NSG552 Psychopharmacology Exam 1 Review
2025/2026 - 100% Correct Questions & A
Grade Verified Answers
A 26-year-old woman is started on sertraline 50 mg for first major depressive episode.
Which receptor target underlies its antidepressant effect?
A) Competitive antagonism of D2 receptors
B) Selective blockade of the serotonin re-uptake transporter (SERT)
C) Non-selective inhibition of MAO-A and MAO-B
1. D) Full agonism at 5-HT1A autoreceptors
Answer: B
Rationale: Sertraline is an SSRI; high-affinity binding to SERT increases synaptic 5-HT. It
lacks meaningful D2 or MAO activity, making B the foundational mechanism.
A client on fluoxetine 20 mg reports persistent nausea. Which administration
modification best reduces this adverse effect?
A) Take dose at bedtime without food
B) Take after breakfast and consider temporary dose reduction
C) Split dose into four administrations across the day
2. D) Add ondansetron 8 mg daily long-term
Answer: B
Rationale: GI irritation is common early; giving after food and modest dose taper
mitigates while maintaining therapeutic levels—core counseling for Exam 1.
,Which antidepressant most commonly causes weight gain via potent H1-receptor
antagonism?
A) Paroxetine
B) Escitalopram
C) Bupropion
3. D) Duloxetine
Answer: A
Rationale: Paroxetine’s strong antihistaminic activity increases appetite and sedation;
others lack significant H1 affinity—key receptor-based side effect.
A 34-year-old male is switched from paroxetine to escitalopram to avoid sexual
dysfunction. Which statement best explains this change?
A) Escitalopram lacks 5-HT2C antagonism, minimizing appetite stimulation
B) Escitalopram has lower inhibition of nitric-oxide synthase, preserving arousal
C) Escitalopram is essentially devoid of 5-HT2A/2C and H1 activity, reducing
SSRI-induced sexual side effects
4. D) Escitalopram increases dopamine via NET inhibition
Answer: C
Rationale: Escitalopram’s ultra-selective SERT binding avoids receptor subtypes linked
to sexual impairment; no NET or NO synthase effect—mechanism-based selection.
A patient on phenelzine 45 mg develops occipital headache and BP 190/110 mmHg
after aged cheese. Which neurotransmitter surge is responsible?
A) Tyramine → massive norepinephrine release from vesicles
B) Serotonin excess from SERT blockade
C) Dopamine accumulation via COMO inhibition
5. D) Histamine release from mast-cell degranulation
, Answer: A
Rationale: MAOIs block tyramine breakdown; tyramine displaces NE, causing
hypertensive crisis—core MAOI pharmacology for Exam 1.
Which first-line agent for GAD has no sedation, no withdrawal, and no abuse potential?
A) Lorazepam 1 mg TID
B) Buspirone 5 mg BID titrated to 15 mg BID
C) Hydroxyzine 25 mg PRN
6. D) Zolpidem 10 mg HS
Answer: B
Rationale: Buspirone’s 5-HT1A partial agonism provides anxiolysis without GABAergic
effects—foundational differentiation from benzodiazepines and sedating
antihistamines.
A 50-year-old with cardiac disease needs an antidepressant least likely to prolong QTc.
Which is safest?
A) Citalopram 40 mg
B) Escitalopram 10 mg
C) Amitriptyline 75 mg
7. D) Imipramine 100 mg
Answer: B
Rationale: Escitalopram lacks dose-dependent QT prolongation seen with citalopram
>20 mg and has minimal cardiac sodium-channel blockade—key safety point.
A college student on methylphenidate ER 36 mg reports appetite loss and 3 kg weight
loss. Which strategy best manages this side effect?
2025/2026 - 100% Correct Questions & A
Grade Verified Answers
A 26-year-old woman is started on sertraline 50 mg for first major depressive episode.
Which receptor target underlies its antidepressant effect?
A) Competitive antagonism of D2 receptors
B) Selective blockade of the serotonin re-uptake transporter (SERT)
C) Non-selective inhibition of MAO-A and MAO-B
1. D) Full agonism at 5-HT1A autoreceptors
Answer: B
Rationale: Sertraline is an SSRI; high-affinity binding to SERT increases synaptic 5-HT. It
lacks meaningful D2 or MAO activity, making B the foundational mechanism.
A client on fluoxetine 20 mg reports persistent nausea. Which administration
modification best reduces this adverse effect?
A) Take dose at bedtime without food
B) Take after breakfast and consider temporary dose reduction
C) Split dose into four administrations across the day
2. D) Add ondansetron 8 mg daily long-term
Answer: B
Rationale: GI irritation is common early; giving after food and modest dose taper
mitigates while maintaining therapeutic levels—core counseling for Exam 1.
,Which antidepressant most commonly causes weight gain via potent H1-receptor
antagonism?
A) Paroxetine
B) Escitalopram
C) Bupropion
3. D) Duloxetine
Answer: A
Rationale: Paroxetine’s strong antihistaminic activity increases appetite and sedation;
others lack significant H1 affinity—key receptor-based side effect.
A 34-year-old male is switched from paroxetine to escitalopram to avoid sexual
dysfunction. Which statement best explains this change?
A) Escitalopram lacks 5-HT2C antagonism, minimizing appetite stimulation
B) Escitalopram has lower inhibition of nitric-oxide synthase, preserving arousal
C) Escitalopram is essentially devoid of 5-HT2A/2C and H1 activity, reducing
SSRI-induced sexual side effects
4. D) Escitalopram increases dopamine via NET inhibition
Answer: C
Rationale: Escitalopram’s ultra-selective SERT binding avoids receptor subtypes linked
to sexual impairment; no NET or NO synthase effect—mechanism-based selection.
A patient on phenelzine 45 mg develops occipital headache and BP 190/110 mmHg
after aged cheese. Which neurotransmitter surge is responsible?
A) Tyramine → massive norepinephrine release from vesicles
B) Serotonin excess from SERT blockade
C) Dopamine accumulation via COMO inhibition
5. D) Histamine release from mast-cell degranulation
, Answer: A
Rationale: MAOIs block tyramine breakdown; tyramine displaces NE, causing
hypertensive crisis—core MAOI pharmacology for Exam 1.
Which first-line agent for GAD has no sedation, no withdrawal, and no abuse potential?
A) Lorazepam 1 mg TID
B) Buspirone 5 mg BID titrated to 15 mg BID
C) Hydroxyzine 25 mg PRN
6. D) Zolpidem 10 mg HS
Answer: B
Rationale: Buspirone’s 5-HT1A partial agonism provides anxiolysis without GABAergic
effects—foundational differentiation from benzodiazepines and sedating
antihistamines.
A 50-year-old with cardiac disease needs an antidepressant least likely to prolong QTc.
Which is safest?
A) Citalopram 40 mg
B) Escitalopram 10 mg
C) Amitriptyline 75 mg
7. D) Imipramine 100 mg
Answer: B
Rationale: Escitalopram lacks dose-dependent QT prolongation seen with citalopram
>20 mg and has minimal cardiac sodium-channel blockade—key safety point.
A college student on methylphenidate ER 36 mg reports appetite loss and 3 kg weight
loss. Which strategy best manages this side effect?
