NU 670
Advanced Psychopharmacology & Health
Promotion
Proctored Final Exam
2026
(With Solutions)
MULTIPLE CHOICE (15)
1. Which neurotransmitter is primarily targeted by SSRIs in treating depression?
A) Dopamine B) Serotonin C) Norepinephrine D) GABA Answer: B) Serotonin
Rationale: SSRIs selectively inhibit serotonin reuptake, raising synaptic serotonin,
alleviating depressive symptoms. Knowing this guides monitoring for serotonin
syndrome.
2. A patient on lithium therapy presents with tremors, confusion, and severe
diarrhea. Which is the best immediate action? A) Increase lithium dose B) Check
serum lithium level C) Add NSAIDs for inflammation D) Start antipsychotics Answer:
B) Check serum lithium level Rationale: These symptoms indicate lithium toxicity;
prompt serum levels must be checked to prevent severe toxicity.
3. Which atypical antipsychotic has the highest risk of causing metabolic
syndrome? A) Aripiprazole B) Clozapine C) Ziprasidone D) Lurasidone Answer: B)
Clozapine Rationale: Clozapine is notorious for weight gain, diabetes risk, and
dyslipidemia; essential to educate patients on lifestyle changes.
4. Which class of psychotropic drugs is contraindicated in a patient with narrow-
angle glaucoma? A) Tricyclic antidepressants B) Benzodiazepines C) MAO
inhibitors D) Lithium Answer: A) Tricyclic antidepressants Rationale: TCAs have
anticholinergic properties, which can precipitate angle closure.
5. A patient on MAO inhibitors must avoid which food item to prevent
hypertensive crisis? A) Bananas B) Cheese C) Apples D) Rice Answer: B)
Cheese Rationale: Tyramine-rich foods like aged cheese can lead to dangerous
hypertensive crises with MAOIs.
6. Which of the following is the most accurate indication for the use of
electroconvulsive therapy (ECT)? A) Mild anxiety B) Treatment-resistant major
depression C) First episode psychosis D) Chronic schizophrenia without psychosis
Answer: B) Treatment-resistant major depression Rationale: ECT is effective when
medications fail or rapid response is required.
7. Which psychotropic medication requires regular blood glucose monitoring
due to increased risk of hyperglycemia? A) Fluoxetine B) Clozapine C) Diazepam
D) Haloperidol Answer: B) Clozapine Rationale: Clozapine-induced diabetes is a
serious concern; regular glucose checks are imperative.
8. Which drug is associated with the risk of serotonin syndrome when combined
with SSRIs? A) Lithium B) Tramadol C) Valproate D) Carbamazepine Answer: B)
Tramadol Rationale: Tramadol increases serotonin and when paired with SSRIs,
increases serotonin syndrome risk.
9. What is the recommended monitoring parameter for a patient starting
, carbamazepine? A) Liver function tests B) Serum potassium C) Thyroid function
tests D) Serum amylase Answer: A) Liver function tests Rationale: Carbamazepine
can cause hepatotoxicity; routine LFTs ensure early detection.
10. Which psychotropic medication commonly causes anticholinergic side effects
such as dry mouth and constipation? A) Olanzapine B) Amitriptyline C) Sertraline
D) Risperidone Answer: B) Amitriptyline Rationale: TCAs like amitriptyline have
strong anticholinergic properties.
11. What is the primary mechanism of action for benzodiazepines? A) Dopamine
receptor antagonism B) GABA-A receptor agonism C) Serotonin reuptake inhibition
D) NMDA receptor antagonism Answer: B) GABA-A receptor agonism Rationale:
Benzos enhance GABA, the brain's main inhibitory neurotransmitter, thereby
producing anxiolysis.
12. Which medication is approved for adjunct treatment of alcohol use disorder?
A) Lithium B) Naltrexone C) Fluoxetine D) Phenytoin Answer: B) Naltrexone
Rationale: Naltrexone reduces craving and relapse in alcohol dependence.
13. Which vitamin deficiency is most important to assess in chronic alcoholics
starting psychotropic medication? A) Vitamin B12 B) Vitamin B6 C) Thiamine
(B1) D) Vitamin D Answer: C) Thiamine (B1) Rationale: Thiamine deficiency can
cause Wernicke’s encephalopathy; supplementation is essential.
14. Which health promotion intervention is most effective to reduce metabolic
side effects in patients on second-generation antipsychotics? A) Smoking
cessation programs B) Physical activity and diet counseling C) Routine EKG
monitoring D) Sun exposure Answer: B) Physical activity and diet counseling
Rationale: Lifestyle modifications directly reduce weight gain and metabolic risk.
15. Which of the following psychotropics has the longest half-life, making
adherence less critical? A) Paroxetine B) Fluoxetine C) Sertraline D) Escitalopram
Answer: B) Fluoxetine Rationale: Fluoxetine’s long half-life helps reduce withdrawal
but can complicate initiation or switch.
TRUE/FALSE (10)
16. Lithium therapy is safe during pregnancy without any specific monitoring.
Answer: False Rationale: Lithium is teratogenic (Ebstein anomaly risk); pregnancy
requires close monitoring or alternative meds.
17. Patients on SSRI therapy should be monitored for hyponatremia, especially
elderly patients. Answer: True Rationale: SSRIs can cause SIADH and
hyponatremia, particularly in older adults.
18. Benzodiazepines are recommended as first-line long-term treatment for
generalized anxiety disorder. Answer: False Rationale: Benzos are useful short-
term; long-term use risks dependence and cognitive impairment.
19. Regular ECG monitoring is required for patients on drugs known to prolong
QT interval, such as ziprasidone. Answer: True Rationale: QT prolongation can
lead to torsades; monitoring ensures safety.
20. Clozapine requires weekly CBC monitoring during the first six months of
therapy. Answer: True Rationale: Agranulocytosis risk necessitates weekly blood
counts early in treatment.
21. SSRIs and SNRIs carry a black box warning for increased risk of suicidal
thoughts in adolescents and young adults. Answer: True Rationale: Close
monitoring in this demographic is required early in therapy.
22. Valproate is contraindicated in women of childbearing age due to
teratogenicity. Answer: True Rationale: It carries a high risk of neural tube defects;
alternative treatments preferred.
23. Bupropion is effective as an antidepressant and also aids in smoking
, cessation. Answer: True Rationale: Bupropion inhibits dopamine/norepinephrine
uptake and reduces nicotine craving.
24. Methadone is used only for pain management and never in addiction
treatment. Answer: False Rationale: Methadone is a key medication for opioid use
disorder maintenance therapy.
25. Health promotion activities can improve medication adherence in psychiatric
patients. Answer: True Rationale: Addressing lifestyle, psychoeducation, and
support improves adherence and outcomes.
SHORT ANSWER (7)
26. Name two major side effects of SSRIs that require patient education. Answer:
Sexual dysfunction and gastrointestinal upset Rationale: These common, often
underreported side effects influence adherence.
27. What lab test is critical to monitor when a patient starts on valproic acid?
Answer: Liver function tests (LFTs) and ammonia levels Rationale: Valproate can
cause hepatotoxicity and hyperammonemia.
28. List one non-pharmacological health promotion intervention beneficial for
preventing depression relapse. Answer: Regular physical exercise Rationale:
Exercise is evidenced to reduce depressive symptoms and improve wellbeing.
29. What is the clinical significance of CYP450 enzyme interactions in
psychotropic drug prescribing? Answer: CYP450 interactions can increase or
decrease drug levels leading to toxicity or inefficacy. Rationale: Knowledge prevents
adverse drug reactions and guides proper dosage.
30. Name one psychotropic medication that requires tapering to avoid withdrawal
symptoms. Answer: Diazepam or paroxetine Rationale: Abrupt discontinuation
risks withdrawal or rebound symptoms.
31. What patient education is important when initiating antipsychotics to prevent
orthostatic hypotension? Answer: Advise slow position changes and hydration
Rationale: Minimizing falls and dizziness improves safety.
32. Which neurotransmitter imbalance is primarily implicated in schizophrenia?
Answer: Dopamine hyperactivity in mesolimbic pathway Rationale: This directs
antipsychotic treatment focus.
MATCHING (6)
33-38: Match the drug to its primary adverse effect:
Drug Adverse Effect
1)
A) Clozapine
Agranulocytosis
B) Lithium 2) Nephrotoxicity
3)
C) Haloperidol Extrapyramidal
symptoms
D) Valproate 4) Hepatotoxicity
E)
5) Dependence
Benzodiazepines
F) SSRI 6) Sexual
(Sertraline) dysfunction
Answers: A-1, B-2, C-3, D-4, E-5, F-6 Rationale: Familiarity with common side effects
improves surveillance and patient safety.
FILL IN THE BLANK (2)
Advanced Psychopharmacology & Health
Promotion
Proctored Final Exam
2026
(With Solutions)
MULTIPLE CHOICE (15)
1. Which neurotransmitter is primarily targeted by SSRIs in treating depression?
A) Dopamine B) Serotonin C) Norepinephrine D) GABA Answer: B) Serotonin
Rationale: SSRIs selectively inhibit serotonin reuptake, raising synaptic serotonin,
alleviating depressive symptoms. Knowing this guides monitoring for serotonin
syndrome.
2. A patient on lithium therapy presents with tremors, confusion, and severe
diarrhea. Which is the best immediate action? A) Increase lithium dose B) Check
serum lithium level C) Add NSAIDs for inflammation D) Start antipsychotics Answer:
B) Check serum lithium level Rationale: These symptoms indicate lithium toxicity;
prompt serum levels must be checked to prevent severe toxicity.
3. Which atypical antipsychotic has the highest risk of causing metabolic
syndrome? A) Aripiprazole B) Clozapine C) Ziprasidone D) Lurasidone Answer: B)
Clozapine Rationale: Clozapine is notorious for weight gain, diabetes risk, and
dyslipidemia; essential to educate patients on lifestyle changes.
4. Which class of psychotropic drugs is contraindicated in a patient with narrow-
angle glaucoma? A) Tricyclic antidepressants B) Benzodiazepines C) MAO
inhibitors D) Lithium Answer: A) Tricyclic antidepressants Rationale: TCAs have
anticholinergic properties, which can precipitate angle closure.
5. A patient on MAO inhibitors must avoid which food item to prevent
hypertensive crisis? A) Bananas B) Cheese C) Apples D) Rice Answer: B)
Cheese Rationale: Tyramine-rich foods like aged cheese can lead to dangerous
hypertensive crises with MAOIs.
6. Which of the following is the most accurate indication for the use of
electroconvulsive therapy (ECT)? A) Mild anxiety B) Treatment-resistant major
depression C) First episode psychosis D) Chronic schizophrenia without psychosis
Answer: B) Treatment-resistant major depression Rationale: ECT is effective when
medications fail or rapid response is required.
7. Which psychotropic medication requires regular blood glucose monitoring
due to increased risk of hyperglycemia? A) Fluoxetine B) Clozapine C) Diazepam
D) Haloperidol Answer: B) Clozapine Rationale: Clozapine-induced diabetes is a
serious concern; regular glucose checks are imperative.
8. Which drug is associated with the risk of serotonin syndrome when combined
with SSRIs? A) Lithium B) Tramadol C) Valproate D) Carbamazepine Answer: B)
Tramadol Rationale: Tramadol increases serotonin and when paired with SSRIs,
increases serotonin syndrome risk.
9. What is the recommended monitoring parameter for a patient starting
, carbamazepine? A) Liver function tests B) Serum potassium C) Thyroid function
tests D) Serum amylase Answer: A) Liver function tests Rationale: Carbamazepine
can cause hepatotoxicity; routine LFTs ensure early detection.
10. Which psychotropic medication commonly causes anticholinergic side effects
such as dry mouth and constipation? A) Olanzapine B) Amitriptyline C) Sertraline
D) Risperidone Answer: B) Amitriptyline Rationale: TCAs like amitriptyline have
strong anticholinergic properties.
11. What is the primary mechanism of action for benzodiazepines? A) Dopamine
receptor antagonism B) GABA-A receptor agonism C) Serotonin reuptake inhibition
D) NMDA receptor antagonism Answer: B) GABA-A receptor agonism Rationale:
Benzos enhance GABA, the brain's main inhibitory neurotransmitter, thereby
producing anxiolysis.
12. Which medication is approved for adjunct treatment of alcohol use disorder?
A) Lithium B) Naltrexone C) Fluoxetine D) Phenytoin Answer: B) Naltrexone
Rationale: Naltrexone reduces craving and relapse in alcohol dependence.
13. Which vitamin deficiency is most important to assess in chronic alcoholics
starting psychotropic medication? A) Vitamin B12 B) Vitamin B6 C) Thiamine
(B1) D) Vitamin D Answer: C) Thiamine (B1) Rationale: Thiamine deficiency can
cause Wernicke’s encephalopathy; supplementation is essential.
14. Which health promotion intervention is most effective to reduce metabolic
side effects in patients on second-generation antipsychotics? A) Smoking
cessation programs B) Physical activity and diet counseling C) Routine EKG
monitoring D) Sun exposure Answer: B) Physical activity and diet counseling
Rationale: Lifestyle modifications directly reduce weight gain and metabolic risk.
15. Which of the following psychotropics has the longest half-life, making
adherence less critical? A) Paroxetine B) Fluoxetine C) Sertraline D) Escitalopram
Answer: B) Fluoxetine Rationale: Fluoxetine’s long half-life helps reduce withdrawal
but can complicate initiation or switch.
TRUE/FALSE (10)
16. Lithium therapy is safe during pregnancy without any specific monitoring.
Answer: False Rationale: Lithium is teratogenic (Ebstein anomaly risk); pregnancy
requires close monitoring or alternative meds.
17. Patients on SSRI therapy should be monitored for hyponatremia, especially
elderly patients. Answer: True Rationale: SSRIs can cause SIADH and
hyponatremia, particularly in older adults.
18. Benzodiazepines are recommended as first-line long-term treatment for
generalized anxiety disorder. Answer: False Rationale: Benzos are useful short-
term; long-term use risks dependence and cognitive impairment.
19. Regular ECG monitoring is required for patients on drugs known to prolong
QT interval, such as ziprasidone. Answer: True Rationale: QT prolongation can
lead to torsades; monitoring ensures safety.
20. Clozapine requires weekly CBC monitoring during the first six months of
therapy. Answer: True Rationale: Agranulocytosis risk necessitates weekly blood
counts early in treatment.
21. SSRIs and SNRIs carry a black box warning for increased risk of suicidal
thoughts in adolescents and young adults. Answer: True Rationale: Close
monitoring in this demographic is required early in therapy.
22. Valproate is contraindicated in women of childbearing age due to
teratogenicity. Answer: True Rationale: It carries a high risk of neural tube defects;
alternative treatments preferred.
23. Bupropion is effective as an antidepressant and also aids in smoking
, cessation. Answer: True Rationale: Bupropion inhibits dopamine/norepinephrine
uptake and reduces nicotine craving.
24. Methadone is used only for pain management and never in addiction
treatment. Answer: False Rationale: Methadone is a key medication for opioid use
disorder maintenance therapy.
25. Health promotion activities can improve medication adherence in psychiatric
patients. Answer: True Rationale: Addressing lifestyle, psychoeducation, and
support improves adherence and outcomes.
SHORT ANSWER (7)
26. Name two major side effects of SSRIs that require patient education. Answer:
Sexual dysfunction and gastrointestinal upset Rationale: These common, often
underreported side effects influence adherence.
27. What lab test is critical to monitor when a patient starts on valproic acid?
Answer: Liver function tests (LFTs) and ammonia levels Rationale: Valproate can
cause hepatotoxicity and hyperammonemia.
28. List one non-pharmacological health promotion intervention beneficial for
preventing depression relapse. Answer: Regular physical exercise Rationale:
Exercise is evidenced to reduce depressive symptoms and improve wellbeing.
29. What is the clinical significance of CYP450 enzyme interactions in
psychotropic drug prescribing? Answer: CYP450 interactions can increase or
decrease drug levels leading to toxicity or inefficacy. Rationale: Knowledge prevents
adverse drug reactions and guides proper dosage.
30. Name one psychotropic medication that requires tapering to avoid withdrawal
symptoms. Answer: Diazepam or paroxetine Rationale: Abrupt discontinuation
risks withdrawal or rebound symptoms.
31. What patient education is important when initiating antipsychotics to prevent
orthostatic hypotension? Answer: Advise slow position changes and hydration
Rationale: Minimizing falls and dizziness improves safety.
32. Which neurotransmitter imbalance is primarily implicated in schizophrenia?
Answer: Dopamine hyperactivity in mesolimbic pathway Rationale: This directs
antipsychotic treatment focus.
MATCHING (6)
33-38: Match the drug to its primary adverse effect:
Drug Adverse Effect
1)
A) Clozapine
Agranulocytosis
B) Lithium 2) Nephrotoxicity
3)
C) Haloperidol Extrapyramidal
symptoms
D) Valproate 4) Hepatotoxicity
E)
5) Dependence
Benzodiazepines
F) SSRI 6) Sexual
(Sertraline) dysfunction
Answers: A-1, B-2, C-3, D-4, E-5, F-6 Rationale: Familiarity with common side effects
improves surveillance and patient safety.
FILL IN THE BLANK (2)
