NURS 5359 Exam 1 | Questions and Answers at the end
of the page with explanations | Fall 2025/2026 Update
| 100% Correct.
Question 1
Question: Identify the different dopamine pathways and what role each pathway
plays in relation to schizophrenia/psychosis symptoms and treatment.
-Answer- :
1. Mesolimbic Pathway: Associated with the 'reward' system; overactivity is
linked to the positive symptoms of schizophrenia (hallucinations,
delusions).
2. Mesocortical Pathway: Impacts the prefrontal cortex; underactivity is
associated with negative symptoms (apathy, social withdrawal).
3. Nigrostriatal Pathway: Primarily involved in motor control; blockade by
antipsychotics causes Extrapyramidal Symptoms (EPS).
4. Tuberoinfundibular Pathway: Regulates prolactin secretion; blockade leads
to hyperprolactinemia (galactorrhea, sexual dysfunction).
Explanation: Understanding these pathways is key to the "dopamine hypothesis"
of schizophrenia and explains both the therapeutic effects and side effects of
antipsychotics. Antipsychotics work mainly by blocking dopamine D2 receptors in
the mesolimbic pathway to reduce positive symptoms. However, blocking the
other pathways leads to the major side effects: negative symptoms can worsen
from mesocortical blockade, movement disorders from nigrostriatal blockade,
and hormonal issues from tuberoinfundibular blockade.
,Question 2
Question: Identify potential medical emergencies associated with antipsychotic
medications such as neuroleptic malignant syndrome, and how to manage these
emergencies.
-Answer- :
• Neuroleptic Malignant Syndrome (NMS): A life-threatening reaction
characterized by muscle rigidity, fever, altered mental status, and
autonomic dysfunction.
• Management: Immediate discontinuation of the antipsychotic, intensive
supportive care (often in ICU), and treatment with medications like
dantrolene or bromocriptine.
Explanation: NMS is a rare but deadly complication of dopamine blockade. It's a
medical emergency because it can lead to rhabdomyolysis, kidney failure, and
death. Management focuses on stopping the cause, aggressive supportive
measures (cooling, hydration, respiratory support), and using specific drugs to
reverse the dopamine blockade and severe muscle rigidity.
Question 3
Question: Know the following medication, including its most commonly expected
side effects, drug interactions, potentially serious adverse events, FDA indications,
and lab work that should be monitored prior to starting and while on the
medication: Aripiprazole.
-Answer- :
• FDA Indications: Schizophrenia, bipolar disorder, major depressive disorder
(adjunct), irritability associated with autistic disorder.
• Common Side Effects: Headache, anxiety, insomnia, nausea, dizziness,
akathisia.
• Serious Adverse Events: Risk of stroke in elderly patients with dementia-
related psychosis; tardive dyskinesia; NMS.
, • Drug Interactions: Other CNS depressants; strong inhibitors or inducers of
CYP3A4 and CYP2D6 enzymes.
• Monitoring: Assess for worsening psychiatric condition, signs of tardive
dyskinesia, and metabolic changes (weight, blood glucose, lipids).
Explanation: Aripiprazole is unique as a partial dopamine agonist, meaning it
stabilizes rather than just blocks dopamine. This gives it a different side effect
profile—lower risk of sedation and metabolic issues, but a notable risk of
akathisia (inner restlessness). Its metabolism via CYP3A4 and CYP2D6 means co-
administration with drugs that affect these enzymes (e.g., certain
antidepressants, antifungals) requires careful dose adjustment.
Question 4
Question: Know the following medication...: Brexpiprazole.
-Answer- :
• FDA Indications: Schizophrenia; adjunct treatment for major depressive
disorder (MDD).
• Common Side Effects: Weight gain, sedation, headache, gastrointestinal
disturbances (constipation, nausea).
• Serious Adverse Events: Metabolic changes (increased
cholesterol/glucose); slight risk of stroke in elderly with dementia-related
psychosis.
• Drug Interactions: Other CNS depressants; strong inhibitors or inducers of
CYP3A4 and CYP2D6 enzymes.
• Monitoring: Metabolic parameters (weight, glucose, lipids).
Explanation: Brexpiprazole is structurally similar to aripiprazole (also a partial
agonist) and is often used when aripiprazole causes activating side effects like
akathisia, as brexpiprazole is generally more sedating. It shares the same
metabolic pathways, so drug interaction concerns are identical.
, Question 5
Question: Know the following medication...: Chlorpromazine.
-Answer- :
• FDA Indications: Schizophrenia, manic phases of bipolar disorder, severe
behavioral problems.
• Common Side Effects: Significant sedation, dry mouth, blurred vision,
constipation, orthostatic hypotension, EPS.
• Serious Adverse Events: Severe EPS, tardive dyskinesia, NMS,
cardiovascular effects.
• Drug Interactions: Other CNS depressants, anticholinergic agents, drugs
affecting CYP450 enzymes.
• Monitoring: Movement disorders, metabolic changes, cardiovascular
stability (blood pressure).
Explanation: Chlorpromazine is the prototypical low-potency first-generation
antipsychotic. "Low potency" means it requires a higher milligram dose for effect
and has strong affinity for receptors other than D2, leading to
prominent anticholinergic (dry mouth, constipation) and antiadrenergic (low
blood pressure, sedation) side effects, but a relatively lower risk of acute EPS
compared to high-potency drugs like haloperidol.
Question 6
Question: Know the following medication...: Clozapine.
-Answer- :
• FDA Indications: Treatment-resistant schizophrenia; reducing risk of
recurrent suicidal behavior in schizophrenia/schizoaffective disorder.
• Common Side Effects: Sedation, hypersalivation, constipation, weight gain.
• Serious Adverse Events: Agranulocytosis, myocarditis, seizures, severe
constipation/paralytic ileus.
of the page with explanations | Fall 2025/2026 Update
| 100% Correct.
Question 1
Question: Identify the different dopamine pathways and what role each pathway
plays in relation to schizophrenia/psychosis symptoms and treatment.
-Answer- :
1. Mesolimbic Pathway: Associated with the 'reward' system; overactivity is
linked to the positive symptoms of schizophrenia (hallucinations,
delusions).
2. Mesocortical Pathway: Impacts the prefrontal cortex; underactivity is
associated with negative symptoms (apathy, social withdrawal).
3. Nigrostriatal Pathway: Primarily involved in motor control; blockade by
antipsychotics causes Extrapyramidal Symptoms (EPS).
4. Tuberoinfundibular Pathway: Regulates prolactin secretion; blockade leads
to hyperprolactinemia (galactorrhea, sexual dysfunction).
Explanation: Understanding these pathways is key to the "dopamine hypothesis"
of schizophrenia and explains both the therapeutic effects and side effects of
antipsychotics. Antipsychotics work mainly by blocking dopamine D2 receptors in
the mesolimbic pathway to reduce positive symptoms. However, blocking the
other pathways leads to the major side effects: negative symptoms can worsen
from mesocortical blockade, movement disorders from nigrostriatal blockade,
and hormonal issues from tuberoinfundibular blockade.
,Question 2
Question: Identify potential medical emergencies associated with antipsychotic
medications such as neuroleptic malignant syndrome, and how to manage these
emergencies.
-Answer- :
• Neuroleptic Malignant Syndrome (NMS): A life-threatening reaction
characterized by muscle rigidity, fever, altered mental status, and
autonomic dysfunction.
• Management: Immediate discontinuation of the antipsychotic, intensive
supportive care (often in ICU), and treatment with medications like
dantrolene or bromocriptine.
Explanation: NMS is a rare but deadly complication of dopamine blockade. It's a
medical emergency because it can lead to rhabdomyolysis, kidney failure, and
death. Management focuses on stopping the cause, aggressive supportive
measures (cooling, hydration, respiratory support), and using specific drugs to
reverse the dopamine blockade and severe muscle rigidity.
Question 3
Question: Know the following medication, including its most commonly expected
side effects, drug interactions, potentially serious adverse events, FDA indications,
and lab work that should be monitored prior to starting and while on the
medication: Aripiprazole.
-Answer- :
• FDA Indications: Schizophrenia, bipolar disorder, major depressive disorder
(adjunct), irritability associated with autistic disorder.
• Common Side Effects: Headache, anxiety, insomnia, nausea, dizziness,
akathisia.
• Serious Adverse Events: Risk of stroke in elderly patients with dementia-
related psychosis; tardive dyskinesia; NMS.
, • Drug Interactions: Other CNS depressants; strong inhibitors or inducers of
CYP3A4 and CYP2D6 enzymes.
• Monitoring: Assess for worsening psychiatric condition, signs of tardive
dyskinesia, and metabolic changes (weight, blood glucose, lipids).
Explanation: Aripiprazole is unique as a partial dopamine agonist, meaning it
stabilizes rather than just blocks dopamine. This gives it a different side effect
profile—lower risk of sedation and metabolic issues, but a notable risk of
akathisia (inner restlessness). Its metabolism via CYP3A4 and CYP2D6 means co-
administration with drugs that affect these enzymes (e.g., certain
antidepressants, antifungals) requires careful dose adjustment.
Question 4
Question: Know the following medication...: Brexpiprazole.
-Answer- :
• FDA Indications: Schizophrenia; adjunct treatment for major depressive
disorder (MDD).
• Common Side Effects: Weight gain, sedation, headache, gastrointestinal
disturbances (constipation, nausea).
• Serious Adverse Events: Metabolic changes (increased
cholesterol/glucose); slight risk of stroke in elderly with dementia-related
psychosis.
• Drug Interactions: Other CNS depressants; strong inhibitors or inducers of
CYP3A4 and CYP2D6 enzymes.
• Monitoring: Metabolic parameters (weight, glucose, lipids).
Explanation: Brexpiprazole is structurally similar to aripiprazole (also a partial
agonist) and is often used when aripiprazole causes activating side effects like
akathisia, as brexpiprazole is generally more sedating. It shares the same
metabolic pathways, so drug interaction concerns are identical.
, Question 5
Question: Know the following medication...: Chlorpromazine.
-Answer- :
• FDA Indications: Schizophrenia, manic phases of bipolar disorder, severe
behavioral problems.
• Common Side Effects: Significant sedation, dry mouth, blurred vision,
constipation, orthostatic hypotension, EPS.
• Serious Adverse Events: Severe EPS, tardive dyskinesia, NMS,
cardiovascular effects.
• Drug Interactions: Other CNS depressants, anticholinergic agents, drugs
affecting CYP450 enzymes.
• Monitoring: Movement disorders, metabolic changes, cardiovascular
stability (blood pressure).
Explanation: Chlorpromazine is the prototypical low-potency first-generation
antipsychotic. "Low potency" means it requires a higher milligram dose for effect
and has strong affinity for receptors other than D2, leading to
prominent anticholinergic (dry mouth, constipation) and antiadrenergic (low
blood pressure, sedation) side effects, but a relatively lower risk of acute EPS
compared to high-potency drugs like haloperidol.
Question 6
Question: Know the following medication...: Clozapine.
-Answer- :
• FDA Indications: Treatment-resistant schizophrenia; reducing risk of
recurrent suicidal behavior in schizophrenia/schizoaffective disorder.
• Common Side Effects: Sedation, hypersalivation, constipation, weight gain.
• Serious Adverse Events: Agranulocytosis, myocarditis, seizures, severe
constipation/paralytic ileus.
