Barkley Psychopharmacology Practice
Exam 200 Original Practice Questions
with Detailed Rationales
Table of Contents
1. Antidepressants (Questions 1–45)
2. Antipsychotics (Questions 46–85)
3. Mood Stabilizers (Questions 86–120)
4. Anxiolytics and Hypnotics (Questions 121–150)
5. ADHD Medications (Questions 151–175)
6. Psychopharmacology in Special Populations (Questions 176–
190)
7. Drug Interactions and Toxicity (Questions 191–200)
8. Answer Key Summary
9. Exam Preparation Tips
Section 1: Antidepressants (Questions 1–45)
1. A 28-year-old female with major depressive disorder has
failed trials of sertraline and fluoxetine due to intolerable
side effects. She reports significant fatigue, hypersomnia,
and increased appetite. Which of the following
antidepressants is MOST appropriate as a next-line agent?
A. Paroxetine
B. Bupropion
C. Citalopram
D. Escitalopram
,Correct Answer: B. Bupropion
Rationale: Bupropion is a norepinephrine-dopamine reuptake
inhibitor (NDRI) that is activating and associated with weight
loss rather than weight gain. It is particularly useful for patients
with fatigue, hypersomnia, and increased appetite who have
failed SSRIs. Paroxetine, citalopram, and escitalopram are all
SSRIs and would likely produce similar side effect profiles .
2. A 36-year-old male patient presents with symptoms of
major depression. He is not currently taking any
prescription or over-the-counter medications. Drug
treatment is to be initiated with fluoxetine. What is the
proper counseling information to be provided?
A. Take the drug as prescribed; it may take 2 weeks or more to
feel improvement
B. Don't eat fermented cheese during the treatment period
C. Report immediately if you have any problem with sexual
activity
D. All of the above
Correct Answer: D. All of the above
Rationale: Patients starting fluoxetine should be counseled that
therapeutic effects may take 2–4 weeks or longer. While
tyramine restrictions are not required for SSRIs (only MAOIs),
patients should be informed about potential sexual side effects.
Reporting any concerning symptoms is always appropriate .
3. A 34-year-old man who was prescribed citalopram for
depression has decided to stop taking the drug. When
questioned, he said that it was affecting his sexual
performance. He is also trying to overcome his dependency
on tobacco products. If you decide to reinstitute drug
,therapy in this patient, the best choice would be:
A. Amitriptyline
B. Bupropion
C. Fluoxetine
D. Venlafaxine
Correct Answer: B. Bupropion
Rationale: Bupropion is associated with a lower incidence of
sexual dysfunction compared to SSRIs. Additionally, bupropion
is FDA-approved for smoking cessation, making it an ideal
choice for this patient .
4. Which of the following statements about the mechanism
of action of antidepressant drugs is correct?
A. Bupropion inhibits serotonin reuptake into nerve endings
B. Fluoxetine inhibits NE reuptake into nerve endings
C. Duloxetine inhibits serotonin and NE reuptake into nerve
endings
D. Amitriptyline inhibits serotonin and NE reuptake into nerve
endings
E. Both C and D
Correct Answer: E. Both C and D
Rationale: Duloxetine is an SNRI that inhibits both serotonin
and norepinephrine reuptake. Amitriptyline is a TCA that also
inhibits both serotonin and norepinephrine reuptake.
Bupropion inhibits dopamine and norepinephrine reuptake (not
serotonin), and fluoxetine is an SSRI (not NE reuptake inhibitor)
.
5. A 62-year-old woman with symptoms of depression has a
prior medical history of narrow-angle glaucoma. Which of
the following treatments should be avoided in this patient?
, A. Amitriptyline
B. Bupropion
C. Venlafaxine
D. Citalopram
Correct Answer: A. Amitriptyline
Rationale: Tricyclic antidepressants like amitriptyline have
strong anticholinergic properties that can precipitate acute
angle-closure glaucoma. They should be avoided in patients
with narrow-angle glaucoma .
6. A 67-year-old man presents with complaints of light-
headedness and dizziness when standing up from a seated
position. He reports these symptoms started after
treatment with an antidepressant a few weeks ago. Which
of the following antidepressant agents most likely caused
these symptoms?
A. Venlafaxine
B. Bupropion
C. Escitalopram
D. Imipramine
Correct Answer: D. Imipramine
Rationale: Imipramine is a tricyclic antidepressant with strong
alpha-1 adrenergic blocking effects, leading to orthostatic
hypotension. This is particularly problematic in older adults .
7. A patient with major depressive disorder is started on
sertraline. The PMHNP should educate the patient that the
therapeutic effect may not be fully evident for:
A. 1–2 days
B. 1–2 weeks
Exam 200 Original Practice Questions
with Detailed Rationales
Table of Contents
1. Antidepressants (Questions 1–45)
2. Antipsychotics (Questions 46–85)
3. Mood Stabilizers (Questions 86–120)
4. Anxiolytics and Hypnotics (Questions 121–150)
5. ADHD Medications (Questions 151–175)
6. Psychopharmacology in Special Populations (Questions 176–
190)
7. Drug Interactions and Toxicity (Questions 191–200)
8. Answer Key Summary
9. Exam Preparation Tips
Section 1: Antidepressants (Questions 1–45)
1. A 28-year-old female with major depressive disorder has
failed trials of sertraline and fluoxetine due to intolerable
side effects. She reports significant fatigue, hypersomnia,
and increased appetite. Which of the following
antidepressants is MOST appropriate as a next-line agent?
A. Paroxetine
B. Bupropion
C. Citalopram
D. Escitalopram
,Correct Answer: B. Bupropion
Rationale: Bupropion is a norepinephrine-dopamine reuptake
inhibitor (NDRI) that is activating and associated with weight
loss rather than weight gain. It is particularly useful for patients
with fatigue, hypersomnia, and increased appetite who have
failed SSRIs. Paroxetine, citalopram, and escitalopram are all
SSRIs and would likely produce similar side effect profiles .
2. A 36-year-old male patient presents with symptoms of
major depression. He is not currently taking any
prescription or over-the-counter medications. Drug
treatment is to be initiated with fluoxetine. What is the
proper counseling information to be provided?
A. Take the drug as prescribed; it may take 2 weeks or more to
feel improvement
B. Don't eat fermented cheese during the treatment period
C. Report immediately if you have any problem with sexual
activity
D. All of the above
Correct Answer: D. All of the above
Rationale: Patients starting fluoxetine should be counseled that
therapeutic effects may take 2–4 weeks or longer. While
tyramine restrictions are not required for SSRIs (only MAOIs),
patients should be informed about potential sexual side effects.
Reporting any concerning symptoms is always appropriate .
3. A 34-year-old man who was prescribed citalopram for
depression has decided to stop taking the drug. When
questioned, he said that it was affecting his sexual
performance. He is also trying to overcome his dependency
on tobacco products. If you decide to reinstitute drug
,therapy in this patient, the best choice would be:
A. Amitriptyline
B. Bupropion
C. Fluoxetine
D. Venlafaxine
Correct Answer: B. Bupropion
Rationale: Bupropion is associated with a lower incidence of
sexual dysfunction compared to SSRIs. Additionally, bupropion
is FDA-approved for smoking cessation, making it an ideal
choice for this patient .
4. Which of the following statements about the mechanism
of action of antidepressant drugs is correct?
A. Bupropion inhibits serotonin reuptake into nerve endings
B. Fluoxetine inhibits NE reuptake into nerve endings
C. Duloxetine inhibits serotonin and NE reuptake into nerve
endings
D. Amitriptyline inhibits serotonin and NE reuptake into nerve
endings
E. Both C and D
Correct Answer: E. Both C and D
Rationale: Duloxetine is an SNRI that inhibits both serotonin
and norepinephrine reuptake. Amitriptyline is a TCA that also
inhibits both serotonin and norepinephrine reuptake.
Bupropion inhibits dopamine and norepinephrine reuptake (not
serotonin), and fluoxetine is an SSRI (not NE reuptake inhibitor)
.
5. A 62-year-old woman with symptoms of depression has a
prior medical history of narrow-angle glaucoma. Which of
the following treatments should be avoided in this patient?
, A. Amitriptyline
B. Bupropion
C. Venlafaxine
D. Citalopram
Correct Answer: A. Amitriptyline
Rationale: Tricyclic antidepressants like amitriptyline have
strong anticholinergic properties that can precipitate acute
angle-closure glaucoma. They should be avoided in patients
with narrow-angle glaucoma .
6. A 67-year-old man presents with complaints of light-
headedness and dizziness when standing up from a seated
position. He reports these symptoms started after
treatment with an antidepressant a few weeks ago. Which
of the following antidepressant agents most likely caused
these symptoms?
A. Venlafaxine
B. Bupropion
C. Escitalopram
D. Imipramine
Correct Answer: D. Imipramine
Rationale: Imipramine is a tricyclic antidepressant with strong
alpha-1 adrenergic blocking effects, leading to orthostatic
hypotension. This is particularly problematic in older adults .
7. A patient with major depressive disorder is started on
sertraline. The PMHNP should educate the patient that the
therapeutic effect may not be fully evident for:
A. 1–2 days
B. 1–2 weeks
