NR 546 Psychopharmacology Midterm Exam: Comprehensive
Assessment of Neuroreceptor Mechanisms, Pharmacokinetic
Principles, Adverse Effect Management, and Clinical Decision-
Making for Major Psychiatric Disorders in Advanced Practice
Nursing
Questions 1–150 (Multiple Choice – Select
One Best Answer)
Section 1: Neurobiology & Pharmacokinetics (Q1–
20)
1. Which neurotransmitter is synthesized from tyrosine via DOPA?
A) Serotonin
B) Dopamine
C) GABA
D) Acetylcholine
Answer: B – Tyrosine → L-DOPA → dopamine via aromatic L-amino
acid decarboxylase.
2. A medication with high plasma protein binding (99%) is
discontinued. How does this affect drug washout?
A) Faster elimination
B) Prolonged elimination half-life
C) No change
D) Increased renal clearance
,Answer: B – High protein binding means large volume of
distribution; slow release from tissues.
3. Which CYP enzyme is primarily responsible for metabolism of
aripiprazole?
A) CYP2D6
B) CYP3A4
C) CYP1A2
D) CYP2C19
Answer: A – Aripiprazole is a CYP2D6 and CYP3A4 substrate; 2D6
poor metabolizers have higher levels.
4. A patient on fluvoxamine reports insomnia. Fluvoxamine
inhibits which CYP enzyme that metabolizes caffeine?
A) CYP1A2
B) CYP2D6
C) CYP3A4
D) CYP2C9
Answer: A – Fluvoxamine is a strong CYP1A2 inhibitor → caffeine
levels ↑.
5. Which receptor is an autoreceptor that inhibits dopamine
release when stimulated?
A) D1
B) D2 presynaptic
C) 5-HT2A
D) Alpha-2
Answer: B – Presynaptic D2 autoreceptors inhibit dopamine
synthesis/release.
6. A drug that is a weak base (pKa 8.4) will be ionized in which pH
environment?
,A) Stomach (pH 1.5)
B) Blood (pH 7.4)
C) Urine (pH 5.0)
D) Intestine (pH 6.5)
Answer: A – Weak bases are ionized (trapped) in acidic
environments.
7. Which second messenger is decreased by G protein Gi
activation?
A) cAMP
B) IP3
C) DAG
D) Calcium
Answer: A – Gi inhibits adenylyl cyclase → cAMP ↓.
8. The therapeutic lag of SSRIs (2–4 weeks) is best explained by:
A) Slow receptor binding
B) Downstream changes in BDNF and neurogenesis
C) Poor oral absorption
D) CYP induction
Answer: B – SSRI effects require gene expression changes.
9. Which lab value is most important to monitor in a patient on
valproate?
A) Serum creatinine
B) Ammonia level
C) CBC with differential
D) Thyroid panel
Answer: C – Valproate can cause thrombocytopenia and
neutropenia.
, 10. Which antipsychotic has the highest affinity for D2 receptors?
A) Quetiapine
B) Clozapine
C) Haloperidol
D) Aripiprazole
Answer: C – Haloperidol has very high D2 affinity (Ki ~1 nM).
11. A patient’s lithium level is 1.8 mEq/L. They have nausea, coarse
tremor, and ataxia. What is the next step?
A) Increase lithium
B) Hold lithium and check level again
C) Add haloperidol
D) Give IV fluids only
Answer: B – Hold lithium; mild-moderate toxicity; recheck.
12. Which transporter is inhibited by cocaine?
A) DAT, NET, SERT
B) VMAT only
C) GABA transporter
D) Glutamate transporter
Answer: A – Cocaine is a non-selective monoamine reuptake
inhibitor.
13. A patient on phenelzine eats pepperoni pizza and develops
hypertensive crisis. The mechanism is:
A) Tyramine displacing norepinephrine
B) Direct alpha-1 agonism
C) Serotonin syndrome
D) Histamine release
Answer: A – Tyramine enters neuron via NET, displaces
norepinephrine.
Assessment of Neuroreceptor Mechanisms, Pharmacokinetic
Principles, Adverse Effect Management, and Clinical Decision-
Making for Major Psychiatric Disorders in Advanced Practice
Nursing
Questions 1–150 (Multiple Choice – Select
One Best Answer)
Section 1: Neurobiology & Pharmacokinetics (Q1–
20)
1. Which neurotransmitter is synthesized from tyrosine via DOPA?
A) Serotonin
B) Dopamine
C) GABA
D) Acetylcholine
Answer: B – Tyrosine → L-DOPA → dopamine via aromatic L-amino
acid decarboxylase.
2. A medication with high plasma protein binding (99%) is
discontinued. How does this affect drug washout?
A) Faster elimination
B) Prolonged elimination half-life
C) No change
D) Increased renal clearance
,Answer: B – High protein binding means large volume of
distribution; slow release from tissues.
3. Which CYP enzyme is primarily responsible for metabolism of
aripiprazole?
A) CYP2D6
B) CYP3A4
C) CYP1A2
D) CYP2C19
Answer: A – Aripiprazole is a CYP2D6 and CYP3A4 substrate; 2D6
poor metabolizers have higher levels.
4. A patient on fluvoxamine reports insomnia. Fluvoxamine
inhibits which CYP enzyme that metabolizes caffeine?
A) CYP1A2
B) CYP2D6
C) CYP3A4
D) CYP2C9
Answer: A – Fluvoxamine is a strong CYP1A2 inhibitor → caffeine
levels ↑.
5. Which receptor is an autoreceptor that inhibits dopamine
release when stimulated?
A) D1
B) D2 presynaptic
C) 5-HT2A
D) Alpha-2
Answer: B – Presynaptic D2 autoreceptors inhibit dopamine
synthesis/release.
6. A drug that is a weak base (pKa 8.4) will be ionized in which pH
environment?
,A) Stomach (pH 1.5)
B) Blood (pH 7.4)
C) Urine (pH 5.0)
D) Intestine (pH 6.5)
Answer: A – Weak bases are ionized (trapped) in acidic
environments.
7. Which second messenger is decreased by G protein Gi
activation?
A) cAMP
B) IP3
C) DAG
D) Calcium
Answer: A – Gi inhibits adenylyl cyclase → cAMP ↓.
8. The therapeutic lag of SSRIs (2–4 weeks) is best explained by:
A) Slow receptor binding
B) Downstream changes in BDNF and neurogenesis
C) Poor oral absorption
D) CYP induction
Answer: B – SSRI effects require gene expression changes.
9. Which lab value is most important to monitor in a patient on
valproate?
A) Serum creatinine
B) Ammonia level
C) CBC with differential
D) Thyroid panel
Answer: C – Valproate can cause thrombocytopenia and
neutropenia.
, 10. Which antipsychotic has the highest affinity for D2 receptors?
A) Quetiapine
B) Clozapine
C) Haloperidol
D) Aripiprazole
Answer: C – Haloperidol has very high D2 affinity (Ki ~1 nM).
11. A patient’s lithium level is 1.8 mEq/L. They have nausea, coarse
tremor, and ataxia. What is the next step?
A) Increase lithium
B) Hold lithium and check level again
C) Add haloperidol
D) Give IV fluids only
Answer: B – Hold lithium; mild-moderate toxicity; recheck.
12. Which transporter is inhibited by cocaine?
A) DAT, NET, SERT
B) VMAT only
C) GABA transporter
D) Glutamate transporter
Answer: A – Cocaine is a non-selective monoamine reuptake
inhibitor.
13. A patient on phenelzine eats pepperoni pizza and develops
hypertensive crisis. The mechanism is:
A) Tyramine displacing norepinephrine
B) Direct alpha-1 agonism
C) Serotonin syndrome
D) Histamine release
Answer: A – Tyramine enters neuron via NET, displaces
norepinephrine.
