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: Basic Neuropharmacology (Q1–20)
1. Which receptor is primarily responsible for the therapeutic
antipsychotic effect of D2 antagonists?
A) 5-HT2A
B) D1
C) D2
D) Alpha-1
Answer: C – D2 blockade in mesolimbic pathway reduces positive
symptoms.
2. A drug with high affinity for histamine H1 receptors is most
likely to cause:
A) Weight gain
B) Insomnia
C) Diarrhea
,D) Hypertension
Answer: A – H1 antagonism increases appetite and sedation.
3. Which pharmacokinetic parameter determines time to steady
state?
A) Bioavailability
B) Half-life
C) Volume of distribution
D) Protein binding
Answer: B – Steady state reached in 4–5 half-lives.
4. CYP2D6 poor metabolizers are at risk for toxicity from:
A) Lamotrigine
B) Fluoxetine
C) Lithium
D) Gabapentin
Answer: B – Fluoxetine and many SSRIs rely on CYP2D6.
5. The primary excitatory neurotransmitter in the CNS is:
A) GABA
B) Glycine
C) Glutamate
D) Serotonin
Answer: C – Glutamate acts on NMDA, AMPA, kainate receptors.
6. Which second messenger system is linked to Gs protein-
coupled receptors?
A) cAMP increase
B) IP3 increase
C) Calcium decrease
D) cAMP decrease
Answer: A – Gs activates adenylyl cyclase → cAMP ↑.
,7. A medication that is a strong CYP3A4 inhibitor will increase
levels of:
A) Lamotrigine
B) Lithium
C) Quetiapine
D) Gabapentin
Answer: C – Quetiapine metabolized by CYP3A4.
8. The blood-brain barrier is compromised in which condition?
A) Mild anxiety
B) Multiple sclerosis
C) ADHD
D) Insomnia
Answer: B – Inflammation disrupts tight junctions.
9. Which receptor type is ligand-gated ion channel?
A) D2
B) 5-HT2A
C) GABA-A
D) M1
Answer: C – GABA-A is chloride channel; others are GPCRs.
10. A drug with zero-order kinetics:
A) Doubles half-life with dose increase
B) Shows constant amount eliminated per time
C) Reaches steady state in 1 day
D) Is always renally cleared
Answer: B – E.g., phenytoin, high-dose aspirin.
11. Which transporter is the target of stimulants like
methylphenidate?
A) SERT
, B) NET
C) DAT
D) VMAT
Answer: C – Dopamine transporter inhibition increases synaptic
dopamine.
12. Antagonism of which receptor causes orthostatic
hypotension?
A) D2
B) Alpha-1
C) 5-HT1A
D) H1
Answer: B – Alpha-1 blockade causes vasodilation.
13. Which medication requires renal dose adjustment?
A) Quetiapine
B) Lithium
C) Paroxetine
D) Olanzapine
Answer: B – Lithium 100% renally excreted.
14. The term "efficacy" refers to:
A) Dose needed for effect
B) Maximum effect achievable
C) Rate of metabolism
D) Binding affinity
Answer: B – Intrinsic activity of drug at receptor.
15. Which neurotransmitter is synthesized from tryptophan?
A) Dopamine
B) Norepinephrine
C) Serotonin
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: Basic Neuropharmacology (Q1–20)
1. Which receptor is primarily responsible for the therapeutic
antipsychotic effect of D2 antagonists?
A) 5-HT2A
B) D1
C) D2
D) Alpha-1
Answer: C – D2 blockade in mesolimbic pathway reduces positive
symptoms.
2. A drug with high affinity for histamine H1 receptors is most
likely to cause:
A) Weight gain
B) Insomnia
C) Diarrhea
,D) Hypertension
Answer: A – H1 antagonism increases appetite and sedation.
3. Which pharmacokinetic parameter determines time to steady
state?
A) Bioavailability
B) Half-life
C) Volume of distribution
D) Protein binding
Answer: B – Steady state reached in 4–5 half-lives.
4. CYP2D6 poor metabolizers are at risk for toxicity from:
A) Lamotrigine
B) Fluoxetine
C) Lithium
D) Gabapentin
Answer: B – Fluoxetine and many SSRIs rely on CYP2D6.
5. The primary excitatory neurotransmitter in the CNS is:
A) GABA
B) Glycine
C) Glutamate
D) Serotonin
Answer: C – Glutamate acts on NMDA, AMPA, kainate receptors.
6. Which second messenger system is linked to Gs protein-
coupled receptors?
A) cAMP increase
B) IP3 increase
C) Calcium decrease
D) cAMP decrease
Answer: A – Gs activates adenylyl cyclase → cAMP ↑.
,7. A medication that is a strong CYP3A4 inhibitor will increase
levels of:
A) Lamotrigine
B) Lithium
C) Quetiapine
D) Gabapentin
Answer: C – Quetiapine metabolized by CYP3A4.
8. The blood-brain barrier is compromised in which condition?
A) Mild anxiety
B) Multiple sclerosis
C) ADHD
D) Insomnia
Answer: B – Inflammation disrupts tight junctions.
9. Which receptor type is ligand-gated ion channel?
A) D2
B) 5-HT2A
C) GABA-A
D) M1
Answer: C – GABA-A is chloride channel; others are GPCRs.
10. A drug with zero-order kinetics:
A) Doubles half-life with dose increase
B) Shows constant amount eliminated per time
C) Reaches steady state in 1 day
D) Is always renally cleared
Answer: B – E.g., phenytoin, high-dose aspirin.
11. Which transporter is the target of stimulants like
methylphenidate?
A) SERT
, B) NET
C) DAT
D) VMAT
Answer: C – Dopamine transporter inhibition increases synaptic
dopamine.
12. Antagonism of which receptor causes orthostatic
hypotension?
A) D2
B) Alpha-1
C) 5-HT1A
D) H1
Answer: B – Alpha-1 blockade causes vasodilation.
13. Which medication requires renal dose adjustment?
A) Quetiapine
B) Lithium
C) Paroxetine
D) Olanzapine
Answer: B – Lithium 100% renally excreted.
14. The term "efficacy" refers to:
A) Dose needed for effect
B) Maximum effect achievable
C) Rate of metabolism
D) Binding affinity
Answer: B – Intrinsic activity of drug at receptor.
15. Which neurotransmitter is synthesized from tryptophan?
A) Dopamine
B) Norepinephrine
C) Serotonin
