NU 643 Exam 4 V3 | NU 643 Advanced
Psychopharmacology | Actual Q&A with
Rationale (NU643 Exam 4) | Regis
University
1. Which of the following is the primary mechanism of action for Methylphenidate (Ritalin) in
the treatment of ADHD?
A. Antagonism of NMDA glutamate receptors in the prefrontal cortex
B. Direct stimulation of postsynaptic alpha-2A adrenergic receptors
C. Promotion of the release of dopamine from presynaptic storage vesicles
D. Inhibition of the reuptake of dopamine and norepinephrine via transporter blockade
Answer: D
Rationale: Methylphenidate works primarily by blocking the dopamine transporter (DAT)
and norepinephrine transporter (NET). This inhibition increases the synaptic
concentration of these catecholamines in the prefrontal cortex. Unlike amphetamines, it
does not significantly increase the release of dopamine from storage vesicles.
2. A 72-year-old patient with Alzheimer’s disease is started on Donepezil. Which side effect is
most likely to necessitate a slow titration?
A. Gastrointestinal distress, including nausea and diarrhea
B. Hypertension and tachycardia
,C. Extrapyramidal symptoms and tremors
D. Insomnia and vivid dreaming
Answer: A
Rationale: Donepezil is a cholinesterase inhibitor that increases acetylcholine levels, which
can overstimulate the parasympathetic nervous system. This commonly leads to
gastrointestinal side effects such as nausea, vomiting, and diarrhea. Slow titration is
recommended to improve patient tolerance and minimize these adverse effects.
3. Which medication for Alcohol Use Disorder is contraindicated in a patient with a creatinine
clearance (CrCl) of less than 30 mL/min?
A. Naltrexone
B. Acamprosate
C. Disulfiram
D. Gabapentin
Answer: B
Rationale: Acamprosate is primarily excreted by the kidneys and is contraindicated in
patients with severe renal impairment. For patients with moderate renal impairment (CrCl
30-50 mL/min), a dose reduction is required. Monitoring renal function is essential prior to
and during therapy with this agent.
, 4. What is the mechanism of action of Atomoxetine (Strattera)?
A. Alpha-2 Adrenergic Agonist
B. Partial Agonist at Dopamine D2 receptors
C. Irreversible Monoamine Oxidase Inhibitor
D. Selective Norepinephrine Reuptake Inhibitor (SNRI)
Answer: D
Rationale: Atomoxetine is a non-stimulant medication that selectively inhibits the
presynaptic norepinephrine transporter. This leads to increased levels of both
norepinephrine and dopamine in the prefrontal cortex specifically. Because it does not
increase dopamine in the nucleus accumbens, it carries a lower risk for abuse compared to
stimulants.
5. When prescribing Varenicline (Chantix) for smoking cessation, the clinician should monitor
the patient for which serious adverse effect?
A. Acute renal failure
B. Severe weight gain and metabolic syndrome
C. Neuropsychiatric symptoms, including suicidal ideation
D. Hypotension and bradycardia
Answer: C
Psychopharmacology | Actual Q&A with
Rationale (NU643 Exam 4) | Regis
University
1. Which of the following is the primary mechanism of action for Methylphenidate (Ritalin) in
the treatment of ADHD?
A. Antagonism of NMDA glutamate receptors in the prefrontal cortex
B. Direct stimulation of postsynaptic alpha-2A adrenergic receptors
C. Promotion of the release of dopamine from presynaptic storage vesicles
D. Inhibition of the reuptake of dopamine and norepinephrine via transporter blockade
Answer: D
Rationale: Methylphenidate works primarily by blocking the dopamine transporter (DAT)
and norepinephrine transporter (NET). This inhibition increases the synaptic
concentration of these catecholamines in the prefrontal cortex. Unlike amphetamines, it
does not significantly increase the release of dopamine from storage vesicles.
2. A 72-year-old patient with Alzheimer’s disease is started on Donepezil. Which side effect is
most likely to necessitate a slow titration?
A. Gastrointestinal distress, including nausea and diarrhea
B. Hypertension and tachycardia
,C. Extrapyramidal symptoms and tremors
D. Insomnia and vivid dreaming
Answer: A
Rationale: Donepezil is a cholinesterase inhibitor that increases acetylcholine levels, which
can overstimulate the parasympathetic nervous system. This commonly leads to
gastrointestinal side effects such as nausea, vomiting, and diarrhea. Slow titration is
recommended to improve patient tolerance and minimize these adverse effects.
3. Which medication for Alcohol Use Disorder is contraindicated in a patient with a creatinine
clearance (CrCl) of less than 30 mL/min?
A. Naltrexone
B. Acamprosate
C. Disulfiram
D. Gabapentin
Answer: B
Rationale: Acamprosate is primarily excreted by the kidneys and is contraindicated in
patients with severe renal impairment. For patients with moderate renal impairment (CrCl
30-50 mL/min), a dose reduction is required. Monitoring renal function is essential prior to
and during therapy with this agent.
, 4. What is the mechanism of action of Atomoxetine (Strattera)?
A. Alpha-2 Adrenergic Agonist
B. Partial Agonist at Dopamine D2 receptors
C. Irreversible Monoamine Oxidase Inhibitor
D. Selective Norepinephrine Reuptake Inhibitor (SNRI)
Answer: D
Rationale: Atomoxetine is a non-stimulant medication that selectively inhibits the
presynaptic norepinephrine transporter. This leads to increased levels of both
norepinephrine and dopamine in the prefrontal cortex specifically. Because it does not
increase dopamine in the nucleus accumbens, it carries a lower risk for abuse compared to
stimulants.
5. When prescribing Varenicline (Chantix) for smoking cessation, the clinician should monitor
the patient for which serious adverse effect?
A. Acute renal failure
B. Severe weight gain and metabolic syndrome
C. Neuropsychiatric symptoms, including suicidal ideation
D. Hypotension and bradycardia
Answer: C
