,NSG 552 Exam 3 - Psychopharmacology - Wilkes
University – (2026–2027) Actual (PDF)
1. A patient's CYP2D6 poor metabolizer phenotype is confirmed. Which antidepressant would require
the largest dose reduction to avoid toxicity?
A) Escitalopram
B) Sertraline
C) Fluoxetine
D) Citalopram
Correct Answer: C) Fluoxetine
Rationale: Fluoxetine and its active metabolite norfluoxetine are potent CYP2D6 inhibitors. In a poor
metabolizer, fluoxetine levels rise significantly, increasing the risk of serotonin toxicity. Escitalopram
and citalopram are less dependent on CYP2D6; sertraline affects CYP2D6 mildly.
2. The therapeutic index of lithium is narrow. A toxic level is generally considered to be:
A) >0.6 mEq/L
B) >1.2 mEq/L
C) >1.5 mEq/L
D) >2.0 mEq/L
Correct Answer: C) >1.5 mEq/L
Rationale: Acute toxicity is generally considered at levels >1.5 mEq/L, with severe toxicity at >2.0
mEq/L. The therapeutic range is 0.6–1.2 mEq/L for acute mania and 0.6–0.8 mEq/L for maintenance.
Levels above 1.5 mEq/L require immediate attention.
3. Which medication requires baseline and periodic ECG monitoring due to risk of QT prolongation?
A) Bupropion
B) Venlafaxine
C) Citalopram (above 40 mg)
D) Mirtazapine
Correct Answer: C) Citalopram (above 40 mg)
,Rationale: The FDA has issued a warning that citalopram >40 mg/day causes dose-dependent QT
prolongation with risk of torsade de pointes. Venlafaxine and mirtazapine have minimal QT effects;
bupropion has no significant QT effect.
4. A patient on an MAOI eats aged cheese and develops a severe headache and hypertension. Which
medication is the first-line treatment for this hypertensive crisis?
A) Naloxone
B) Phentolamine
C) Flumazenil
D) Propranolol
Correct Answer: B) Phentolamine
Rationale: Phentolamine (5 mg IV) is an alpha-1 antagonist used for MAOI-induced hypertensive crisis.
Propranolol can worsen unopposed alpha stimulation and is contraindicated. Naloxone and flumazenil
are not appropriate for this condition.
5. Which anticonvulsant used as a mood stabilizer requires HLA-B*1502 screening in Asian patients?
A) Valproate
B) Lamotrigine
C) Oxcarbazepine
D) Carbamazepine
Correct Answer: D) Carbamazepine
Rationale: The HLA-B*1502 allele is strongly associated with Stevens-Johnson syndrome and toxic
epidermal necrolysis in Han Chinese, Thai, and other Asian populations taking carbamazepine.
Screening is recommended before initiating carbamazepine in at-risk populations.
6. The primary mechanism of action of SSRIs is:
A) Blockade of presynaptic dopamine receptors
B) Inhibition of serotonin reuptake pump
C) Antagonism of 5-HT2A receptors
D) Enhancement of GABA activity
Correct Answer: B) Inhibition of serotonin reuptake pump
, Rationale: SSRIs selectively bind to the serotonin transporter (SERT), increasing synaptic serotonin
levels. They do not directly block dopamine, antagonize 5-HT2A receptors, or enhance GABA activity.
7. Which medication is most likely to cause a false-positive urine amphetamine screen?
A) Quetiapine
B) Bupropion
C) Trazodone
D) Lamotrigine
Correct Answer: B) Bupropion
Rationale: Bupropion (and some other antidepressants) can cause false-positive urine amphetamine
screens due to structural similarities or cross-reactivity with immunoassays.
8. Why are benzodiazepines contraindicated in PTSD treatment?
A) They are ineffective for anxiety symptoms
B) They interfere with cognitive processes necessary for CBT and carry a high risk of dependence
C) They cause excessive sedation that improves PTSD symptoms
D) They are not FDA-approved for any psychiatric condition
Correct Answer: B) They interfere with cognitive processes necessary for CBT and carry a high risk of
dependence
Rationale: Benzodiazepines are contraindicated in PTSD because they interfere with cognitive
processes necessary for cognitive-behavioral therapy and carry a high risk of dependence, particularly
in patients with comorbid substance use disorders.
9. Which medications are FDA-approved for the treatment of PTSD?
A) Fluoxetine and sertraline
B) Sertraline and paroxetine
C) Paroxetine and venlafaxine
D) Duloxetine and fluoxetine
Correct Answer: B) Sertraline and paroxetine
University – (2026–2027) Actual (PDF)
1. A patient's CYP2D6 poor metabolizer phenotype is confirmed. Which antidepressant would require
the largest dose reduction to avoid toxicity?
A) Escitalopram
B) Sertraline
C) Fluoxetine
D) Citalopram
Correct Answer: C) Fluoxetine
Rationale: Fluoxetine and its active metabolite norfluoxetine are potent CYP2D6 inhibitors. In a poor
metabolizer, fluoxetine levels rise significantly, increasing the risk of serotonin toxicity. Escitalopram
and citalopram are less dependent on CYP2D6; sertraline affects CYP2D6 mildly.
2. The therapeutic index of lithium is narrow. A toxic level is generally considered to be:
A) >0.6 mEq/L
B) >1.2 mEq/L
C) >1.5 mEq/L
D) >2.0 mEq/L
Correct Answer: C) >1.5 mEq/L
Rationale: Acute toxicity is generally considered at levels >1.5 mEq/L, with severe toxicity at >2.0
mEq/L. The therapeutic range is 0.6–1.2 mEq/L for acute mania and 0.6–0.8 mEq/L for maintenance.
Levels above 1.5 mEq/L require immediate attention.
3. Which medication requires baseline and periodic ECG monitoring due to risk of QT prolongation?
A) Bupropion
B) Venlafaxine
C) Citalopram (above 40 mg)
D) Mirtazapine
Correct Answer: C) Citalopram (above 40 mg)
,Rationale: The FDA has issued a warning that citalopram >40 mg/day causes dose-dependent QT
prolongation with risk of torsade de pointes. Venlafaxine and mirtazapine have minimal QT effects;
bupropion has no significant QT effect.
4. A patient on an MAOI eats aged cheese and develops a severe headache and hypertension. Which
medication is the first-line treatment for this hypertensive crisis?
A) Naloxone
B) Phentolamine
C) Flumazenil
D) Propranolol
Correct Answer: B) Phentolamine
Rationale: Phentolamine (5 mg IV) is an alpha-1 antagonist used for MAOI-induced hypertensive crisis.
Propranolol can worsen unopposed alpha stimulation and is contraindicated. Naloxone and flumazenil
are not appropriate for this condition.
5. Which anticonvulsant used as a mood stabilizer requires HLA-B*1502 screening in Asian patients?
A) Valproate
B) Lamotrigine
C) Oxcarbazepine
D) Carbamazepine
Correct Answer: D) Carbamazepine
Rationale: The HLA-B*1502 allele is strongly associated with Stevens-Johnson syndrome and toxic
epidermal necrolysis in Han Chinese, Thai, and other Asian populations taking carbamazepine.
Screening is recommended before initiating carbamazepine in at-risk populations.
6. The primary mechanism of action of SSRIs is:
A) Blockade of presynaptic dopamine receptors
B) Inhibition of serotonin reuptake pump
C) Antagonism of 5-HT2A receptors
D) Enhancement of GABA activity
Correct Answer: B) Inhibition of serotonin reuptake pump
, Rationale: SSRIs selectively bind to the serotonin transporter (SERT), increasing synaptic serotonin
levels. They do not directly block dopamine, antagonize 5-HT2A receptors, or enhance GABA activity.
7. Which medication is most likely to cause a false-positive urine amphetamine screen?
A) Quetiapine
B) Bupropion
C) Trazodone
D) Lamotrigine
Correct Answer: B) Bupropion
Rationale: Bupropion (and some other antidepressants) can cause false-positive urine amphetamine
screens due to structural similarities or cross-reactivity with immunoassays.
8. Why are benzodiazepines contraindicated in PTSD treatment?
A) They are ineffective for anxiety symptoms
B) They interfere with cognitive processes necessary for CBT and carry a high risk of dependence
C) They cause excessive sedation that improves PTSD symptoms
D) They are not FDA-approved for any psychiatric condition
Correct Answer: B) They interfere with cognitive processes necessary for CBT and carry a high risk of
dependence
Rationale: Benzodiazepines are contraindicated in PTSD because they interfere with cognitive
processes necessary for cognitive-behavioral therapy and carry a high risk of dependence, particularly
in patients with comorbid substance use disorders.
9. Which medications are FDA-approved for the treatment of PTSD?
A) Fluoxetine and sertraline
B) Sertraline and paroxetine
C) Paroxetine and venlafaxine
D) Duloxetine and fluoxetine
Correct Answer: B) Sertraline and paroxetine
