,NR 546 Final Exam | Advanced Psychopharmacology
(2026) Q&A | Chamberlain College
1. Which of the following is considered first-line pharmacotherapy for major depressive
disorder?
A) Tricyclic antidepressant
B) Monoamine oxidase inhibitor
C) Selective serotonin reuptake inhibitor
D) Atypical antipsychotic
Correct Answer: C) Selective serotonin reuptake inhibitor
Rationale: SSRIs are recommended as first-line treatment for MDD due to their favorable
safety profile, tolerability, and evidence base. TCAs and MAOIs are reserved for treatment-
resistant cases due to side effect burdens. Atypical antipsychotics are used as augmentation,
not initial monotherapy. This aligns with current clinical guidelines.
2. A 32-year-old patient with bipolar I disorder is currently experiencing a manic episode with
depressive features. Which combination therapy is considered first-line?
A) Bupropion and aripiprazole
B) Lithium and lamotrigine
C) Valproic acid and duloxetine
D) Atomoxetine and risperidone
Correct Answer: B) Lithium and lamotrigine
Rationale: Lithium remains the gold standard for acute mania and maintenance, while
lamotrigine is effective for bipolar depression. This combination addresses both poles of the
illness without precipitating rapid cycling. Antidepressant monotherapy is avoided.
Bupropion plus aripiprazole is not standard for bipolar I.
,3. The monoamine hypothesis of depression postulates that depressive symptoms arise from:
A) Excess monoamine neurotransmission
B) Deficiency of monoamine neurotransmission
C) Overactivity of GABAergic interneurons
D) Hypersensitivity of postsynaptic dopamine receptors
Correct Answer: B) Deficiency of monoamine neurotransmission
Rationale: The monoamine hypothesis holds that reduced serotonin, norepinephrine, and
dopamine in critical brain regions leads to depression. Antidepressants increase monoamine
levels, supporting this theory. Excess monoamines are linked to mania, and GABA or
dopamine hypersensitivity alone does not explain the core deficit.
4. A patient abruptly discontinues their SSRI after long-term use and develops dizziness,
nausea, and “brain zaps.” Which agent is most notorious for causing this discontinuation
syndrome?
A) Fluoxetine
B) Sertraline
C) Paroxetine
D) Escitalopram
Correct Answer: C) Paroxetine
Rationale: Paroxetine has the shortest half-life among SSRIs and lacks an active metabolite,
leading to rapid washout and severe discontinuation symptoms. Fluoxetine’s long half-life
provides self-tapering. Sertraline and escitalopram have intermediate risk. Tapering is
essential when discontinuing paroxetine.
, 5. The PMHNP is prescribing an antidepressant for a patient with a history of seizures. Which
agent is contraindicated?
A) Venlafaxine
B) Trazodone
C) Bupropion
D) Amitriptyline
Correct Answer: C) Bupropion
Rationale: Bupropion lowers the seizure threshold in a dose-dependent manner and is
contraindicated in patients with seizure disorders, eating disorders, or those at high risk.
Venlafaxine, trazodone, and amitriptyline do not carry this specific contraindication. The
seizure risk requires careful screening before prescribing bupropion.
6. A patient taking trazodone for insomnia reports a painful, persistent erection lasting over
four hours. The PMHNP should advise the patient to:
A) Take ibuprofen and wait for it to resolve
B) Seek emergency medical attention immediately
C) Reduce the trazodone dose the next day
D) Apply ice and elevate the scrotum
Correct Answer: B) Seek emergency medical attention immediately
Rationale: Priapism is a rare but serious adverse effect of trazodone, caused by alpha-
adrenergic blockade. Ischemic priapism can lead to permanent erectile dysfunction if not
treated promptly within hours. Ibuprofen, dose reduction, or local measures are insufficient;
emergency urologic intervention is necessary.
7. Which neurotransmitter combination does bupropion primarily inhibit the reuptake of?
A) Serotonin and norepinephrine
(2026) Q&A | Chamberlain College
1. Which of the following is considered first-line pharmacotherapy for major depressive
disorder?
A) Tricyclic antidepressant
B) Monoamine oxidase inhibitor
C) Selective serotonin reuptake inhibitor
D) Atypical antipsychotic
Correct Answer: C) Selective serotonin reuptake inhibitor
Rationale: SSRIs are recommended as first-line treatment for MDD due to their favorable
safety profile, tolerability, and evidence base. TCAs and MAOIs are reserved for treatment-
resistant cases due to side effect burdens. Atypical antipsychotics are used as augmentation,
not initial monotherapy. This aligns with current clinical guidelines.
2. A 32-year-old patient with bipolar I disorder is currently experiencing a manic episode with
depressive features. Which combination therapy is considered first-line?
A) Bupropion and aripiprazole
B) Lithium and lamotrigine
C) Valproic acid and duloxetine
D) Atomoxetine and risperidone
Correct Answer: B) Lithium and lamotrigine
Rationale: Lithium remains the gold standard for acute mania and maintenance, while
lamotrigine is effective for bipolar depression. This combination addresses both poles of the
illness without precipitating rapid cycling. Antidepressant monotherapy is avoided.
Bupropion plus aripiprazole is not standard for bipolar I.
,3. The monoamine hypothesis of depression postulates that depressive symptoms arise from:
A) Excess monoamine neurotransmission
B) Deficiency of monoamine neurotransmission
C) Overactivity of GABAergic interneurons
D) Hypersensitivity of postsynaptic dopamine receptors
Correct Answer: B) Deficiency of monoamine neurotransmission
Rationale: The monoamine hypothesis holds that reduced serotonin, norepinephrine, and
dopamine in critical brain regions leads to depression. Antidepressants increase monoamine
levels, supporting this theory. Excess monoamines are linked to mania, and GABA or
dopamine hypersensitivity alone does not explain the core deficit.
4. A patient abruptly discontinues their SSRI after long-term use and develops dizziness,
nausea, and “brain zaps.” Which agent is most notorious for causing this discontinuation
syndrome?
A) Fluoxetine
B) Sertraline
C) Paroxetine
D) Escitalopram
Correct Answer: C) Paroxetine
Rationale: Paroxetine has the shortest half-life among SSRIs and lacks an active metabolite,
leading to rapid washout and severe discontinuation symptoms. Fluoxetine’s long half-life
provides self-tapering. Sertraline and escitalopram have intermediate risk. Tapering is
essential when discontinuing paroxetine.
, 5. The PMHNP is prescribing an antidepressant for a patient with a history of seizures. Which
agent is contraindicated?
A) Venlafaxine
B) Trazodone
C) Bupropion
D) Amitriptyline
Correct Answer: C) Bupropion
Rationale: Bupropion lowers the seizure threshold in a dose-dependent manner and is
contraindicated in patients with seizure disorders, eating disorders, or those at high risk.
Venlafaxine, trazodone, and amitriptyline do not carry this specific contraindication. The
seizure risk requires careful screening before prescribing bupropion.
6. A patient taking trazodone for insomnia reports a painful, persistent erection lasting over
four hours. The PMHNP should advise the patient to:
A) Take ibuprofen and wait for it to resolve
B) Seek emergency medical attention immediately
C) Reduce the trazodone dose the next day
D) Apply ice and elevate the scrotum
Correct Answer: B) Seek emergency medical attention immediately
Rationale: Priapism is a rare but serious adverse effect of trazodone, caused by alpha-
adrenergic blockade. Ischemic priapism can lead to permanent erectile dysfunction if not
treated promptly within hours. Ibuprofen, dose reduction, or local measures are insufficient;
emergency urologic intervention is necessary.
7. Which neurotransmitter combination does bupropion primarily inhibit the reuptake of?
A) Serotonin and norepinephrine
