NR546 | NR546 Advanced Pharmacology
Psychopharmacology for the PMHNP Wk 7
Midterm Exam | Questions with Correct Answers
and Expert Explanation for Each Question |
Chamberlain
1. A patient is prescribed a medication that is a CYP2D6 substrate. If the patient is also
taking a CYP2D6 inhibitor, what is the expected clinical consequence?
A. Decreased plasma levels of the substrate
B. Increased plasma levels of the substrate
C. No change in substrate levels
D. Decreased risk of toxicity
Correct Answer: B
Expert Explanation: Inhibitors block the metabolic pathway of the substrate,
leading to higher plasma concentrations and an increased risk of toxicity. This is a
crucial concept in psychopharmacology for avoiding adverse drug reactions. The
PMHNP must monitor for signs of overdose when adding an inhibitor.
2. Which neurotransmitter is primarily involved in the reward system and the
regulation of movement?
A. Serotonin
B. Dopamine
,C. GABA
D. Glutamate
Correct Answer: B
Expert Explanation: Dopamine pathways include the mesolimbic (reward) and
nigrostriatal (movement) systems. Alterations in these pathways are linked to
conditions like addiction and Parkinson’s disease. Antipsychotic medications often
target these dopamine pathways.
3. A patient experiences muscle rigidity, high fever, and autonomic instability after
starting Haloperidol. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Tardive Dyskinesia
C. Extrapyramidal Symptoms (EPS)
D. Neuroleptic Malignant Syndrome (NMS)
Correct Answer: D
Expert Explanation: Neuroleptic Malignant Syndrome is a rare but life-threatening
reaction to antipsychotic drugs, characterized by fever, rigidity, and altered mental
status. It is differentiated from serotonin syndrome primarily by the presence of
,‘lead-pipe’ rigidity rather than hyperreflexia. Immediate discontinuation of the
offending agent is required.
4. Which antidepressant is specifically contraindicated in patients with a history of
seizure disorders or eating disorders?
A. Fluoxetine
B. Bupropion
C. Sertraline
D. Venlafaxine
Correct Answer: B
Expert Explanation: Bupropion lowers the seizure threshold, particularly at high
doses or in patients with electrolyte imbalances common in eating disorders. It is
categorized as an NDRI (Norepinephrine-Dopamine Reuptake Inhibitor). Its lack of
serotonergic activity makes it useful for patients concerned about sexual side
effects.
5. What is the primary mechanism of action for Selective Serotonin Reuptake
Inhibitors (SSRIs)?
A. Antagonizing 5-HT2A receptors
B. Stimulating postsynaptic GABA receptors
, C. Increasing the breakdown of serotonin in the synaptic cleft
D. Inhibiting the reuptake of serotonin at the presynaptic neuron
Correct Answer: D
Expert Explanation: SSRIs increase the concentration of serotonin in the synaptic
cleft by blocking the serotonin transporter (SERT). This increased availability leads
to downstream changes in receptor sensitivity. They are considered first-line
treatment for depression and anxiety due to their safety profile.
6. A patient on Lithium therapy presents with tremors, ataxia, and confusion. What is
the priority action?
A. Increase the dose
B. Switch to Valproic acid immediately
C. Check a stat serum Lithium level
D. Add a benzodiazepine
Correct Answer: C
Expert Explanation: Lithium has a narrow therapeutic index, and these symptoms
are classic signs of Lithium toxicity. Toxic levels can lead to permanent neurological
damage or death. The level must be checked before proceeding with any
management changes.
Psychopharmacology for the PMHNP Wk 7
Midterm Exam | Questions with Correct Answers
and Expert Explanation for Each Question |
Chamberlain
1. A patient is prescribed a medication that is a CYP2D6 substrate. If the patient is also
taking a CYP2D6 inhibitor, what is the expected clinical consequence?
A. Decreased plasma levels of the substrate
B. Increased plasma levels of the substrate
C. No change in substrate levels
D. Decreased risk of toxicity
Correct Answer: B
Expert Explanation: Inhibitors block the metabolic pathway of the substrate,
leading to higher plasma concentrations and an increased risk of toxicity. This is a
crucial concept in psychopharmacology for avoiding adverse drug reactions. The
PMHNP must monitor for signs of overdose when adding an inhibitor.
2. Which neurotransmitter is primarily involved in the reward system and the
regulation of movement?
A. Serotonin
B. Dopamine
,C. GABA
D. Glutamate
Correct Answer: B
Expert Explanation: Dopamine pathways include the mesolimbic (reward) and
nigrostriatal (movement) systems. Alterations in these pathways are linked to
conditions like addiction and Parkinson’s disease. Antipsychotic medications often
target these dopamine pathways.
3. A patient experiences muscle rigidity, high fever, and autonomic instability after
starting Haloperidol. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Tardive Dyskinesia
C. Extrapyramidal Symptoms (EPS)
D. Neuroleptic Malignant Syndrome (NMS)
Correct Answer: D
Expert Explanation: Neuroleptic Malignant Syndrome is a rare but life-threatening
reaction to antipsychotic drugs, characterized by fever, rigidity, and altered mental
status. It is differentiated from serotonin syndrome primarily by the presence of
,‘lead-pipe’ rigidity rather than hyperreflexia. Immediate discontinuation of the
offending agent is required.
4. Which antidepressant is specifically contraindicated in patients with a history of
seizure disorders or eating disorders?
A. Fluoxetine
B. Bupropion
C. Sertraline
D. Venlafaxine
Correct Answer: B
Expert Explanation: Bupropion lowers the seizure threshold, particularly at high
doses or in patients with electrolyte imbalances common in eating disorders. It is
categorized as an NDRI (Norepinephrine-Dopamine Reuptake Inhibitor). Its lack of
serotonergic activity makes it useful for patients concerned about sexual side
effects.
5. What is the primary mechanism of action for Selective Serotonin Reuptake
Inhibitors (SSRIs)?
A. Antagonizing 5-HT2A receptors
B. Stimulating postsynaptic GABA receptors
, C. Increasing the breakdown of serotonin in the synaptic cleft
D. Inhibiting the reuptake of serotonin at the presynaptic neuron
Correct Answer: D
Expert Explanation: SSRIs increase the concentration of serotonin in the synaptic
cleft by blocking the serotonin transporter (SERT). This increased availability leads
to downstream changes in receptor sensitivity. They are considered first-line
treatment for depression and anxiety due to their safety profile.
6. A patient on Lithium therapy presents with tremors, ataxia, and confusion. What is
the priority action?
A. Increase the dose
B. Switch to Valproic acid immediately
C. Check a stat serum Lithium level
D. Add a benzodiazepine
Correct Answer: C
Expert Explanation: Lithium has a narrow therapeutic index, and these symptoms
are classic signs of Lithium toxicity. Toxic levels can lead to permanent neurological
damage or death. The level must be checked before proceeding with any
management changes.
