Wilkes University NSG 533 Exam 1 (pdf) | 2026/2027 | Advanced
Pharmacology Q&A | Pharmacology
1. Which of the following SSRIs requires up to a 5-week washout period
because of the long half-life of its potent active metabolite?
A) Escitalopram
B) Fluvoxamine
C) Fluoxetine
D) Sertraline
Correct Answer: Fluoxetine
Rationale: Fluoxetine has a long half-life (1-3 days) and its active metabolite,
norfluoxetine, has an even longer half-life (7-15 days). This necessitates a 5-
week washout period when switching to or from an MAOI to prevent
serotonin syndrome. Escitalopram, fluvoxamine, and sertraline have shorter
half-lives and do not require the same extended washout period.
2. Which of the following symptoms is most likely to improve within
approximately 1 week of starting antidepressant treatment?
A) Depressed mood
B) Suicidal thoughts
C) Anhedonia
D) Sleep
Correct Answer: Sleep
Rationale: Sleep disturbances often improve within the first week of
antidepressant therapy, while mood, anhedonia, and suicidal thoughts
typically take 2-4 weeks or longer to respond. This differential response is
important for patient education and managing expectations.
,3. Of the following combinations of medications, which one would you want
to avoid?
A) Fluoxetine-lithium
B) Fluoxetine-phenelzine
C) Citalopram-valproic acid
D) Citalopram-aripiprazole
Correct Answer: Fluoxetine-phenelzine
Rationale: Combining an SSRI (fluoxetine) with an MAOI (phenelzine) can
cause serotonin syndrome, a potentially life-threatening condition
characterized by agitation, hyperthermia, muscle rigidity, and autonomic
instability. A 5-week washout period is required when switching from
fluoxetine to an MAOI due to its long half-life.
4. A 26-year-old man with a history of depression has been taking sertraline
200 mg/day for 12 weeks with no response. The physician asks for your
recommendation. The most reasonable recommendation would be to:
A) Increase sertraline
B) Add fluoxetine
C) Switch to amitriptyline
D) Change to venlafaxine
E) Decrease sertraline
Correct Answer: Change to venlafaxine
Rationale: After 12 weeks of adequate dosing with sertraline (200 mg/day is
the maximum recommended dose), the patient has not responded.
Increasing the dose is not appropriate as the patient is already at the
,maximum dose. Switching to a different class, such as venlafaxine (an SNRI),
is a reasonable next step. Adding fluoxetine would not be appropriate, and
amitriptyline is a TCA with more side effects.
5. Which of the following is a dangerous combination?
A) MAOI-lorazepam
B) MAOI-acetaminophen
C) MAOI-meperidine
D) MAOI-ziprasidone
Correct Answer: MAOI-meperidine
Rationale: Combining an MAOI with meperidine can cause serotonin
syndrome. This is a potentially fatal drug interaction. MAOIs should also not
be combined with SSRIs, SNRIs, or other serotonergic agents. The
combination of an MAOI with meperidine is specifically contraindicated.
6. A 23-year-old married white woman comes to the outpatient psychiatric
clinic complaining of decreased sleep, decreased appetite, decreased
concentration, depressed mood, thoughts of death, and lack of interest in
activities for 6 weeks' duration. She has no history of psychiatric illness and
takes no medications except for Ortho-Tri Cyclen Lo daily. Based upon the
patient's symptoms, choose the best medication to treat this patient.
A) Nefazodone 100 mg po twice daily
B) Paroxetine 20 mg po daily
C) St. John's wort 300 mg po three times daily
D) Sertraline 50 mg po daily
Correct Answer: Sertraline 50 mg po daily
, Rationale: The patient presents with classic symptoms of major depressive
disorder. Sertraline is a first-line SSRI with a favorable side effect profile.
Paroxetine is an SSRI but has more anticholinergic side effects and is
associated with weight gain and sexual dysfunction. Nefazodone is less
commonly used due to hepatotoxicity concerns, and St. John's wort is an
herbal supplement with variable efficacy and drug interactions.
7. What are the four common mechanisms of cell injury and death?
A) ATP depletion, oxygen-derived free radicals, intracellular calcium influx,
membrane permeability defects
B) ATP depletion, apoptosis, necrosis, inflammation
C) Hypoxia, ischemia, reperfusion injury, oxidative stress
D) Necrosis, apoptosis, autophagy, pyroptosis
Correct Answer: ATP depletion, oxygen-derived free radicals, intracellular
calcium influx, membrane permeability defects
Rationale: The four common mechanisms of cell injury and death are: (1) ATP
depletion, (2) oxygen and oxygen-derived free radicals, (3) intracellular
calcium and loss of calcium homeostasis, and (4) defects in membrane
permeability. These mechanisms underlie most forms of cellular injury and
contribute to the pathogenesis of many diseases.
8. What is the most common stressor of disease?
A) Calcium influx
B) Free radical damage
C) ATP depletion
D) Membrane permeability defects
Correct Answer: ATP depletion
Pharmacology Q&A | Pharmacology
1. Which of the following SSRIs requires up to a 5-week washout period
because of the long half-life of its potent active metabolite?
A) Escitalopram
B) Fluvoxamine
C) Fluoxetine
D) Sertraline
Correct Answer: Fluoxetine
Rationale: Fluoxetine has a long half-life (1-3 days) and its active metabolite,
norfluoxetine, has an even longer half-life (7-15 days). This necessitates a 5-
week washout period when switching to or from an MAOI to prevent
serotonin syndrome. Escitalopram, fluvoxamine, and sertraline have shorter
half-lives and do not require the same extended washout period.
2. Which of the following symptoms is most likely to improve within
approximately 1 week of starting antidepressant treatment?
A) Depressed mood
B) Suicidal thoughts
C) Anhedonia
D) Sleep
Correct Answer: Sleep
Rationale: Sleep disturbances often improve within the first week of
antidepressant therapy, while mood, anhedonia, and suicidal thoughts
typically take 2-4 weeks or longer to respond. This differential response is
important for patient education and managing expectations.
,3. Of the following combinations of medications, which one would you want
to avoid?
A) Fluoxetine-lithium
B) Fluoxetine-phenelzine
C) Citalopram-valproic acid
D) Citalopram-aripiprazole
Correct Answer: Fluoxetine-phenelzine
Rationale: Combining an SSRI (fluoxetine) with an MAOI (phenelzine) can
cause serotonin syndrome, a potentially life-threatening condition
characterized by agitation, hyperthermia, muscle rigidity, and autonomic
instability. A 5-week washout period is required when switching from
fluoxetine to an MAOI due to its long half-life.
4. A 26-year-old man with a history of depression has been taking sertraline
200 mg/day for 12 weeks with no response. The physician asks for your
recommendation. The most reasonable recommendation would be to:
A) Increase sertraline
B) Add fluoxetine
C) Switch to amitriptyline
D) Change to venlafaxine
E) Decrease sertraline
Correct Answer: Change to venlafaxine
Rationale: After 12 weeks of adequate dosing with sertraline (200 mg/day is
the maximum recommended dose), the patient has not responded.
Increasing the dose is not appropriate as the patient is already at the
,maximum dose. Switching to a different class, such as venlafaxine (an SNRI),
is a reasonable next step. Adding fluoxetine would not be appropriate, and
amitriptyline is a TCA with more side effects.
5. Which of the following is a dangerous combination?
A) MAOI-lorazepam
B) MAOI-acetaminophen
C) MAOI-meperidine
D) MAOI-ziprasidone
Correct Answer: MAOI-meperidine
Rationale: Combining an MAOI with meperidine can cause serotonin
syndrome. This is a potentially fatal drug interaction. MAOIs should also not
be combined with SSRIs, SNRIs, or other serotonergic agents. The
combination of an MAOI with meperidine is specifically contraindicated.
6. A 23-year-old married white woman comes to the outpatient psychiatric
clinic complaining of decreased sleep, decreased appetite, decreased
concentration, depressed mood, thoughts of death, and lack of interest in
activities for 6 weeks' duration. She has no history of psychiatric illness and
takes no medications except for Ortho-Tri Cyclen Lo daily. Based upon the
patient's symptoms, choose the best medication to treat this patient.
A) Nefazodone 100 mg po twice daily
B) Paroxetine 20 mg po daily
C) St. John's wort 300 mg po three times daily
D) Sertraline 50 mg po daily
Correct Answer: Sertraline 50 mg po daily
, Rationale: The patient presents with classic symptoms of major depressive
disorder. Sertraline is a first-line SSRI with a favorable side effect profile.
Paroxetine is an SSRI but has more anticholinergic side effects and is
associated with weight gain and sexual dysfunction. Nefazodone is less
commonly used due to hepatotoxicity concerns, and St. John's wort is an
herbal supplement with variable efficacy and drug interactions.
7. What are the four common mechanisms of cell injury and death?
A) ATP depletion, oxygen-derived free radicals, intracellular calcium influx,
membrane permeability defects
B) ATP depletion, apoptosis, necrosis, inflammation
C) Hypoxia, ischemia, reperfusion injury, oxidative stress
D) Necrosis, apoptosis, autophagy, pyroptosis
Correct Answer: ATP depletion, oxygen-derived free radicals, intracellular
calcium influx, membrane permeability defects
Rationale: The four common mechanisms of cell injury and death are: (1) ATP
depletion, (2) oxygen and oxygen-derived free radicals, (3) intracellular
calcium and loss of calcium homeostasis, and (4) defects in membrane
permeability. These mechanisms underlie most forms of cellular injury and
contribute to the pathogenesis of many diseases.
8. What is the most common stressor of disease?
A) Calcium influx
B) Free radical damage
C) ATP depletion
D) Membrane permeability defects
Correct Answer: ATP depletion
