NR546 PSYCHOPHARMACOLOGY
ADVANCED EXAM STUDY GUIDE
1. Which dopamine pathway is primarily associated with the positive symptoms of
schizophrenia, such as hallucinations and delusions, when overactive?
A. Mesocortical pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesolimbic pathway
Answer: D
Conceptual Explanation: The mesolimbic pathway involves dopamine projections from
the ventral tegmental area to the nucleus accumbens; overactivity here is linked to positive
symptoms of psychosis.
2. A patient who smokes a pack of cigarettes a day is prescribed Clozapine. If the patient
suddenly quits smoking, what is the most likely effect on the Clozapine blood level?
A. The level will decrease significantly.
B. The level will remain unchanged.
,C. The level will become undetectable.
D. The level will increase, potentially leading to toxicity.
Answer: D
Conceptual Explanation: Polycyclic aromatic hydrocarbons in cigarette smoke induce the
CYP1A2 enzyme. When smoking stops, the enzyme activity slows down, leading to higher
serum levels of drugs metabolized by 1A2, like clozapine.
3. Which of the following physical findings is most characteristic of Serotonin Syndrome
compared to Neuroleptic Malignant Syndrome?
A. Lead-pipe rigidity
B. Bradycardia
C. Hyperreflexia and myoclonus
D. Hypothermia
Answer: C
Conceptual Explanation: Serotonin syndrome is characterized by neuromuscular
irritability like hyperreflexia and myoclonus, whereas NMS is characterized by ‘lead-pipe’
muscle rigidity.
4. What is the therapeutic reference range for Lithium in the maintenance phase of treating
Bipolar Disorder?
A. 0.2 - 0.5 mEq/L
, B. 1.5 - 2.0 mEq/L
C. 0.6 - 1.2 mEq/L
D. 2.5 - 3.0 mEq/L
Answer: C
Conceptual Explanation: The standard therapeutic range for lithium maintenance is 0.6 to
1.2 mEq/L; levels above 1.5 mEq/L indicate toxicity.
5. What is the primary mechanism of action of First-Generation Antipsychotics (FGAs)?
A. 5HT2A receptor antagonism
B. D2 receptor partial agonism
C. D2 receptor antagonism
D. Alpha-1 adrenergic agonism
Answer: C
Conceptual Explanation: FGAs, also known as typical antipsychotics, work primarily by
blocking D2 receptors in the brain.
6. Which antidepressant is most likely to cause a hypertensive crisis when combined with
foods high in tyramine?
A. Sertraline
B. Phenelzine
ADVANCED EXAM STUDY GUIDE
1. Which dopamine pathway is primarily associated with the positive symptoms of
schizophrenia, such as hallucinations and delusions, when overactive?
A. Mesocortical pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesolimbic pathway
Answer: D
Conceptual Explanation: The mesolimbic pathway involves dopamine projections from
the ventral tegmental area to the nucleus accumbens; overactivity here is linked to positive
symptoms of psychosis.
2. A patient who smokes a pack of cigarettes a day is prescribed Clozapine. If the patient
suddenly quits smoking, what is the most likely effect on the Clozapine blood level?
A. The level will decrease significantly.
B. The level will remain unchanged.
,C. The level will become undetectable.
D. The level will increase, potentially leading to toxicity.
Answer: D
Conceptual Explanation: Polycyclic aromatic hydrocarbons in cigarette smoke induce the
CYP1A2 enzyme. When smoking stops, the enzyme activity slows down, leading to higher
serum levels of drugs metabolized by 1A2, like clozapine.
3. Which of the following physical findings is most characteristic of Serotonin Syndrome
compared to Neuroleptic Malignant Syndrome?
A. Lead-pipe rigidity
B. Bradycardia
C. Hyperreflexia and myoclonus
D. Hypothermia
Answer: C
Conceptual Explanation: Serotonin syndrome is characterized by neuromuscular
irritability like hyperreflexia and myoclonus, whereas NMS is characterized by ‘lead-pipe’
muscle rigidity.
4. What is the therapeutic reference range for Lithium in the maintenance phase of treating
Bipolar Disorder?
A. 0.2 - 0.5 mEq/L
, B. 1.5 - 2.0 mEq/L
C. 0.6 - 1.2 mEq/L
D. 2.5 - 3.0 mEq/L
Answer: C
Conceptual Explanation: The standard therapeutic range for lithium maintenance is 0.6 to
1.2 mEq/L; levels above 1.5 mEq/L indicate toxicity.
5. What is the primary mechanism of action of First-Generation Antipsychotics (FGAs)?
A. 5HT2A receptor antagonism
B. D2 receptor partial agonism
C. D2 receptor antagonism
D. Alpha-1 adrenergic agonism
Answer: C
Conceptual Explanation: FGAs, also known as typical antipsychotics, work primarily by
blocking D2 receptors in the brain.
6. Which antidepressant is most likely to cause a hypertensive crisis when combined with
foods high in tyramine?
A. Sertraline
B. Phenelzine
