NSG 526 EXAM 2 PRACTICE -
ADVANCED PSYCHOPHARMACOLOGY
QUESTIONS WITH VERIFIED ANSWERS
2026/2027
1. A patient who has been stable on Olanzapine for several months starts smoking a pack of
cigarettes daily. What effect should the clinician anticipate regarding the medication levels?
A. Olanzapine levels will increase significantly due to competitive inhibition.
B. There will be no change as Olanzapine is metabolized by CYP2D6.
C. Olanzapine levels will decrease because tobacco smoke induces the CYP1A2 enzyme.
D. Olanzapine levels will decrease because nicotine inhibits gastric absorption.
Answer: C
Conceptual Explanation: Tobacco smoke contains polycyclic aromatic hydrocarbons that
induce the CYP1A2 enzyme, which is responsible for the metabolism of olanzapine and
clozapine, leading to reduced serum concentrations.
2. Over-activity in which dopaminergic pathway is primarily associated with the positive
symptoms of schizophrenia, such as hallucinations and delusions?
A. Mesolimbic pathway
B. Tuberoinfundibular pathway
,C. Mesocortical pathway
D. Nigrostriatal pathway
Answer: A
Conceptual Explanation: The mesolimbic pathway projects from the ventral tegmental
area to the nucleus accumbens; hyperactivity here is linked to positive psychotic
symptoms.
3. When prescribing Lamotrigine to a patient already taking Valproate, how should the
Lamotrigine dosing be adjusted?
A. The Lamotrigine dose should be doubled to overcome competitive binding.
B. The Lamotrigine starting dose should be reduced by 50% because Valproate inhibits its
metabolism.
C. No adjustment is needed as they use different metabolic pathways.
D. Lamotrigine should be taken in the morning and Valproate at night to avoid interaction.
Answer: B
Conceptual Explanation: Valproate inhibits the glucuronidation of Lamotrigine, doubling
its serum levels and increasing the risk of Stevens-Johnson Syndrome (SJS).
4. What is the absolute minimum Absolute Neutrophil Count (ANC) required to initiate
Clozapine therapy in a non-benign ethnic neutropenia patient?
A. 500/mm³
, B. 1000/mm³
C. 1500/mm³
D. 2000/mm³
Answer: C
Conceptual Explanation: Standard guidelines require an ANC of at least 1500/mm³ before
starting Clozapine to monitor for agranulocytosis risk.
5. A patient taking Lithium for Bipolar Disorder is prescribed Hydrochlorothiazide (HCTZ) for
hypertension. What is the most likely consequence of this combination?
A. Increased renal clearance of Lithium and subtherapeutic levels.
B. Increased serum Lithium levels and potential toxicity.
C. Reduced Lithium levels due to increased water excretion.
D. Development of hyperkalemia due to drug interaction.
Answer: B
Conceptual Explanation: Thiazide diuretics cause the kidneys to reabsorb sodium and
lithium in the proximal tubule, leading to increased lithium levels and potential toxicity.
6. Which of the following clinical findings is a hallmark sign used to differentiate Serotonin
Syndrome from Neuroleptic Malignant Syndrome (NMS)?
A. Hyperthermia
B. Hyperreflexia and myoclonus
ADVANCED PSYCHOPHARMACOLOGY
QUESTIONS WITH VERIFIED ANSWERS
2026/2027
1. A patient who has been stable on Olanzapine for several months starts smoking a pack of
cigarettes daily. What effect should the clinician anticipate regarding the medication levels?
A. Olanzapine levels will increase significantly due to competitive inhibition.
B. There will be no change as Olanzapine is metabolized by CYP2D6.
C. Olanzapine levels will decrease because tobacco smoke induces the CYP1A2 enzyme.
D. Olanzapine levels will decrease because nicotine inhibits gastric absorption.
Answer: C
Conceptual Explanation: Tobacco smoke contains polycyclic aromatic hydrocarbons that
induce the CYP1A2 enzyme, which is responsible for the metabolism of olanzapine and
clozapine, leading to reduced serum concentrations.
2. Over-activity in which dopaminergic pathway is primarily associated with the positive
symptoms of schizophrenia, such as hallucinations and delusions?
A. Mesolimbic pathway
B. Tuberoinfundibular pathway
,C. Mesocortical pathway
D. Nigrostriatal pathway
Answer: A
Conceptual Explanation: The mesolimbic pathway projects from the ventral tegmental
area to the nucleus accumbens; hyperactivity here is linked to positive psychotic
symptoms.
3. When prescribing Lamotrigine to a patient already taking Valproate, how should the
Lamotrigine dosing be adjusted?
A. The Lamotrigine dose should be doubled to overcome competitive binding.
B. The Lamotrigine starting dose should be reduced by 50% because Valproate inhibits its
metabolism.
C. No adjustment is needed as they use different metabolic pathways.
D. Lamotrigine should be taken in the morning and Valproate at night to avoid interaction.
Answer: B
Conceptual Explanation: Valproate inhibits the glucuronidation of Lamotrigine, doubling
its serum levels and increasing the risk of Stevens-Johnson Syndrome (SJS).
4. What is the absolute minimum Absolute Neutrophil Count (ANC) required to initiate
Clozapine therapy in a non-benign ethnic neutropenia patient?
A. 500/mm³
, B. 1000/mm³
C. 1500/mm³
D. 2000/mm³
Answer: C
Conceptual Explanation: Standard guidelines require an ANC of at least 1500/mm³ before
starting Clozapine to monitor for agranulocytosis risk.
5. A patient taking Lithium for Bipolar Disorder is prescribed Hydrochlorothiazide (HCTZ) for
hypertension. What is the most likely consequence of this combination?
A. Increased renal clearance of Lithium and subtherapeutic levels.
B. Increased serum Lithium levels and potential toxicity.
C. Reduced Lithium levels due to increased water excretion.
D. Development of hyperkalemia due to drug interaction.
Answer: B
Conceptual Explanation: Thiazide diuretics cause the kidneys to reabsorb sodium and
lithium in the proximal tubule, leading to increased lithium levels and potential toxicity.
6. Which of the following clinical findings is a hallmark sign used to differentiate Serotonin
Syndrome from Neuroleptic Malignant Syndrome (NMS)?
A. Hyperthermia
B. Hyperreflexia and myoclonus
