NR 546 PSYCHOPHARMACOLOGY
FINAL EXAM ADVANCED STUDY
GUIDE QUESTIONS AND ANSWERS
1. A patient is prescribed a medication that acts as an inverse agonist at a specific receptor
site. What is the pharmacological effect of this drug?
A. It blocks the endogenous ligand from binding but has no intrinsic activity.
B. It binds to the receptor and induces the opposite effect of an agonist.
C. It binds to the receptor and produces a submaximal response compared to a full agonist.
D. It increases the affinity of the receptor for its natural neurotransmitter.
Answer: B
Conceptual Explanation: Inverse agonists bind to the same receptor as agonists but
produce the opposite pharmacological effect, reducing the constitutive activity of the
receptor.
2. Which dopaminergic pathway is primarily associated with the negative symptoms of
schizophrenia and cognitive impairment?
A. Mesolimbic pathway
,B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesocortical pathway
Answer: D
Conceptual Explanation: Hypofunction of the mesocortical pathway is theorized to be
responsible for the negative and cognitive symptoms of schizophrenia.
3. A patient taking Clozapine presents with a sudden high fever, muscle rigidity, and
autonomic instability. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome (NMS)
C. Agranulocytosis
D. Anticholinergic Toxicity
Answer: B
Conceptual Explanation: NMS is characterized by ‘lead-pipe’ rigidity, high fever, and
autonomic dysfunction, often associated with antipsychotic use.
4. Which cytochrome P450 enzyme is significantly inhibited by Fluoxetine and Paroxetine,
potentially increasing levels of TCAs?
A. CYP3A4
B. CYP1A2
, C. CYP2D6
D. CYP2C19
Answer: C
Conceptual Explanation: Fluoxetine and Paroxetine are potent inhibitors of CYP2D6,
which metabolizes many TCAs and antipsychotics.
5. What is the primary mechanism of action for the antidepressant Mirtazapine?
A. Selective inhibition of serotonin reuptake
B. NMDA receptor antagonism
C. Inhibition of Monoamine Oxidase Type B
D. Alpha-2 adrenergic antagonism and 5-HT2/5-HT3 antagonism
Answer: D
Conceptual Explanation: Mirtazapine is a NaSSA that blocks alpha-2 autoreceptors
(increasing NE and 5-HT) and specific serotonin receptor subtypes.
6. Which mood stabilizer is associated with the highest risk of causing Stevens-Johnson
Syndrome (SJS), particularly in patients with the HLA-B*1502 allele?
A. Lithium
B. Valproate
C. Topiramate
FINAL EXAM ADVANCED STUDY
GUIDE QUESTIONS AND ANSWERS
1. A patient is prescribed a medication that acts as an inverse agonist at a specific receptor
site. What is the pharmacological effect of this drug?
A. It blocks the endogenous ligand from binding but has no intrinsic activity.
B. It binds to the receptor and induces the opposite effect of an agonist.
C. It binds to the receptor and produces a submaximal response compared to a full agonist.
D. It increases the affinity of the receptor for its natural neurotransmitter.
Answer: B
Conceptual Explanation: Inverse agonists bind to the same receptor as agonists but
produce the opposite pharmacological effect, reducing the constitutive activity of the
receptor.
2. Which dopaminergic pathway is primarily associated with the negative symptoms of
schizophrenia and cognitive impairment?
A. Mesolimbic pathway
,B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesocortical pathway
Answer: D
Conceptual Explanation: Hypofunction of the mesocortical pathway is theorized to be
responsible for the negative and cognitive symptoms of schizophrenia.
3. A patient taking Clozapine presents with a sudden high fever, muscle rigidity, and
autonomic instability. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome (NMS)
C. Agranulocytosis
D. Anticholinergic Toxicity
Answer: B
Conceptual Explanation: NMS is characterized by ‘lead-pipe’ rigidity, high fever, and
autonomic dysfunction, often associated with antipsychotic use.
4. Which cytochrome P450 enzyme is significantly inhibited by Fluoxetine and Paroxetine,
potentially increasing levels of TCAs?
A. CYP3A4
B. CYP1A2
, C. CYP2D6
D. CYP2C19
Answer: C
Conceptual Explanation: Fluoxetine and Paroxetine are potent inhibitors of CYP2D6,
which metabolizes many TCAs and antipsychotics.
5. What is the primary mechanism of action for the antidepressant Mirtazapine?
A. Selective inhibition of serotonin reuptake
B. NMDA receptor antagonism
C. Inhibition of Monoamine Oxidase Type B
D. Alpha-2 adrenergic antagonism and 5-HT2/5-HT3 antagonism
Answer: D
Conceptual Explanation: Mirtazapine is a NaSSA that blocks alpha-2 autoreceptors
(increasing NE and 5-HT) and specific serotonin receptor subtypes.
6. Which mood stabilizer is associated with the highest risk of causing Stevens-Johnson
Syndrome (SJS), particularly in patients with the HLA-B*1502 allele?
A. Lithium
B. Valproate
C. Topiramate
