NURS 6630 Final Exam (2024) Walden
University – Question and Answers.docx
NURS 6630 Psychopharmacology Final Exam Study Guide (Questions 1-100)
1. A 32-year-old patient with major depressive disorder (MDD) has been on
sertraline (Zoloft) for 6 weeks with minimal improvement. The provider decides
to switch to venlafaxine (Effexor XR). What is the primary pharmacological
advantage of this switch?
A) Venlafaxine has a shorter half-life, allowing for quicker titration.
B) Venlafaxine inhibits both serotonin and norepinephrine reuptake (SNRI),
offering a dual mechanism of action.
C) Venlafaxine is less likely to cause sexual dysfunction.
D) Venlafaxine does not interact with the CYP450 enzyme system.
Answer: B) Venlafaxine inhibits both serotonin and norepinephrine reuptake
(SNRI), offering a dual mechanism of action.
Explanation:
• Mechanism of Action: Sertraline is a selective serotonin reuptake inhibitor
(SSRI), blocking only the serotonin transporter (SERT). Venlafaxine is a
serotonin-norepinephrine reuptake inhibitor (SNRI). At lower doses, it
primarily affects serotonin, but at therapeutic doses (above 150 mg), it
significantly blocks both SERT and the norepinephrine transporter (NET).
This dual action can be effective for patients who do not respond to a
single-neurotransmitter agent.
• Neurotransmitters: By increasing both serotonin and norepinephrine in the
synapse, venlafaxine addresses a broader range of depressive symptoms.
Norepinephrine potentiation is particularly associated with improved
, energy, focus, and interest (anhedonia), which may not fully respond to
SSRIs alone.
• Receptor Activity: Unlike some older antidepressants (TCAs), venlafaxine
has minimal affinity for histaminergic, cholinergic, or alpha-adrenergic
receptors, leading to a different side effect profile.
• Side Effects: Common side effects include nausea, insomnia, sweating, and
sexual dysfunction. At higher doses, venlafaxine can cause a sustained
increase in blood pressure due to norepinephrine reuptake inhibition,
requiring regular monitoring.
• Nursing Implications: The nurse should educate the patient to monitor
blood pressure regularly, especially after dose increases. Abrupt
discontinuation should be avoided due to a discontinuation syndrome
(dizziness, "brain zaps," nausea) resulting from the short half-life of the
active metabolite.
2. A patient with schizophrenia has been non-compliant with oral antipsychotics
due to significant weight gain and sedation. Which of the following long-acting
injectable (LAI) antipsychotics is most likely to minimize these metabolic side
effects?
A) Paliperidone palmitate (Invega Sustenna)
B) Aripiprazole monohydrate (Abilify Maintena)
C) Olanzapine pamoate (Zyprexa Relprevv)
D) Haloperidol decanoate (Haldol DA)
Answer: B) Aripiprazole monohydrate (Abilify Maintena)
Explanation:
• Mechanism of Action: Aripiprazole is a partial dopamine D2 and serotonin
5-HT1A receptor agonist and a 5-HT2A receptor antagonist. This unique
mechanism stabilizes the dopamine system rather than completely blocking
it.
• Receptor Activity (Metabolic Profile):
, o Histamine H1: Aripiprazole has very low affinity for histamine
receptors, resulting in minimal sedation compared to options like
olanzapine.
o Serotonin 5-HT2C: Antagonism at this receptor is linked to weight
gain. Aripiprazole has minimal 5-HT2C antagonism.
o Metabolic Side Effects: Compared to olanzapine and paliperidone,
aripiprazole is considered "metabolically friendly," with a lower risk
of significant weight gain, dyslipidemia, and hyperglycemia.
• Comparison of Options:
o A (Paliperidone): An active metabolite of risperidone. Effective but
carries moderate risk of weight gain, hyperprolactinemia, and
metabolic changes.
o B (Aripiprazole): Best metabolic profile of the options listed.
o C (Olanzapine): Highest risk of weight gain, metabolic syndrome, and
sedation due to strong H1 and 5-HT2C antagonism.
o D (Haloperidol): High potency first-generation (typical) antipsychotic.
Low metabolic risk, but high risk of extrapyramidal symptoms (EPS)
and tardive dyskinesia (TD), which also affects compliance.
• Nursing Implications: When initiating LAIs, the nurse must ensure the
patient has tolerated the oral formulation first. For aripiprazole, the patient
must be enrolled in the patient registry program due to the risk of post-
injection delirium/sedation syndrome (although this is more specific to the
older formulation).
3. A patient with bipolar I disorder is being discharged on lithium (Lithobid).
Which of the following statements by the patient indicates a need for further
teaching regarding lithium toxicity?
A) "I should call my provider if I experience persistent diarrhea or vomiting."
B) "I need to maintain a consistent intake of salt and fluids."
, C) "It is safe to take ibuprofen (Motrin) for headaches while on lithium."
D) "I will schedule regular blood tests to monitor my lithium levels."
Answer: C) "It is safe to take ibuprofen (Motrin) for headaches while on lithium."
Explanation:
• Mechanism of Action: Lithium is a mood stabilizer used for acute mania
and maintenance in bipolar disorder. Its exact mechanism is unknown but
involves modulation of intracellular second messenger systems (inositol
depletion) and neurotransmitter release.
• Drug-Drug Interactions (Pharmacokinetics): Nonsteroidal anti-
inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and COX-2 inhibitors
decrease the renal clearance of lithium by inhibiting prostaglandin
synthesis, which affects renal blood flow and sodium reabsorption. This
leads to increased lithium levels and risk of toxicity.
• Risk Factors for Toxicity: Lithium has a narrow therapeutic index (0.6-1.2
mEq/L for maintenance). Toxicity is exacerbated by:
o Dehydration (fluid loss from sweating, diarrhea, vomiting).
o Sodium depletion (low salt diet).
o Reduced renal function.
o Drug interactions (NSAIDs, thiazide diuretics, ACE inhibitors).
• Signs of Toxicity: Early signs include nausea, vomiting, diarrhea, lethargy,
fine hand tremor, and muscle weakness. Severe toxicity leads to coarse
tremor, ataxia, confusion, seizures, and coma.
• Nursing Implications: Educate patients to avoid NSAIDs, use
acetaminophen cautiously instead, maintain hydration, and report any
signs of infection/illness that cause fluid loss immediately.
4. A patient is started on quetiapine (Seroquel) for bipolar depression. The
nurse understands that this medication's efficacy in depression is primarily
attributed to its active metabolite's activity at which receptor?
University – Question and Answers.docx
NURS 6630 Psychopharmacology Final Exam Study Guide (Questions 1-100)
1. A 32-year-old patient with major depressive disorder (MDD) has been on
sertraline (Zoloft) for 6 weeks with minimal improvement. The provider decides
to switch to venlafaxine (Effexor XR). What is the primary pharmacological
advantage of this switch?
A) Venlafaxine has a shorter half-life, allowing for quicker titration.
B) Venlafaxine inhibits both serotonin and norepinephrine reuptake (SNRI),
offering a dual mechanism of action.
C) Venlafaxine is less likely to cause sexual dysfunction.
D) Venlafaxine does not interact with the CYP450 enzyme system.
Answer: B) Venlafaxine inhibits both serotonin and norepinephrine reuptake
(SNRI), offering a dual mechanism of action.
Explanation:
• Mechanism of Action: Sertraline is a selective serotonin reuptake inhibitor
(SSRI), blocking only the serotonin transporter (SERT). Venlafaxine is a
serotonin-norepinephrine reuptake inhibitor (SNRI). At lower doses, it
primarily affects serotonin, but at therapeutic doses (above 150 mg), it
significantly blocks both SERT and the norepinephrine transporter (NET).
This dual action can be effective for patients who do not respond to a
single-neurotransmitter agent.
• Neurotransmitters: By increasing both serotonin and norepinephrine in the
synapse, venlafaxine addresses a broader range of depressive symptoms.
Norepinephrine potentiation is particularly associated with improved
, energy, focus, and interest (anhedonia), which may not fully respond to
SSRIs alone.
• Receptor Activity: Unlike some older antidepressants (TCAs), venlafaxine
has minimal affinity for histaminergic, cholinergic, or alpha-adrenergic
receptors, leading to a different side effect profile.
• Side Effects: Common side effects include nausea, insomnia, sweating, and
sexual dysfunction. At higher doses, venlafaxine can cause a sustained
increase in blood pressure due to norepinephrine reuptake inhibition,
requiring regular monitoring.
• Nursing Implications: The nurse should educate the patient to monitor
blood pressure regularly, especially after dose increases. Abrupt
discontinuation should be avoided due to a discontinuation syndrome
(dizziness, "brain zaps," nausea) resulting from the short half-life of the
active metabolite.
2. A patient with schizophrenia has been non-compliant with oral antipsychotics
due to significant weight gain and sedation. Which of the following long-acting
injectable (LAI) antipsychotics is most likely to minimize these metabolic side
effects?
A) Paliperidone palmitate (Invega Sustenna)
B) Aripiprazole monohydrate (Abilify Maintena)
C) Olanzapine pamoate (Zyprexa Relprevv)
D) Haloperidol decanoate (Haldol DA)
Answer: B) Aripiprazole monohydrate (Abilify Maintena)
Explanation:
• Mechanism of Action: Aripiprazole is a partial dopamine D2 and serotonin
5-HT1A receptor agonist and a 5-HT2A receptor antagonist. This unique
mechanism stabilizes the dopamine system rather than completely blocking
it.
• Receptor Activity (Metabolic Profile):
, o Histamine H1: Aripiprazole has very low affinity for histamine
receptors, resulting in minimal sedation compared to options like
olanzapine.
o Serotonin 5-HT2C: Antagonism at this receptor is linked to weight
gain. Aripiprazole has minimal 5-HT2C antagonism.
o Metabolic Side Effects: Compared to olanzapine and paliperidone,
aripiprazole is considered "metabolically friendly," with a lower risk
of significant weight gain, dyslipidemia, and hyperglycemia.
• Comparison of Options:
o A (Paliperidone): An active metabolite of risperidone. Effective but
carries moderate risk of weight gain, hyperprolactinemia, and
metabolic changes.
o B (Aripiprazole): Best metabolic profile of the options listed.
o C (Olanzapine): Highest risk of weight gain, metabolic syndrome, and
sedation due to strong H1 and 5-HT2C antagonism.
o D (Haloperidol): High potency first-generation (typical) antipsychotic.
Low metabolic risk, but high risk of extrapyramidal symptoms (EPS)
and tardive dyskinesia (TD), which also affects compliance.
• Nursing Implications: When initiating LAIs, the nurse must ensure the
patient has tolerated the oral formulation first. For aripiprazole, the patient
must be enrolled in the patient registry program due to the risk of post-
injection delirium/sedation syndrome (although this is more specific to the
older formulation).
3. A patient with bipolar I disorder is being discharged on lithium (Lithobid).
Which of the following statements by the patient indicates a need for further
teaching regarding lithium toxicity?
A) "I should call my provider if I experience persistent diarrhea or vomiting."
B) "I need to maintain a consistent intake of salt and fluids."
, C) "It is safe to take ibuprofen (Motrin) for headaches while on lithium."
D) "I will schedule regular blood tests to monitor my lithium levels."
Answer: C) "It is safe to take ibuprofen (Motrin) for headaches while on lithium."
Explanation:
• Mechanism of Action: Lithium is a mood stabilizer used for acute mania
and maintenance in bipolar disorder. Its exact mechanism is unknown but
involves modulation of intracellular second messenger systems (inositol
depletion) and neurotransmitter release.
• Drug-Drug Interactions (Pharmacokinetics): Nonsteroidal anti-
inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and COX-2 inhibitors
decrease the renal clearance of lithium by inhibiting prostaglandin
synthesis, which affects renal blood flow and sodium reabsorption. This
leads to increased lithium levels and risk of toxicity.
• Risk Factors for Toxicity: Lithium has a narrow therapeutic index (0.6-1.2
mEq/L for maintenance). Toxicity is exacerbated by:
o Dehydration (fluid loss from sweating, diarrhea, vomiting).
o Sodium depletion (low salt diet).
o Reduced renal function.
o Drug interactions (NSAIDs, thiazide diuretics, ACE inhibitors).
• Signs of Toxicity: Early signs include nausea, vomiting, diarrhea, lethargy,
fine hand tremor, and muscle weakness. Severe toxicity leads to coarse
tremor, ataxia, confusion, seizures, and coma.
• Nursing Implications: Educate patients to avoid NSAIDs, use
acetaminophen cautiously instead, maintain hydration, and report any
signs of infection/illness that cause fluid loss immediately.
4. A patient is started on quetiapine (Seroquel) for bipolar depression. The
nurse understands that this medication's efficacy in depression is primarily
attributed to its active metabolite's activity at which receptor?
