NU 643 Final Exam V2 | NU 643 Advanced
Psychopharmacology | Actual Q&A with Rationale
(NU643 Final Exam) | Regis University
1. A patient with Treatment-Resistant Depression (TRD) is started on Esketamine (Spravato).
Which mechanism of action distinguishes this agent from traditional monoamine-based
antidepressants?
A. Selective inhibition of the serotonin transporter (SERT)
B. Potentiation of Gamma-Aminobutyric Acid (GABA) receptors
C. Antagonism of the N-methyl-D-aspartate (NMDA) receptor
D. Agonism of the alpha-2 adrenergic receptor
Correct Answer: C
Explanation: Esketamine acts primarily as a non-competitive antagonist of the NMDA
glutamate receptor. This mechanism leads to a surge in glutamate and subsequent
activation of AMPA receptors, which promotes synaptogenesis. This rapid-acting approach
differs significantly from the delayed effect seen with SSRIs or SNRIs.
2. When prescribing Clozapine (Clozaril), the Psychiatric-Mental Health Nurse Practitioner
(PMHNP) must monitor the Absolute Neutrophil Count (ANC). What is the threshold for
initiating ‘Benign Ethnic Neutropenia’ protocols?
A. ANC less than 500/mm3
B. ANC less than 1,000/mm3
,C. ANC less than 1,500/mm3
D. ANC less than 2,000/mm3
Correct Answer: B
Explanation: For patients with documented Benign Ethnic Neutropenia (BEN), the ANC
threshold for starting or continuing Clozapine is lower than the general population. The
monitoring criteria for these patients use an ANC of less than 1,000/mm3 as the cutoff for
treatment interruption. This distinction prevents the unnecessary withholding of effective
treatment in specific ethnic populations.
3. A 45-year-old male with Bipolar I Disorder presents with symptoms of Lithium toxicity,
including coarse tremors and ataxia. His serum Lithium level is 2.2 mEq/L. What is the most
appropriate immediate action?
A. Reduce the dose by 50% and recheck in one week
B. Discontinue Lithium and initiate IV hydration
C. Switch to Valproic acid immediately
D. Administer a dose of Lorazepam for the tremors
Correct Answer: B
Explanation: A serum lithium level of 2.2 mEq/L indicates moderate to severe toxicity,
which requires immediate discontinuation of the medication. The patient needs
intravenous hydration and close monitoring of renal function and electrolytes to facilitate
,clearance. Failure to address these levels can lead to permanent neurological damage or
death.
4. Which cytochrome P450 enzyme is primarily responsible for the metabolism of most
antipsychotics and is subject to genetic polymorphism leading to ‘poor metabolizer’ status?
A. CYP1A2
B. CYP2C19
C. CYP3A4
D. CYP2D6
Correct Answer: D
Explanation: CYP2D6 is a critical enzyme in psychopharmacology as it metabolizes a wide
range of antidepressants and antipsychotics. Approximately 7-10% of Caucasians are poor
metabolizers, which increases the risk of side effects at standard doses. Testing for this
polymorphism can help guide precision dosing for patients who fail standard trials.
5. A patient taking Phenelzine (Nardil) attends a dinner party and consumes aged cheeses and
red wine. Which medical emergency is the patient at risk for?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome
C. Hypertensive Crisis
D. Agranulocytosis
, Correct Answer: C
Explanation: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that prevents the
breakdown of tyramine in the gut. High levels of tyramine trigger the release of
norepinephrine, leading to severe vasoconstriction and a dangerous spike in blood
pressure. Patients must strictly adhere to a low-tyramine diet to avoid this life-threatening
interaction.
6. Which second-generation antipsychotic is associated with the highest risk of QTc
prolongation and requires an EKG if the patient has a history of cardiac disease?
A. Aripiprazole (Abilify)
B. Ziprasidone (Geodon)
C. Lurasidone (Latuda)
D. Olanzapine (Zyprexa)
Correct Answer: B
Explanation: Ziprasidone is known to have a dose-dependent effect on the QTc interval,
increasing the risk of Torsades de Pointes. While other antipsychotics can impact the QTc,
Ziprasidone’s profile warrants specific caution in patients with pre-existing cardiac
conditions. Clinicians should monitor electrolytes and concurrent medications that might
further prolong the interval.
Psychopharmacology | Actual Q&A with Rationale
(NU643 Final Exam) | Regis University
1. A patient with Treatment-Resistant Depression (TRD) is started on Esketamine (Spravato).
Which mechanism of action distinguishes this agent from traditional monoamine-based
antidepressants?
A. Selective inhibition of the serotonin transporter (SERT)
B. Potentiation of Gamma-Aminobutyric Acid (GABA) receptors
C. Antagonism of the N-methyl-D-aspartate (NMDA) receptor
D. Agonism of the alpha-2 adrenergic receptor
Correct Answer: C
Explanation: Esketamine acts primarily as a non-competitive antagonist of the NMDA
glutamate receptor. This mechanism leads to a surge in glutamate and subsequent
activation of AMPA receptors, which promotes synaptogenesis. This rapid-acting approach
differs significantly from the delayed effect seen with SSRIs or SNRIs.
2. When prescribing Clozapine (Clozaril), the Psychiatric-Mental Health Nurse Practitioner
(PMHNP) must monitor the Absolute Neutrophil Count (ANC). What is the threshold for
initiating ‘Benign Ethnic Neutropenia’ protocols?
A. ANC less than 500/mm3
B. ANC less than 1,000/mm3
,C. ANC less than 1,500/mm3
D. ANC less than 2,000/mm3
Correct Answer: B
Explanation: For patients with documented Benign Ethnic Neutropenia (BEN), the ANC
threshold for starting or continuing Clozapine is lower than the general population. The
monitoring criteria for these patients use an ANC of less than 1,000/mm3 as the cutoff for
treatment interruption. This distinction prevents the unnecessary withholding of effective
treatment in specific ethnic populations.
3. A 45-year-old male with Bipolar I Disorder presents with symptoms of Lithium toxicity,
including coarse tremors and ataxia. His serum Lithium level is 2.2 mEq/L. What is the most
appropriate immediate action?
A. Reduce the dose by 50% and recheck in one week
B. Discontinue Lithium and initiate IV hydration
C. Switch to Valproic acid immediately
D. Administer a dose of Lorazepam for the tremors
Correct Answer: B
Explanation: A serum lithium level of 2.2 mEq/L indicates moderate to severe toxicity,
which requires immediate discontinuation of the medication. The patient needs
intravenous hydration and close monitoring of renal function and electrolytes to facilitate
,clearance. Failure to address these levels can lead to permanent neurological damage or
death.
4. Which cytochrome P450 enzyme is primarily responsible for the metabolism of most
antipsychotics and is subject to genetic polymorphism leading to ‘poor metabolizer’ status?
A. CYP1A2
B. CYP2C19
C. CYP3A4
D. CYP2D6
Correct Answer: D
Explanation: CYP2D6 is a critical enzyme in psychopharmacology as it metabolizes a wide
range of antidepressants and antipsychotics. Approximately 7-10% of Caucasians are poor
metabolizers, which increases the risk of side effects at standard doses. Testing for this
polymorphism can help guide precision dosing for patients who fail standard trials.
5. A patient taking Phenelzine (Nardil) attends a dinner party and consumes aged cheeses and
red wine. Which medical emergency is the patient at risk for?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome
C. Hypertensive Crisis
D. Agranulocytosis
, Correct Answer: C
Explanation: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that prevents the
breakdown of tyramine in the gut. High levels of tyramine trigger the release of
norepinephrine, leading to severe vasoconstriction and a dangerous spike in blood
pressure. Patients must strictly adhere to a low-tyramine diet to avoid this life-threatening
interaction.
6. Which second-generation antipsychotic is associated with the highest risk of QTc
prolongation and requires an EKG if the patient has a history of cardiac disease?
A. Aripiprazole (Abilify)
B. Ziprasidone (Geodon)
C. Lurasidone (Latuda)
D. Olanzapine (Zyprexa)
Correct Answer: B
Explanation: Ziprasidone is known to have a dose-dependent effect on the QTc interval,
increasing the risk of Torsades de Pointes. While other antipsychotics can impact the QTc,
Ziprasidone’s profile warrants specific caution in patients with pre-existing cardiac
conditions. Clinicians should monitor electrolytes and concurrent medications that might
further prolong the interval.
