NSG 552 EXAM 2 – WILKES
PSYCHOPHARMACOLOGY ACTUAL
QUESTIONS AND ANSWERS 2026/2027
1. Which neurotransmitter is primarily involved in the mechanism of action of Second
Generation Antipsychotics (SGAs) through antagonism of its 5HT2A receptors?
A. Serotonin
B. Dopamine
C. GABA
D. Norepinephrine
Answer: A
Conceptual Explanation: SGAs are characterized by their dual action as D2 antagonists
and 5HT2A (Serotonin) antagonists, which helps reduce EPS compared to First Generation
Antipsychotics.
2. A patient taking Lithium presents with a serum level of 1.8 mEq/L, coarse tremors, and
confusion. What is the most likely interpretation?
A. Therapeutic level for acute mania
,B. Subtherapeutic level
C. Normal maintenance level
D. Lithium toxicity
Answer: D
Conceptual Explanation: Lithium toxicity typically occurs at levels above 1.5 mEq/L.
Levels between 1.5-2.0 often manifest as gastrointestinal distress, coarse tremors, and
confusion.
3. Which antidepressant is known for having a very long half-life (up to 1-2 weeks for its
active metabolite), requiring a longer washout period?
A. Fluoxetine
B. Paroxetine
C. Sertraline
D. Escitalopram
Answer: A
Conceptual Explanation: Fluoxetine has a very long half-life, and its active metabolite
norfluoxetine can stay in the system for weeks, necessitating a longer washout to avoid
serotonin syndrome.
, 4. To minimize the risk of Stevens-Johnson Syndrome (SJS) when initiating Lamotrigine, what
is the clinical standard?
A. Administering a high loading dose
B. Co-administering with Valproate at full dose
C. Slow titration schedule
D. Checking HLA-B*1502 in all patients
Answer: C
Conceptual Explanation: Lamotrigine must be titrated slowly over several weeks to
minimize the risk of a life-threatening rash like SJS.
5. Which symptom is a classic differentiator for Serotonin Syndrome compared to Neuroleptic
Malignant Syndrome (NMS)?
A. Hyperthermia
B. Muscle rigidity (Lead pipe)
C. Hyperreflexia and Myoclonus
D. Autonomic instability
Answer: C
Conceptual Explanation: Serotonin Syndrome is characterized by hyperreflexia and
myoclonus, whereas NMS is characterized by ‘lead-pipe’ muscle rigidity and bradyreflexia.
PSYCHOPHARMACOLOGY ACTUAL
QUESTIONS AND ANSWERS 2026/2027
1. Which neurotransmitter is primarily involved in the mechanism of action of Second
Generation Antipsychotics (SGAs) through antagonism of its 5HT2A receptors?
A. Serotonin
B. Dopamine
C. GABA
D. Norepinephrine
Answer: A
Conceptual Explanation: SGAs are characterized by their dual action as D2 antagonists
and 5HT2A (Serotonin) antagonists, which helps reduce EPS compared to First Generation
Antipsychotics.
2. A patient taking Lithium presents with a serum level of 1.8 mEq/L, coarse tremors, and
confusion. What is the most likely interpretation?
A. Therapeutic level for acute mania
,B. Subtherapeutic level
C. Normal maintenance level
D. Lithium toxicity
Answer: D
Conceptual Explanation: Lithium toxicity typically occurs at levels above 1.5 mEq/L.
Levels between 1.5-2.0 often manifest as gastrointestinal distress, coarse tremors, and
confusion.
3. Which antidepressant is known for having a very long half-life (up to 1-2 weeks for its
active metabolite), requiring a longer washout period?
A. Fluoxetine
B. Paroxetine
C. Sertraline
D. Escitalopram
Answer: A
Conceptual Explanation: Fluoxetine has a very long half-life, and its active metabolite
norfluoxetine can stay in the system for weeks, necessitating a longer washout to avoid
serotonin syndrome.
, 4. To minimize the risk of Stevens-Johnson Syndrome (SJS) when initiating Lamotrigine, what
is the clinical standard?
A. Administering a high loading dose
B. Co-administering with Valproate at full dose
C. Slow titration schedule
D. Checking HLA-B*1502 in all patients
Answer: C
Conceptual Explanation: Lamotrigine must be titrated slowly over several weeks to
minimize the risk of a life-threatening rash like SJS.
5. Which symptom is a classic differentiator for Serotonin Syndrome compared to Neuroleptic
Malignant Syndrome (NMS)?
A. Hyperthermia
B. Muscle rigidity (Lead pipe)
C. Hyperreflexia and Myoclonus
D. Autonomic instability
Answer: C
Conceptual Explanation: Serotonin Syndrome is characterized by hyperreflexia and
myoclonus, whereas NMS is characterized by ‘lead-pipe’ muscle rigidity and bradyreflexia.
