,
,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: Foundational Neuropharmacology (Q1–20)
1. Which amino acid is the precursor for serotonin synthesis?
A) Tyrosine
B) Tryptophan
C) Phenylalanine
D) Histidine
Answer: B – Tryptophan → 5-HTP → serotonin via tryptophan hydroxylase.
2. A drug that is a substrate of P-glycoprotein (P-gp) at the blood-brain barrier
will have:
A) Increased brain penetration
B) Decreased brain penetration
C) No change
D) Increased renal excretion
Answer: B – P-gp actively pumps drugs out of brain endothelium.
3. Which CYP enzyme is primarily responsible for metabolism of olanzapine?
A) CYP1A2
B) CYP2D6
C) CYP3A4
D) CYP2C19
Answer: A – Olanzapine is mainly metabolized by CYP1A2; smoking induces CYP1A2
and lowers olanzapine levels.
4. A patient on clozapine smokes 2 packs/day. What change in clozapine level is
expected?
A) Increased
B) Decreased
C) No change
, D) Variable
Answer: B – Smoking induces CYP1A2, reducing clozapine levels by up to 50%.
5. Which receptor is an ionotropic glutamate receptor?
A) mGluR5
B) NMDA
C) D2
D) 5-HT2A
Answer: B – NMDA, AMPA, and kainate are ionotropic; mGluRs are metabotropic.
6. A medication with linear (first-order) kinetics has which property?
A) Half-life increases with dose
B) Clearance is proportional to concentration
C) Saturable metabolism
D) Zero-order at high doses
Answer: B – First-order: constant fraction eliminated per unit time.
7. Which second messenger is increased by Gq protein-coupled receptor
activation?
A) cAMP
B) IP3 and DAG
C) cGMP
D) cAMP decrease
Answer: B – Gq activates phospholipase C → IP3 (calcium release) and DAG (PKC
activation).
8. Which antidepressant is a potent inhibitor of CYP2D6?
A) Citalopram
B) Escitalopram
C) Paroxetine
D) Sertraline
Answer: C – Paroxetine is a strong CYP2D6 inhibitor; fluoxetine also strong.
9. The therapeutic effect of SSRIs in OCD typically requires:
A) 2–4 weeks at lower doses
B) 10–12 weeks at higher doses
C) Immediate response
D) 1 week
Answer: B – OCD often requires higher SSRI doses and longer duration (up to 12
weeks).
,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: Foundational Neuropharmacology (Q1–20)
1. Which amino acid is the precursor for serotonin synthesis?
A) Tyrosine
B) Tryptophan
C) Phenylalanine
D) Histidine
Answer: B – Tryptophan → 5-HTP → serotonin via tryptophan hydroxylase.
2. A drug that is a substrate of P-glycoprotein (P-gp) at the blood-brain barrier
will have:
A) Increased brain penetration
B) Decreased brain penetration
C) No change
D) Increased renal excretion
Answer: B – P-gp actively pumps drugs out of brain endothelium.
3. Which CYP enzyme is primarily responsible for metabolism of olanzapine?
A) CYP1A2
B) CYP2D6
C) CYP3A4
D) CYP2C19
Answer: A – Olanzapine is mainly metabolized by CYP1A2; smoking induces CYP1A2
and lowers olanzapine levels.
4. A patient on clozapine smokes 2 packs/day. What change in clozapine level is
expected?
A) Increased
B) Decreased
C) No change
, D) Variable
Answer: B – Smoking induces CYP1A2, reducing clozapine levels by up to 50%.
5. Which receptor is an ionotropic glutamate receptor?
A) mGluR5
B) NMDA
C) D2
D) 5-HT2A
Answer: B – NMDA, AMPA, and kainate are ionotropic; mGluRs are metabotropic.
6. A medication with linear (first-order) kinetics has which property?
A) Half-life increases with dose
B) Clearance is proportional to concentration
C) Saturable metabolism
D) Zero-order at high doses
Answer: B – First-order: constant fraction eliminated per unit time.
7. Which second messenger is increased by Gq protein-coupled receptor
activation?
A) cAMP
B) IP3 and DAG
C) cGMP
D) cAMP decrease
Answer: B – Gq activates phospholipase C → IP3 (calcium release) and DAG (PKC
activation).
8. Which antidepressant is a potent inhibitor of CYP2D6?
A) Citalopram
B) Escitalopram
C) Paroxetine
D) Sertraline
Answer: C – Paroxetine is a strong CYP2D6 inhibitor; fluoxetine also strong.
9. The therapeutic effect of SSRIs in OCD typically requires:
A) 2–4 weeks at lower doses
B) 10–12 weeks at higher doses
C) Immediate response
D) 1 week
Answer: B – OCD often requires higher SSRI doses and longer duration (up to 12
weeks).
