NR 546 / NR546 Final Exam Guide
2024/2025: Chamberlain’s Verified Q&A for
Psychopharmacology (New!!!)
Course
Hesi
1. Q: What is the mechanism of action of SSRIs, and why are they first-line
treatment for major depressive disorder (MDD)?
A: SSRIs (e.g., fluoxetine, sertraline) inhibit the reuptake of serotonin (5-HT) in the synaptic
cleft, increasing serotonin levels. They are first-line due to their favorable side effect profile,
lower toxicity in overdose, and broad-spectrum efficacy.
2. Q: Which psychotropic medication requires baseline and periodic CBC
monitoring due to the risk of agranulocytosis?
A: Clozapine. It carries a black box warning for agranulocytosis; absolute neutrophil count
(ANC) must be monitored weekly for the first 6 months, then every 2 weeks, and monthly after
one year if stable.
3. Q: A 22-year-old female with bipolar disorder is starting lithium. What labs
should be obtained before initiating therapy?
A: Baseline labs should include serum creatinine/BUN (renal function), thyroid function
tests (TSH), pregnancy test, and electrolytes (especially sodium). Lithium is nephrotoxic, can
cause hypothyroidism, and is teratogenic (esp. 1st trimester).
4. Q: Which class of antidepressants is associated with hypertensive crisis when
taken with tyramine-rich foods?
A: Monoamine oxidase inhibitors (MAOIs). Tyramine is normally broken down by MAO;
when MAO is inhibited, tyramine can cause catecholamine surge → severe hypertension.
5. Q: Why are benzodiazepines contraindicated in patients with substance use
disorders?
,A: Benzodiazepines have a high potential for dependence and abuse. They act on the GABA-
A receptor, producing sedative and anxiolytic effects, which can be reinforcing in individuals
with addictive tendencies.
6. Q: A patient on risperidone develops tremor and rigidity. What is the likely
diagnosis, and what is the treatment?
A: Likely extrapyramidal symptoms (EPS), specifically drug-induced parkinsonism. Treat
with benztropine or trihexyphenidyl, both anticholinergics.
7. Q: What is serotonin syndrome, and which drug combinations increase its
risk?
A: Serotonin syndrome is a potentially life-threatening condition caused by excess
serotonergic activity. Risk increases when SSRIs are combined with MAOIs, SNRIs,
triptans, or linezolid. Symptoms include hyperreflexia, clonus, agitation, and fever.
8. Q: What is the black box warning for all antidepressants, particularly in
adolescents and young adults?
A: Increased risk of suicidal thoughts and behaviors, especially during the first few weeks of
treatment or when doses are changed.
9. Q: Compare the onset of action and side effect profile of SSRIs vs. SNRIs.
A: SSRIs take 2–4 weeks for effect; side effects include GI upset, sexual dysfunction. SNRIs
(e.g., venlafaxine) also increase norepinephrine, causing possible hypertension and more
activating effects, especially at higher doses.
10. Q: Which medications are FDA-approved for PTSD, and what is the role of
prazosin?
A: Sertraline and paroxetine are FDA-approved SSRIs for PTSD. Prazosin, an alpha-1
blocker, is used off-label to treat nightmares and sleep disturbances in PTSD.
, 11. Q: What is the primary concern when prescribing bupropion (Wellbutrin) to a patient
with a history of bulimia nervosa?
A: Seizure risk. Bupropion lowers the seizure threshold, especially in individuals with eating
disorders or alcohol withdrawal.
12. Q: Which atypical antipsychotic is most associated with significant weight gain and
metabolic syndrome?
A: Olanzapine. It causes increased appetite, weight gain, insulin resistance, and dyslipidemia.
Regular metabolic monitoring is essential.
13. Q: What is the therapeutic serum range for lithium in the treatment of bipolar disorder
(maintenance phase)?
A: 0.6–1.2 mEq/L. Toxicity usually occurs >1.5 mEq/L; early signs include nausea, tremor, and
diarrhea; severe toxicity can lead to seizures and coma.
14. Q: A patient on valproic acid develops jaundice and right upper quadrant pain. What
lab should be checked immediately?
A: Liver function tests (LFTs). Valproic acid is hepatotoxic, especially in young children and
patients with mitochondrial disorders.
15. Q: What are symptoms of neuroleptic malignant syndrome (NMS), and how is it
managed?
A: Symptoms: hyperthermia, "lead-pipe" rigidity, autonomic instability, altered mental
status.
Treatment: Discontinue antipsychotic, administer dantrolene or bromocriptine, and provide
supportive care.
16. Q: Which neurotransmitters are most implicated in schizophrenia pathophysiology and
antipsychotic drug action?
A: Primarily dopamine (↑ in mesolimbic pathway) and serotonin. First-gen antipsychotics
block D2 receptors; second-gen block both D2 and 5-HT2A receptors.
2024/2025: Chamberlain’s Verified Q&A for
Psychopharmacology (New!!!)
Course
Hesi
1. Q: What is the mechanism of action of SSRIs, and why are they first-line
treatment for major depressive disorder (MDD)?
A: SSRIs (e.g., fluoxetine, sertraline) inhibit the reuptake of serotonin (5-HT) in the synaptic
cleft, increasing serotonin levels. They are first-line due to their favorable side effect profile,
lower toxicity in overdose, and broad-spectrum efficacy.
2. Q: Which psychotropic medication requires baseline and periodic CBC
monitoring due to the risk of agranulocytosis?
A: Clozapine. It carries a black box warning for agranulocytosis; absolute neutrophil count
(ANC) must be monitored weekly for the first 6 months, then every 2 weeks, and monthly after
one year if stable.
3. Q: A 22-year-old female with bipolar disorder is starting lithium. What labs
should be obtained before initiating therapy?
A: Baseline labs should include serum creatinine/BUN (renal function), thyroid function
tests (TSH), pregnancy test, and electrolytes (especially sodium). Lithium is nephrotoxic, can
cause hypothyroidism, and is teratogenic (esp. 1st trimester).
4. Q: Which class of antidepressants is associated with hypertensive crisis when
taken with tyramine-rich foods?
A: Monoamine oxidase inhibitors (MAOIs). Tyramine is normally broken down by MAO;
when MAO is inhibited, tyramine can cause catecholamine surge → severe hypertension.
5. Q: Why are benzodiazepines contraindicated in patients with substance use
disorders?
,A: Benzodiazepines have a high potential for dependence and abuse. They act on the GABA-
A receptor, producing sedative and anxiolytic effects, which can be reinforcing in individuals
with addictive tendencies.
6. Q: A patient on risperidone develops tremor and rigidity. What is the likely
diagnosis, and what is the treatment?
A: Likely extrapyramidal symptoms (EPS), specifically drug-induced parkinsonism. Treat
with benztropine or trihexyphenidyl, both anticholinergics.
7. Q: What is serotonin syndrome, and which drug combinations increase its
risk?
A: Serotonin syndrome is a potentially life-threatening condition caused by excess
serotonergic activity. Risk increases when SSRIs are combined with MAOIs, SNRIs,
triptans, or linezolid. Symptoms include hyperreflexia, clonus, agitation, and fever.
8. Q: What is the black box warning for all antidepressants, particularly in
adolescents and young adults?
A: Increased risk of suicidal thoughts and behaviors, especially during the first few weeks of
treatment or when doses are changed.
9. Q: Compare the onset of action and side effect profile of SSRIs vs. SNRIs.
A: SSRIs take 2–4 weeks for effect; side effects include GI upset, sexual dysfunction. SNRIs
(e.g., venlafaxine) also increase norepinephrine, causing possible hypertension and more
activating effects, especially at higher doses.
10. Q: Which medications are FDA-approved for PTSD, and what is the role of
prazosin?
A: Sertraline and paroxetine are FDA-approved SSRIs for PTSD. Prazosin, an alpha-1
blocker, is used off-label to treat nightmares and sleep disturbances in PTSD.
, 11. Q: What is the primary concern when prescribing bupropion (Wellbutrin) to a patient
with a history of bulimia nervosa?
A: Seizure risk. Bupropion lowers the seizure threshold, especially in individuals with eating
disorders or alcohol withdrawal.
12. Q: Which atypical antipsychotic is most associated with significant weight gain and
metabolic syndrome?
A: Olanzapine. It causes increased appetite, weight gain, insulin resistance, and dyslipidemia.
Regular metabolic monitoring is essential.
13. Q: What is the therapeutic serum range for lithium in the treatment of bipolar disorder
(maintenance phase)?
A: 0.6–1.2 mEq/L. Toxicity usually occurs >1.5 mEq/L; early signs include nausea, tremor, and
diarrhea; severe toxicity can lead to seizures and coma.
14. Q: A patient on valproic acid develops jaundice and right upper quadrant pain. What
lab should be checked immediately?
A: Liver function tests (LFTs). Valproic acid is hepatotoxic, especially in young children and
patients with mitochondrial disorders.
15. Q: What are symptoms of neuroleptic malignant syndrome (NMS), and how is it
managed?
A: Symptoms: hyperthermia, "lead-pipe" rigidity, autonomic instability, altered mental
status.
Treatment: Discontinue antipsychotic, administer dantrolene or bromocriptine, and provide
supportive care.
16. Q: Which neurotransmitters are most implicated in schizophrenia pathophysiology and
antipsychotic drug action?
A: Primarily dopamine (↑ in mesolimbic pathway) and serotonin. First-gen antipsychotics
block D2 receptors; second-gen block both D2 and 5-HT2A receptors.
