NR546 PSYCHOPHARMACOLOGY
FINAL EXAM PREP QUESTIONS AND
ANSWERS
1. Which cytochrome P450 enzyme is responsible for the metabolism of approximately 50%
of all clinically used medications?
A. CYP2D6
B. CYP3A4
C. CYP1A2
D. CYP2C19
Answer: B
Conceptual Explanation: CYP3A4 is the most abundant and important enzyme,
metabolizing about 50% of medications. Inhibition or induction of this enzyme leads to
many drug-drug interactions.
2. A patient taking Lithium presents with coarse tremors, ataxia, and confusion. What is the
most likely serum lithium level?
A. 0.6 mEq/L
,B. 1.0 mEq/L
C. 2.0 mEq/L or higher
D. 1.2 mEq/L
Answer: C
Conceptual Explanation: Lithium toxicity generally starts above 1.5 mEq/L. Coarse
tremors, ataxia, and confusion are signs of moderate to severe toxicity, typically seen at
levels ≥ 2.0 mEq/L.
3. Which antipsychotic requires mandatory Absolute Neutrophil Count (ANC) monitoring due
to the risk of agranulocytosis?
A. Risperidone
B. Olanzapine
C. Clozapine
D. Quetiapine
Answer: C
Conceptual Explanation: Clozapine is associated with a risk of life-threatening
agranulocytosis, requiring strict blood monitoring through a REMS program.
4. A patient is switched from an SSRI to an MAOI without a sufficient washout period. They
present with hyperreflexia, tremors, and diaphoresis. What is the diagnosis?
A. Neuroleptic Malignant Syndrome (NMS)
, B. Serotonin Syndrome
C. Anticholinergic Toxicity
D. Hypertensive Crisis
Answer: B
Conceptual Explanation: Serotonin Syndrome is characterized by neuromuscular
hyperactivity (hyperreflexia, clonus) caused by excessive serotonin, often due to drug
interactions.
5. What is the primary mechanism of action for Second-Generation Antipsychotics (SGAs)?
A. Pure D2 antagonism
B. D2 antagonism and 5HT2A antagonism
C. D2 agonism and 5HT1A antagonism
D. GABA-A modulation
Answer: B
Conceptual Explanation: SGAs (atypical antipsychotics) are defined by their dual
antagonism of dopamine D2 receptors and serotonin 5HT2A receptors, which helps reduce
EPS.
6. A patient starting Lamotrigine should be educated to immediately report which side effect?
A. Weight gain
B. Sedation
FINAL EXAM PREP QUESTIONS AND
ANSWERS
1. Which cytochrome P450 enzyme is responsible for the metabolism of approximately 50%
of all clinically used medications?
A. CYP2D6
B. CYP3A4
C. CYP1A2
D. CYP2C19
Answer: B
Conceptual Explanation: CYP3A4 is the most abundant and important enzyme,
metabolizing about 50% of medications. Inhibition or induction of this enzyme leads to
many drug-drug interactions.
2. A patient taking Lithium presents with coarse tremors, ataxia, and confusion. What is the
most likely serum lithium level?
A. 0.6 mEq/L
,B. 1.0 mEq/L
C. 2.0 mEq/L or higher
D. 1.2 mEq/L
Answer: C
Conceptual Explanation: Lithium toxicity generally starts above 1.5 mEq/L. Coarse
tremors, ataxia, and confusion are signs of moderate to severe toxicity, typically seen at
levels ≥ 2.0 mEq/L.
3. Which antipsychotic requires mandatory Absolute Neutrophil Count (ANC) monitoring due
to the risk of agranulocytosis?
A. Risperidone
B. Olanzapine
C. Clozapine
D. Quetiapine
Answer: C
Conceptual Explanation: Clozapine is associated with a risk of life-threatening
agranulocytosis, requiring strict blood monitoring through a REMS program.
4. A patient is switched from an SSRI to an MAOI without a sufficient washout period. They
present with hyperreflexia, tremors, and diaphoresis. What is the diagnosis?
A. Neuroleptic Malignant Syndrome (NMS)
, B. Serotonin Syndrome
C. Anticholinergic Toxicity
D. Hypertensive Crisis
Answer: B
Conceptual Explanation: Serotonin Syndrome is characterized by neuromuscular
hyperactivity (hyperreflexia, clonus) caused by excessive serotonin, often due to drug
interactions.
5. What is the primary mechanism of action for Second-Generation Antipsychotics (SGAs)?
A. Pure D2 antagonism
B. D2 antagonism and 5HT2A antagonism
C. D2 agonism and 5HT1A antagonism
D. GABA-A modulation
Answer: B
Conceptual Explanation: SGAs (atypical antipsychotics) are defined by their dual
antagonism of dopamine D2 receptors and serotonin 5HT2A receptors, which helps reduce
EPS.
6. A patient starting Lamotrigine should be educated to immediately report which side effect?
A. Weight gain
B. Sedation
