NR546 | NR546 Advanced Pharmacology
Psychopharmacology for the PMHNP Week 4 Exam
2 | Questions with Correct Answers and Expert
Explanation for Each Question | Chamberlain
1. A patient is prescribed a benzodiazepine for acute anxiety. What is the primary
mechanism of action for this class of medication?
A. Antagonizing dopamine D2 receptors in the mesolimbic pathway.
B. Blocking alpha-1 adrenergic receptors in the brainstem.
C. Inhibiting the reuptake of serotonin at the synaptic cleft.
D. Acting as a positive allosteric modulator at the GABA-A receptor.
Correct Answer: D
Expert Explanation: Benzodiazepines work by binding to a specific site on the
GABA-A receptor complex, which increases the frequency of chloride channel
opening. This enhances the inhibitory effects of GABA, leading to sedation and
anxiolysis. This mechanism is distinct from direct agonists as it requires the
presence of endogenous GABA.
2. Which of the following benzodiazepines is preferred in elderly patients or those
with liver impairment due to its metabolic pathway?
A. Diazepam
,B. Lorazepam
C. Chlordiazepoxide
D. Clonazepam
Correct Answer: B
Expert Explanation: Lorazepam, along with Oxazepam and Temazepam (the ‘LOT’
drugs), undergoes simple glucuronidation and does not have active metabolites.
This makes it safer for patients with reduced hepatic function or the elderly who
may have decreased CYP450 enzyme activity. Other benzodiazepines like Diazepam
have long-lived active metabolites that can accumulate and cause toxicity.
3. A patient with Generalized Anxiety Disorder (GAD) is started on Buspirone. What is
an important piece of education regarding its onset of action?
A. It works immediately to stop a panic attack.
B. The patient will feel sedated within 30 minutes of the first dose.
C. It should only be taken on an ‘as needed’ (PRN) basis.
D. It may take 2 to 4 weeks to achieve full therapeutic effect.
Correct Answer: D
Expert Explanation: Buspirone is a 5-HT1A partial agonist that requires chronic
administration to achieve clinical efficacy. Unlike benzodiazepines, it does not
,provide immediate relief and is not effective for PRN use. Patients must be informed
of this delayed onset to ensure compliance and manage expectations.
4. Which medication is considered a first-line pharmacological treatment for Social
Anxiety Disorder (SAD)?
A. Hydroxyzine
B. Sertraline
C. Alprazolam
D. Atenolol
Correct Answer: B
Expert Explanation: SSRIs like Sertraline and SNRIs are recommended as first-line
treatments for Social Anxiety Disorder due to their efficacy and safety profile. While
beta-blockers like Atenolol help with performance anxiety, they are not first-line for
generalized SAD. Alprazolam is generally reserved for second-line or short-term use
due to dependency risks.
5. A patient suffering from PTSD reports frequent, vivid nightmares. Which medication
is most appropriate to target this specific symptom?
A. Prazosin
B. Fluoxetine
, C. Risperidone
D. Zolpidem
Correct Answer: A
Expert Explanation: Prazosin is an alpha-1 adrenergic antagonist that is frequently
used off-label to treat PTSD-related nightmares and sleep disturbances. It works by
inhibiting the overactive sympathetic response during sleep. Fluoxetine is used for
PTSD overall, but Prazosin is specific for the nightmares.
6. The ‘Z-drugs’ (Zolpidem, Zaleplon, Eszopiclone) differ from traditional
benzodiazepines because they:
A. Are more selective for the alpha-1 subunit of the GABA-A receptor.
B. Have a much longer half-life.
C. Do not carry a risk for dependence or withdrawal.
D. Work by inhibiting the reuptake of melatonin.
Correct Answer: A
Expert Explanation: Z-drugs are non-benzodiazepine hypnotics that preferentially
bind to the alpha-1 subunit of the GABA-A receptor, which is associated with
sedation. Traditional benzodiazepines are non-selective and bind to alpha-1, alpha-
Psychopharmacology for the PMHNP Week 4 Exam
2 | Questions with Correct Answers and Expert
Explanation for Each Question | Chamberlain
1. A patient is prescribed a benzodiazepine for acute anxiety. What is the primary
mechanism of action for this class of medication?
A. Antagonizing dopamine D2 receptors in the mesolimbic pathway.
B. Blocking alpha-1 adrenergic receptors in the brainstem.
C. Inhibiting the reuptake of serotonin at the synaptic cleft.
D. Acting as a positive allosteric modulator at the GABA-A receptor.
Correct Answer: D
Expert Explanation: Benzodiazepines work by binding to a specific site on the
GABA-A receptor complex, which increases the frequency of chloride channel
opening. This enhances the inhibitory effects of GABA, leading to sedation and
anxiolysis. This mechanism is distinct from direct agonists as it requires the
presence of endogenous GABA.
2. Which of the following benzodiazepines is preferred in elderly patients or those
with liver impairment due to its metabolic pathway?
A. Diazepam
,B. Lorazepam
C. Chlordiazepoxide
D. Clonazepam
Correct Answer: B
Expert Explanation: Lorazepam, along with Oxazepam and Temazepam (the ‘LOT’
drugs), undergoes simple glucuronidation and does not have active metabolites.
This makes it safer for patients with reduced hepatic function or the elderly who
may have decreased CYP450 enzyme activity. Other benzodiazepines like Diazepam
have long-lived active metabolites that can accumulate and cause toxicity.
3. A patient with Generalized Anxiety Disorder (GAD) is started on Buspirone. What is
an important piece of education regarding its onset of action?
A. It works immediately to stop a panic attack.
B. The patient will feel sedated within 30 minutes of the first dose.
C. It should only be taken on an ‘as needed’ (PRN) basis.
D. It may take 2 to 4 weeks to achieve full therapeutic effect.
Correct Answer: D
Expert Explanation: Buspirone is a 5-HT1A partial agonist that requires chronic
administration to achieve clinical efficacy. Unlike benzodiazepines, it does not
,provide immediate relief and is not effective for PRN use. Patients must be informed
of this delayed onset to ensure compliance and manage expectations.
4. Which medication is considered a first-line pharmacological treatment for Social
Anxiety Disorder (SAD)?
A. Hydroxyzine
B. Sertraline
C. Alprazolam
D. Atenolol
Correct Answer: B
Expert Explanation: SSRIs like Sertraline and SNRIs are recommended as first-line
treatments for Social Anxiety Disorder due to their efficacy and safety profile. While
beta-blockers like Atenolol help with performance anxiety, they are not first-line for
generalized SAD. Alprazolam is generally reserved for second-line or short-term use
due to dependency risks.
5. A patient suffering from PTSD reports frequent, vivid nightmares. Which medication
is most appropriate to target this specific symptom?
A. Prazosin
B. Fluoxetine
, C. Risperidone
D. Zolpidem
Correct Answer: A
Expert Explanation: Prazosin is an alpha-1 adrenergic antagonist that is frequently
used off-label to treat PTSD-related nightmares and sleep disturbances. It works by
inhibiting the overactive sympathetic response during sleep. Fluoxetine is used for
PTSD overall, but Prazosin is specific for the nightmares.
6. The ‘Z-drugs’ (Zolpidem, Zaleplon, Eszopiclone) differ from traditional
benzodiazepines because they:
A. Are more selective for the alpha-1 subunit of the GABA-A receptor.
B. Have a much longer half-life.
C. Do not carry a risk for dependence or withdrawal.
D. Work by inhibiting the reuptake of melatonin.
Correct Answer: A
Expert Explanation: Z-drugs are non-benzodiazepine hypnotics that preferentially
bind to the alpha-1 subunit of the GABA-A receptor, which is associated with
sedation. Traditional benzodiazepines are non-selective and bind to alpha-1, alpha-
