NU664 PSYCHOPHARMACOLOGY
COMPREHENSIVE PRACTICE EXAM
QUESTIONS AND ANSWERS
1. Which cytochrome P450 enzyme is responsible for the metabolism of approximately 25%
of all psychotropic medications, including many SSRIs and antipsychotics, and is known for
significant genetic polymorphism?
A. CYP1A2
B. CYP3A4
C. CYP2D6
D. CYP2C19
Answer: C
Conceptual Explanation: CYP2D6 is highly polymorphic and metabolizes many
psychotropic drugs. Poor metabolizers are at risk for toxicity, while ultra-rapid
metabolizers may fail therapy.
,2. When switching a patient from a Monoamine Oxidase Inhibitor (MAOI) to a Selective
Serotonin Reuptake Inhibitor (SSRI), what is the minimum required washout period to
prevent serotonin syndrome?
A. 7 days
B. 14 days
C. 21 days
D. 5 weeks
Answer: B
Conceptual Explanation: A 14-day washout period is necessary to allow for the
regeneration of the MAO enzyme before starting an SSRI. Fluoxetine is the exception,
requiring a longer washout when switching FROM fluoxetine TO an MAOI.
3. A patient taking Clozapine presents with an Absolute Neutrophil Count (ANC) of 900/mm3.
According to the Clozapine REMS program, what is the required action?
A. Continue treatment and repeat labs in 48 hours.
B. Reduce the dose by 50% and monitor daily.
C. Discontinue permanently and never rechallenge.
D. Interrupt treatment, consult hematology, and monitor ANC daily.
Answer: D
, Conceptual Explanation: An ANC below 1000/mm3 (Moderate Neutropenia) requires
treatment interruption and daily monitoring until the ANC rises above 1000/mm3.
4. Which dopamine pathway is associated with the development of Extrapyramidal
Symptoms (EPS) when D2 receptors are blocked?
A. Mesolimbic
B. Nigrostriatal
C. Mesocortical
D. Tuberoinfundibular
Answer: B
Conceptual Explanation: Blockade of D2 receptors in the nigrostriatal pathway leads to
motor side effects like parkinsonism, akathisia, and dystonia.
5. Which medication is considered the ‘gold standard’ for treatment-resistant schizophrenia
after the failure of two other antipsychotic trials?
A. Risperidone
B. Olanzapine
C. Aripiprazole
D. Clozapine
Answer: D
COMPREHENSIVE PRACTICE EXAM
QUESTIONS AND ANSWERS
1. Which cytochrome P450 enzyme is responsible for the metabolism of approximately 25%
of all psychotropic medications, including many SSRIs and antipsychotics, and is known for
significant genetic polymorphism?
A. CYP1A2
B. CYP3A4
C. CYP2D6
D. CYP2C19
Answer: C
Conceptual Explanation: CYP2D6 is highly polymorphic and metabolizes many
psychotropic drugs. Poor metabolizers are at risk for toxicity, while ultra-rapid
metabolizers may fail therapy.
,2. When switching a patient from a Monoamine Oxidase Inhibitor (MAOI) to a Selective
Serotonin Reuptake Inhibitor (SSRI), what is the minimum required washout period to
prevent serotonin syndrome?
A. 7 days
B. 14 days
C. 21 days
D. 5 weeks
Answer: B
Conceptual Explanation: A 14-day washout period is necessary to allow for the
regeneration of the MAO enzyme before starting an SSRI. Fluoxetine is the exception,
requiring a longer washout when switching FROM fluoxetine TO an MAOI.
3. A patient taking Clozapine presents with an Absolute Neutrophil Count (ANC) of 900/mm3.
According to the Clozapine REMS program, what is the required action?
A. Continue treatment and repeat labs in 48 hours.
B. Reduce the dose by 50% and monitor daily.
C. Discontinue permanently and never rechallenge.
D. Interrupt treatment, consult hematology, and monitor ANC daily.
Answer: D
, Conceptual Explanation: An ANC below 1000/mm3 (Moderate Neutropenia) requires
treatment interruption and daily monitoring until the ANC rises above 1000/mm3.
4. Which dopamine pathway is associated with the development of Extrapyramidal
Symptoms (EPS) when D2 receptors are blocked?
A. Mesolimbic
B. Nigrostriatal
C. Mesocortical
D. Tuberoinfundibular
Answer: B
Conceptual Explanation: Blockade of D2 receptors in the nigrostriatal pathway leads to
motor side effects like parkinsonism, akathisia, and dystonia.
5. Which medication is considered the ‘gold standard’ for treatment-resistant schizophrenia
after the failure of two other antipsychotic trials?
A. Risperidone
B. Olanzapine
C. Aripiprazole
D. Clozapine
Answer: D
