NR 546 Week 4 Exam V2 | NR 546
Advanced Pharmacology
Psychopharmacology for the PMHNP |
Actual Q&A with Rationale (NR546 Week 4
Exam) | Chamberlain University
1. A 32-year-old patient with Major Depressive Disorder is started on Fluoxetine. Which
unique pharmacological property of Fluoxetine distinguishes it from other SSRIs?
A. It has the shortest half-life of all SSRIs.
B. It is the only SSRI that does not cause sexual dysfunction.
C. It possesses 5-HT2C antagonistic properties which may be energizing.
D. It primarily inhibits the norepinephrine transporter at low doses.
Answer: C
Rationale: Fluoxetine is characterized by its 5-HT2C antagonism, which can lead to
increased release of norepinephrine and dopamine in the prefrontal cortex. This often
results in an ‘energizing’ effect, making it useful for patients with fatigue or reduced
positive affect. Additionally, its long half-life of 2-3 days (and its metabolite norfluoxetine
1-2 weeks) reduces the risk of discontinuation syndrome.
2. When prescribing a Monoamine Oxidase Inhibitor (MAOI), the PMHNP must educate the
patient on avoiding tyramine-rich foods to prevent which complication?
A. Hypertensive Crisis
,B. Serotonin Syndrome
C. Metabolic Syndrome
D. Neuroleptic Malignant Syndrome
Answer: A
Rationale: Tyramine is an indirect-acting sympathomimetic amine that is normally broken
down by MAO-A in the gut. When MAO-A is inhibited, tyramine enters the systemic
circulation and displaces norepinephrine from storage vesicles, leading to a massive
release of NE. This results in severe vasoconstriction and a potentially fatal hypertensive
crisis characterized by headache, tachycardia, and elevated blood pressure.
3. Which antidepressant is specifically contraindicated in patients with a history of seizure
disorders or bulimia nervosa?
A. Sertraline
B. Bupropion
C. Mirtazapine
D. Duloxetine
Answer: B
Rationale: Bupropion is known to lower the seizure threshold, particularly in patients
with pre-existing risk factors. It is strictly contraindicated in patients with eating disorders
like bulimia or anorexia due to a significantly higher incidence of seizures in these
,populations. The mechanism involves the norepinephrine and dopamine reuptake
inhibition affecting neural excitability.
4. A patient switching from Fluoxetine to Phenelzine requires a washout period of how many
weeks to avoid Serotonin Syndrome?
A. 1 week
B. 5 weeks
C. 3 weeks
D. 2 weeks
Answer: B
Rationale: Due to the exceptionally long half-life of fluoxetine and its active metabolite
norfluoxetine, a 5-week washout period is mandatory before starting an MAOI. For most
other SSRIs, a 2-week washout is sufficient. Failure to observe this waiting period can lead
to excessive serotonin levels and life-threatening Serotonin Syndrome.
5. Which SNRI is frequently utilized for the treatment of both depression and chronic pain
conditions such as diabetic peripheral neuropathy?
A. Venlafaxine
B. Duloxetine
C. Desvenlafaxine
D. Levomilnacipran
, Answer: B
Rationale: Duloxetine has a dual mechanism of inhibiting both serotonin and
norepinephrine reuptake across its entire dosing range. The inhibition of norepinephrine
reuptake in the descending spinal pathways is thought to modulate pain signals, making it
effective for various pain syndromes. It is FDA-approved for MDD, GAD, fibromyalgia, and
chronic musculoskeletal pain.
6. A patient presents with confusion, shivering, sweating, and hyperreflexia after an increase
in their Sertraline dose. What is the most likely diagnosis?
A. Anticholinergic toxicity
B. Hypertensive urgency
C. Major Depressive Disorder relapse
D. Serotonin Syndrome
Answer: D
Rationale: Serotonin Syndrome is a potentially life-threatening condition caused by excess
serotonergic activity in the central nervous system. Clinical features typically include the
triad of mental status changes, autonomic hyperactivity, and neuromuscular abnormalities
like hyperreflexia and clonus. Immediate discontinuation of the offending agent and
supportive care are the primary treatments.
Advanced Pharmacology
Psychopharmacology for the PMHNP |
Actual Q&A with Rationale (NR546 Week 4
Exam) | Chamberlain University
1. A 32-year-old patient with Major Depressive Disorder is started on Fluoxetine. Which
unique pharmacological property of Fluoxetine distinguishes it from other SSRIs?
A. It has the shortest half-life of all SSRIs.
B. It is the only SSRI that does not cause sexual dysfunction.
C. It possesses 5-HT2C antagonistic properties which may be energizing.
D. It primarily inhibits the norepinephrine transporter at low doses.
Answer: C
Rationale: Fluoxetine is characterized by its 5-HT2C antagonism, which can lead to
increased release of norepinephrine and dopamine in the prefrontal cortex. This often
results in an ‘energizing’ effect, making it useful for patients with fatigue or reduced
positive affect. Additionally, its long half-life of 2-3 days (and its metabolite norfluoxetine
1-2 weeks) reduces the risk of discontinuation syndrome.
2. When prescribing a Monoamine Oxidase Inhibitor (MAOI), the PMHNP must educate the
patient on avoiding tyramine-rich foods to prevent which complication?
A. Hypertensive Crisis
,B. Serotonin Syndrome
C. Metabolic Syndrome
D. Neuroleptic Malignant Syndrome
Answer: A
Rationale: Tyramine is an indirect-acting sympathomimetic amine that is normally broken
down by MAO-A in the gut. When MAO-A is inhibited, tyramine enters the systemic
circulation and displaces norepinephrine from storage vesicles, leading to a massive
release of NE. This results in severe vasoconstriction and a potentially fatal hypertensive
crisis characterized by headache, tachycardia, and elevated blood pressure.
3. Which antidepressant is specifically contraindicated in patients with a history of seizure
disorders or bulimia nervosa?
A. Sertraline
B. Bupropion
C. Mirtazapine
D. Duloxetine
Answer: B
Rationale: Bupropion is known to lower the seizure threshold, particularly in patients
with pre-existing risk factors. It is strictly contraindicated in patients with eating disorders
like bulimia or anorexia due to a significantly higher incidence of seizures in these
,populations. The mechanism involves the norepinephrine and dopamine reuptake
inhibition affecting neural excitability.
4. A patient switching from Fluoxetine to Phenelzine requires a washout period of how many
weeks to avoid Serotonin Syndrome?
A. 1 week
B. 5 weeks
C. 3 weeks
D. 2 weeks
Answer: B
Rationale: Due to the exceptionally long half-life of fluoxetine and its active metabolite
norfluoxetine, a 5-week washout period is mandatory before starting an MAOI. For most
other SSRIs, a 2-week washout is sufficient. Failure to observe this waiting period can lead
to excessive serotonin levels and life-threatening Serotonin Syndrome.
5. Which SNRI is frequently utilized for the treatment of both depression and chronic pain
conditions such as diabetic peripheral neuropathy?
A. Venlafaxine
B. Duloxetine
C. Desvenlafaxine
D. Levomilnacipran
, Answer: B
Rationale: Duloxetine has a dual mechanism of inhibiting both serotonin and
norepinephrine reuptake across its entire dosing range. The inhibition of norepinephrine
reuptake in the descending spinal pathways is thought to modulate pain signals, making it
effective for various pain syndromes. It is FDA-approved for MDD, GAD, fibromyalgia, and
chronic musculoskeletal pain.
6. A patient presents with confusion, shivering, sweating, and hyperreflexia after an increase
in their Sertraline dose. What is the most likely diagnosis?
A. Anticholinergic toxicity
B. Hypertensive urgency
C. Major Depressive Disorder relapse
D. Serotonin Syndrome
Answer: D
Rationale: Serotonin Syndrome is a potentially life-threatening condition caused by excess
serotonergic activity in the central nervous system. Clinical features typically include the
triad of mental status changes, autonomic hyperactivity, and neuromuscular abnormalities
like hyperreflexia and clonus. Immediate discontinuation of the offending agent and
supportive care are the primary treatments.
