a rash - medication can be given IM in patients with acute agitation associated with schizophrenia Iloperidone (fanapt) - appropriate for patients who struggle with maintaining healthy cholesterol levels Lurasidone (Latuda) needs to be taken with at least 350 calories for proper absorption Risperidone (risperidol) - has the highest risk for hyperprolactinemia - has the highest risk for galactorrhea SGA "2 pips and a rip" aripiprazole (Abilify) brexipiprazole (rexulti) caripraszine (vraylar) - pips bind more potently to DA than 5HT - The rip binds equally - low metabolic risks - low risk of weight gain - potential for EPS BEERS avoid the use of haloperidol, ziprasidone, and olanzapine due to an increased risk of CVA, cognitive decline, and death in persons with dementia and with dementia related psychosis CYP450 Inhibitors Valproate Isoniazid Sulfonamides Amiodarone Chloramphenicol Ketoconazole Quinidine CYP450 Inducers Carbamazepine Rifampin Alcohol Phenytoin Griseofulvin Phenobarbital Sulfonylureas 4 Neurotransmitter Categories 1. cholinergics 2. monoamines 3. amino acids 4. neuropeptides poor metabolizer lower concentration of the enzyme needed to metabolize the drug, so they have HIGHER blood concentrations, elevated drug levels, increased risk of drug-drug interactions AT RISK FOR DRUG TOXICITY extensive metabolizer Patient has normal metabolic activity rapid metabolizer elevated enzyme activity breaks the drug down faster and causes sub therapeutic drug levels. HIGHER doses are needed for the drug to be effective transcription factors A regulatory protein that binds to DNA and affects transcription of specific genes (turns gene expression on and off) signal transduction cascades the process through which cells communicate. controlled by signaling cascades such as the G-linked protein system G Linked Protein Systems pass messages from one receptor to another, triggered by neurotransmitters no agonist The Agonist Spectrum: Constitutive activity Very small activity but not zero "At rest" agonist allows second messenger to act at its greatest potential antagonist blocks an agonist that may be overstimulating neurotransmitters. considered "silent" and cause the the bad SE in medications partial agonis considered "stabilizers" and help maintain balance inverse agonists stabilizes G-protein in a totally inactive form to cause a reduction in signal transduction contingen the process of preparing alternative courses of action that may be used if the primary plans don't achieve the objective olanzapine caution exercise caution in suspected alcohol withdrawals, stimulant intoxication, or anticholinergic intoxication neuroleptic malignant syndrome Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and mental status changes other s/s: diaphoresis, tachypnea, muscle stiffness, altered mental status, tachycardia cardia, hyperthermia