NURS 5359 Exam 1: Antipsychotic Medications
Psychopharmacology
Questions with Answers| Updated| Pass Guaranteed
1. Positive symptoms of schizophrenia (hallucinations, delusions) are
hypothesized to result from excess dopamine activity in which
pathway?
A. Mesolimbic pathway
B. Tuberoinfundibular pathway
C. Mesocortical pathway
D. Nigrostriatal pathway
Answer: A. Mesolimbic pathway
Rationale: Hyperactivity of mesolimbic dopamine neurons is linked to
positive symptoms. D2 blockade here reduces them.
Page 1
,2. Extrapyramidal side effects result mainly from D2 blockade in
which pathway?
A. Tuberoinfundibular pathway
B. Mesolimbic pathway
C. Mesocortical pathway
D. Nigrostriatal pathway
Answer: D. Nigrostriatal pathway
Rationale: The nigrostriatal pathway controls motor function. Blocking D2
receptors there mimics Parkinson disease.
3. Hyperprolactinemia from antipsychotics is caused by D2 blockade
in the:
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesolimbic pathway
Answer: C. Tuberoinfundibular pathway
Rationale: Dopamine normally inhibits prolactin release from the anterior
pituitary.
4. Negative and cognitive symptoms are associated with decreased
dopamine activity in the:
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesolimbic pathway
Answer: A. Mesocortical pathway
Rationale: Low prefrontal dopamine is thought to underlie negative and
cognitive symptoms, which D2 antagonists do not improve and may worsen.
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,5. Therapeutic antipsychotic effect generally occurs at what level of
striatal D2 receptor occupancy?
A. 40 to 50%
B. 20 to 30%
C. 60 to 80%
D. Greater than 90%
Answer: C. 60 to 80%
Rationale: Occupancy above about 80% greatly raises the risk of EPS and
hyperprolactinemia.
6. Why do second-generation antipsychotics generally cause fewer
EPS than first-generation agents?
A. They increase serotonin in the striatum
B. They block D2 more strongly
C. They block only D1 receptors
D. 5-HT2A antagonism increases dopamine release in the nigrostriatal
pathway
Answer: D. 5-HT2A antagonism increases dopamine release in the
nigrostriatal pathway
Rationale: Serotonin normally inhibits dopamine release. Blocking 5-HT2A
disinhibits dopamine and offsets D2 blockade in the striatum.
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, 7. Aripiprazole differs from most antipsychotics because it is a:
A. Full D2 antagonist
B. Selective D1 antagonist
C. Full D2 agonist
D. D2 partial agonist
Answer: D. D2 partial agonist
Rationale: It stabilizes dopamine, reducing activity where it is high and
increasing it where it is low.
8. Cariprazine is characterized by:
A. Selective M1 agonism
B. Partial agonism with preferential binding to D3 receptors
C. Full D2 blockade only
D. 5-HT2A inverse agonism only
Answer: B. Partial agonism with preferential binding to D3 receptors
Rationale: It is a D3-preferring D2/D3 partial agonist, which may help
negative symptoms.
9. Pimavanserin works by:
A. Inhibiting VMAT2
B. Activating muscarinic receptors
C. Blocking D2 receptors
D. Inverse agonism at 5-HT2A receptors with no D2 blockade
Answer: D. Inverse agonism at 5-HT2A receptors with no D2 blockade
Rationale: It is approved for hallucinations and delusions of Parkinson
disease psychosis without worsening motor function.
Page 4
Psychopharmacology
Questions with Answers| Updated| Pass Guaranteed
1. Positive symptoms of schizophrenia (hallucinations, delusions) are
hypothesized to result from excess dopamine activity in which
pathway?
A. Mesolimbic pathway
B. Tuberoinfundibular pathway
C. Mesocortical pathway
D. Nigrostriatal pathway
Answer: A. Mesolimbic pathway
Rationale: Hyperactivity of mesolimbic dopamine neurons is linked to
positive symptoms. D2 blockade here reduces them.
Page 1
,2. Extrapyramidal side effects result mainly from D2 blockade in
which pathway?
A. Tuberoinfundibular pathway
B. Mesolimbic pathway
C. Mesocortical pathway
D. Nigrostriatal pathway
Answer: D. Nigrostriatal pathway
Rationale: The nigrostriatal pathway controls motor function. Blocking D2
receptors there mimics Parkinson disease.
3. Hyperprolactinemia from antipsychotics is caused by D2 blockade
in the:
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesolimbic pathway
Answer: C. Tuberoinfundibular pathway
Rationale: Dopamine normally inhibits prolactin release from the anterior
pituitary.
4. Negative and cognitive symptoms are associated with decreased
dopamine activity in the:
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesolimbic pathway
Answer: A. Mesocortical pathway
Rationale: Low prefrontal dopamine is thought to underlie negative and
cognitive symptoms, which D2 antagonists do not improve and may worsen.
Page 2
,5. Therapeutic antipsychotic effect generally occurs at what level of
striatal D2 receptor occupancy?
A. 40 to 50%
B. 20 to 30%
C. 60 to 80%
D. Greater than 90%
Answer: C. 60 to 80%
Rationale: Occupancy above about 80% greatly raises the risk of EPS and
hyperprolactinemia.
6. Why do second-generation antipsychotics generally cause fewer
EPS than first-generation agents?
A. They increase serotonin in the striatum
B. They block D2 more strongly
C. They block only D1 receptors
D. 5-HT2A antagonism increases dopamine release in the nigrostriatal
pathway
Answer: D. 5-HT2A antagonism increases dopamine release in the
nigrostriatal pathway
Rationale: Serotonin normally inhibits dopamine release. Blocking 5-HT2A
disinhibits dopamine and offsets D2 blockade in the striatum.
Page 3
, 7. Aripiprazole differs from most antipsychotics because it is a:
A. Full D2 antagonist
B. Selective D1 antagonist
C. Full D2 agonist
D. D2 partial agonist
Answer: D. D2 partial agonist
Rationale: It stabilizes dopamine, reducing activity where it is high and
increasing it where it is low.
8. Cariprazine is characterized by:
A. Selective M1 agonism
B. Partial agonism with preferential binding to D3 receptors
C. Full D2 blockade only
D. 5-HT2A inverse agonism only
Answer: B. Partial agonism with preferential binding to D3 receptors
Rationale: It is a D3-preferring D2/D3 partial agonist, which may help
negative symptoms.
9. Pimavanserin works by:
A. Inhibiting VMAT2
B. Activating muscarinic receptors
C. Blocking D2 receptors
D. Inverse agonism at 5-HT2A receptors with no D2 blockade
Answer: D. Inverse agonism at 5-HT2A receptors with no D2 blockade
Rationale: It is approved for hallucinations and delusions of Parkinson
disease psychosis without worsening motor function.
Page 4
