NSG552/ NSG 552 Exam 1 (Latest 2026/2027 Update) | Complete Exam Questions with Verified Answers and Detailed Rationales | Antipsychotics Pharmacology, First-Generation FGAs, Second-Generation SGAs, EPS, Tardive Dyskinesia, NMS | A+ Graded | Wilkes Univer

INSTANT PDF DOWNLOAD This comprehensive EXAM resource for NSG 552 Psychopharmacology Exam 1 (Modules 1-3) at Wilkes University covers Antipsychotics – Pharmacology, Side Effects, EPS, NMS, and Clozapine for the 2026/2027 academic year. It features exam-style questions with verified answers and detailed rationales. Exam 1 Topics Covered: Pharmacokinetics vs Pharmacodynamics (ADME) CYP450 Enzyme System (inducers, inhibitors, substrates) Dopamine Pathways (mesolimbic, mesocortical, nigrostriatal, tuberoinfundibular) First-Generation Antipsychotics (FGAs/Typical) - mechanism, potency, side effects Second-Generation Antipsychotics (SGAs/Atypical) - receptor profiles, metabolic syndrome Extrapyramidal Symptoms (EPS) - acute dystonia, akathisia, parkinsonism, tardive dyskinesia Neuroleptic Malignant Syndrome (NMS) - FALTERED mnemonic, treatment Clozapine - indications, REMS monitoring, agranulocytosis, dose-related seizures Receptor binding - affinity, agonism vs antagonism, upregulation, downregulation ANTIPSYCHOTICS PHARMACOLOGY – COMPLETE Q&A REVIEW Q1. What is the difference between Pharmacokinetics and Pharmacodynamics? Correct Answer: Pharmacokinetics studies how the body acts on the drug (absorption, distribution, metabolism, excretion - ADME). Pharmacodynamics studies how the drug acts on the body (mechanism of action, receptor binding). Rationale: Understanding both concepts is essential for predicting drug behavior in patients. Pharmacokinetics determines dosing, frequency, and route of administration. Pharmacodynamics determines therapeutic effects and side effect profiles. Q2. What are First-Generation Antipsychotics (FGAs)? Correct Answer: Also known as Typical Antipsychotics. Most have strong bond with D2 receptors only, cause EPS symptoms faster due to prolonged receptor dissociation, have more dangerous side effect profiles, more effective at treating positive symptoms (hallucinations, delusions), and are less expensive. Examples: Haloperidol (Haldol), Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Perphenazine (Trilafon). Rationale: FGAs are D2 receptor antagonists with high affinity and slow dissociation from the receptor. Due to their side effect burden (EPS, tardive dyskinesia), they are generally second-line except for acute agitation (IM haloperidol). Q3. What are Second-Generation Antipsychotics (SGAs)? Correct Answer: Also known as Atypical Antipsychotics. Most have weak bond with D2 receptors and block serotonin receptors (5-HT2A), leading to antidepressant and anxiolytic effects. They cause less EPS due to rapid receptor dissociation, have lower risk of neurological side effects, but higher risk of metabolic side effects (weight gain, diabetes, dyslipidemia). Examples: Risperidone (Risperdal), Clozapine (Clozaril), Olanzapine (Zyprexa), Quetiapine (Seroquel), Aripiprazole (Abilify), Ziprasidone (Geodon). Rationale: SGAs are serotonin-dopamine antagonists (SDAs) and are first-line for schizophrenia due to lower EPS risk, but require metabolic monitoring (weight, glucose, lipids). Q4. What are Extrapyramidal Symptoms (EPS)? Correct Answer: Involuntary movements caused by antipsychotic medications occurring as a side effect, including tardive dyskinesia, acute dystonia, parkinsonism, akathisia, akinesia, and NMS. Related to suppression of D2 dopamine receptors in the nigrostriatal pathway. Rationale: EPS results from D2 blockade in the nigrostriatal pathway. Risk is higher with FGAs (80% D2 receptor occupancy) and high-dose SGAs. Acute EPS is treated with anticholinergics (benztropine, diphenhydramine). Q5. What is Tardive Dyskinesia (TD)? Correct Answer: A neurological disorder characterized by involuntary movements of the face and body, often induced by long-term use of antipsychotics. Movements may include: lip smacking, tongue rolling, fly catcher tongue, pill rolling, tongue protrusion, facial grimace, eye blinking. More common with first-generation antipsychotics. Rationale: TD is often irreversible and associated with prolonged antipsychotic use. Risk factors include older age, female sex, longer treatment duration, and FGA use. The AIMS (Abnormal Involuntary Movement Scale) is the screening tool done before prescribing antipsychotics and every 3-6 months. Q6. What are the FDA-approved medications for Tardive Dyskinesia? Correct Answer: Valbenazine (Ingrezza) and Deutetrabenazine (Austedo). Rationale: These are VMAT2 inhibitors that reduce the abnormal involuntary movements characteristic of TD. Clozapine is an atypical antipsychotic less likely to cause tardive dyskinesia and can be used to treat TD. Q7. What is Neuroleptic Malignant Syndrome (NMS)? Correct Answer: A life-threatening idiosyncratic reaction to antipsychotics characterized by FALTERED: Fever, Autonomic instability, Leukocytosis, Tremor, Elevated CK, Rigidity, Excessive sweating, Delirium. Rationale: NMS has 20% mortality if untreated. Caused by a sudden, marked reduction in dopamine activity, either from withdrawal of dopaminergic agents or from blockade of dopamine receptors. Immediate management: discontinue antipsychotic, supportive care, cooling blankets, IV hydration, dantrolene or bromocriptine. Q8. What is unique about Clozapine (Clozaril)?