NSG 552 Psychopharmacology Master Exam (2026/2027) | Wilkes University | 150 Q&A with Rationales | All 3 Exams Combined | PMHNP/FNP

Complete NSG 552 Psychopharmacology Master Study Guide – Exams 1, 2 & 3 Combined – Wilkes University (2026/2027 Academic Year) This digital download is a comprehensive 150-question master practice exam for NSG 552 Psychopharmacology at Wilkes University. Unlike separate exam files, this consolidated master exam integrates key concepts from all three course exams into a single, streamlined 150-question study resource. Designed for graduate nursing students (PMHNP, FNP, AGNP) seeking efficient, high-yield review. What's included: 150 multiple-choice questions with detailed rationales (condensed from 450+ questions across 3 exams) 5 integrated sections covering all core psychopharmacology domains Answers with evidence-based rationales – learn the "why," not just the "what" High-yield, board-style questions – ideal for course exams and certification prep (ANCC, AANP) Section 1: Foundational Concepts (Q1–25) Pharmacokinetics vs. pharmacodynamics (ADME) Receptor theory: agonists, partial agonists, antagonists, inverse agonists Neurotransmitters: glutamate (excitatory), GABA (inhibitory), serotonin (Raphe nuclei), norepinephrine (locus coeruleus) Four dopamine pathways: mesolimbic (positive symptoms), mesocortical (negative symptoms), nigrostriatal (EPS), tuberoinfundibular (prolactin) CYP450 system: inducers (carbamazepine), inhibitors (valproate, grapefruit juice), substrates Half-life, therapeutic index, tolerance, receptor upregulation/downregulation Neuroanatomy: amygdala (emotion), thalamus (relay), frontal lobe (executive function) Section 2: Antipsychotics (Q26–50) First-generation (typical) vs. second-generation (atypical) antipsychotics FGAs: haloperidol – high EPS risk; SGAs: olanzapine, risperidone, quetiapine, aripiprazole, clozapine EPS: acute dystonia (treat with benztropine/diphenhydramine), akathisia (propranolol), pseudo-Parkinsonism, tardive dyskinesia (AIMS monitoring; VMAT2 inhibitors: valbenazine/Ingrezza, deutetrabenazine/Austedo) NMS: fever, lead pipe rigidity, autonomic instability – discontinue antipsychotic immediately Metabolic syndrome: olanzapine/clozapine highest risk; aripiprazole/ziprasidone weight-neutral; monitor weight/BMI, waist circumference, BP, glucose, lipids; metformin off-label for weight gain Clozapine: treatment-resistant schizophrenia, suicidal behavior; REMS ANC monitoring (weekly ×6 mo → q2wk ×6 mo → monthly); agranulocytosis (fever/sore throat → hold + STAT ANC), myocarditis (first 2 months), sialorrhea (glycopyrrolate), severe constipation/ileus (fatal), seizures (dose-dependent) LAIs: reduce relapse; risperidone LAI needs oral overlap 3–4 weeks; aripiprazole/paliperidone LAIs achieve levels without prolonged overlap Smoking (CYP1A2 inducer): reduces clozapine/olanzapine levels; cessation → levels rise 50–70% → dose reduction required CATIE trial: 74% discontinuation rate; olanzapine slightly superior but metabolic burden Pimavanserin (Nuplazid): 5-HT2A inverse agonist, FDA-approved for Parkinson's disease psychosis Section 3: Antidepressants & Mood Stabilizers (Q51–80) Monoamine theory: serotonin, norepinephrine, dopamine deficiency SSRIs: first-line for MDD; sexual dysfunction (#1 discontinuation reason); sertraline preferred in pregnancy/breastfeeding SNRIs: venlafaxine (dose-dependent hypertension), duloxetine Bupropion (NDRI): weight-neutral, no sexual side effects; contraindicated in seizure disorders/eating disorders TCAs: cardiotoxicity in overdose (QRS widening, arrhythmias) MAOIs: tyramine-free diet (aged cheese, cured meats, wine) to prevent hypertensive crisis Serotonin syndrome: AMS + autonomic instability + neuromuscular hyperreactivity (clonus, hyperreflexia) Discontinuation syndrome: paroxetine highest risk (short half-life); fluoxetine lowest risk (long half-life, self-tapering) Lithium: therapeutic range 0.6–1.2 mEq/L; toxicity (coarse tremor, nausea, vomiting, confusion); nephrogenic diabetes insipidus; hypothyroidism; Ebstein's anomaly risk ~0.1–0.2%; NSAIDs/thiazides ↑ lithium levels; hold 24–48 hours before ECT Valproate: effective for rapid cycling/mixed episodes; hepatotoxicity, thrombocytopenia; neural tube defects (pregnancy category D/X) – use effective contraception Lamotrigine: effective for bipolar depression/maintenance; slow titration to prevent SJS/TEN; dose reduce by 50% with valproate Carbamazepine: CYP3A4 inducer; reduces oral contraceptive efficacy (backup method required); agranulocytosis, hyponatremia Section 4: Anxiety Disorders, ADHD & Substance Use Disorders (Q81–110) GAD: SSRIs/SNRIs first-line; buspirone (5-HT1A partial agonist, no abuse potential, delayed onset 2–4 weeks) Panic disorder: SSRIs/SNRIs first-line; benzodiazepines as short-term bridge Performance anxiety: propranolol 30–60 minutes before event Benzodiazepines: avoid in substance use disorders; withdrawal can be life-threatening (seizures, delirium); slow taper required; Beers Criteria (avoid in elderly) ADHD: stimulants first-line (methylphenidate, amphetamines); common side effects: appetite suppression, insomnia, growth suppression (monitor height/weight) Lisdexamfetamine (Vyvanse): prodrug, lower abuse potential Non-stimulants: atomoxetine (NRI, black box warning for suicidal ideation, hepatotoxicity, CYP2D6 interaction with fluoxetine); guanfacine/clonidine (alpha-2 agonists – sedation, hypotension, rebound hypertension if stopped abruptly) Alcohol Use Disorder: naltrexone (mu-opioid antagonist), acamprosate (restores glutamate/GABA balance, renally excreted), disulfiram (aldehyde dehydrogenase inhibitor – avoid all alcohol sources) Opioid Use Disorder: buprenorphine/naloxone (Suboxone – deters IV misuse), methadone (OTP only, QTc prolongation); must be in withdrawal (COWS ≥8–12) before first buprenorphine dose to avoid precipitated withdrawal Nicotine Use Disorder: NRT, bupropion (start 1–2 weeks before quit date), varenicline (partial nicotinic agonist) Stimulant Use Disorder: no FDA-approved medications Naltrexone treats both OUD and AUD simultaneously Section 5: Advanced Treatment Strategies, Dementia & Special Populations (Q111–150) TRD: failure of ≥2 adequate antidepressant trials; augmentation with atypical antipsychotics (aripiprazole 2–5 mg, brexpiprazole, quetiapine XR 150–300 mg, olanzapine-fluoxetine combination) Esketamine (Spravato): NMDA antagonist; intranasal REMS program; requires 2-hour monitoring; must be on oral antidepressant ECT: gold standard for severe TRD, catatonia, suicidality; transient cognitive side effects (RUL placement minimizes) Alzheimer's disease: cholinesterase inhibitors (donepezil, rivastigmine patch, galantamine) first-line for mild-moderate; memantine (NMDA antagonist) for moderate-severe BPSD: non-pharmacologic first-line; antipsychotics black box warning (↑ mortality, CVA events) – use low-dose SGAs only when severe Lewy Body Dementia: extreme antipsychotic sensitivity; pimavanserin preferred Delirium: treat underlying cause; haloperidol or low-dose SGA if severe agitation Insomnia: CBT-I first-line; DORAs (suvorexant, lemborexant, daridorexant) – no respiratory depression, lower abuse potential; Z-drugs (zolpidem) – complex sleep behaviors (sleep-driving) – discontinue immediately; low-dose doxepin (3–6 mg) for sleep maintenance; ramelteon (melatonin agonist) – no abuse potential, safe in COPD Geriatrics: "start low, go slow" (1/4–1/2 adult dose); Beers Criteria; Anticholinergic Cognitive Burden (ACB) scale Pediatrics: SSRI black box warning (suicidal ideation); stimulants – monitor growth Polypharmacy: increased adverse events, interactions, non-adherence Key drug interactions: lithium + thiazides ↑ toxicity; carbamazepine + OCPs ↓ efficacy; clozapine + smoking cessation ↑ levels; warfarin + SSRIs ↑ INR; aripiprazole + CYP2D6 poor metabolizer → 50% dose reduction Shared decision-making: respect patient preferences (e.g., weight-neutral agents) Why this master exam works: 150 high-yield questions – integrated review of all 3 course exams Detailed rationales – understand complex mechanisms, side effects, drug interactions Efficient study – one file instead of three separate 150-question exams Exam & board ready – mirrors Wilkes University NSG 552 and ANCC/AANP certification style Format: PDF (150 questions + answer key + rationales) Institution: Wilkes University Course: NSG 552 – Psychopharmacology Term: 2026/2027 Type: Master Exam (Exams 1, 2 & 3 Combined) Instant download – study on any device or print for offline use.