NURS 660 Exam 4 V3 | NURS 660
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 4 2026)
1. Which of the following stimulants is classified as a prodrug, designed to minimize abuse
potential by requiring enzymatic conversion in the blood?
A. Methylphenidate (Ritalin)
B. Lisdexamfetamine (Vyvanse)
C. Mixed Amphetamine Salts (Adderall)
D. Dexmethylphenidate (Focalin)
Answer: B
Rationale: Lisdexamfetamine is a prodrug that is inactive until it is converted to l-lysine
and d-amphetamine by red blood cell enzymes. This pharmacokinetic property results in a
slower onset of action and reduces the likelihood of a ‘high’ if the medication is snorted or
injected. Because the conversion process is rate-limited by the body’s internal enzymes, it
provides a consistent therapeutic effect throughout the day.
,2. A 72-year-old patient with Alzheimer’s dementia and a history of bradycardia is being
considered for cognitive enhancement therapy. Which medication should be used with
extreme caution due to its side effect profile?
A. Donepezil (Aricept)
B. Memantine (Namenda)
C. Aripiprazole (Abilify)
D. Sertraline (Zoloft)
Answer: A
Rationale: Donepezil is a cholinesterase inhibitor that increases vagal tone and can cause
significant bradycardia or heart block. In geriatric patients with pre-existing conduction
issues, this can lead to syncope or falls. Clinical guidelines recommend monitoring the
pulse and performing an EKG if cardiac history is significant before starting this class of
medication.
3. Which non-stimulant medication for ADHD acts as a selective norepinephrine reuptake
inhibitor (SNRI) and is not classified as a controlled substance?
A. Guanfacine (Intuniv)
B. Modafinil (Provigil)
C. Clonidine (Kapvay)
D. Atomoxetine (Strattera)
,Answer: D
Rationale: Atomoxetine works by selectively inhibiting the presynaptic norepinephrine
transporter in the prefrontal cortex. Unlike stimulants, it does not increase dopamine in the
nucleus accumbens, which explains its lack of abuse potential. It is often a first-line choice
for patients with ADHD who also have a history of substance use disorders.
4. A 10-year-old child is being treated for irritability associated with Autism Spectrum
Disorder (ASD). Which medication is FDA-approved specifically for this indication in pediatric
patients?
A. Fluoxetine (Prozac)
B. Lithium
C. Risperidone (Risperdal)
D. Methylphenidate (Concert)
Answer: C
Rationale: Risperidone and Aripiprazole are the only two atypical antipsychotics FDA-
approved for the treatment of irritability and aggression in children with Autism. These
medications help manage symptoms such as temper tantrums, self-injurious behavior, and
aggression toward others. Close monitoring for metabolic side effects like weight gain and
hyperprolactinemia is required.
, 5. Which medication used for Alcohol Use Disorder (AUD) acts by inhibiting aldehyde
dehydrogenase, leading to a physical reaction if alcohol is consumed?
A. Naltrexone (ReVia)
B. Disulfiram (Antabuse)
C. Acamprosate (Campral)
D. Topiramate (Topamax)
Answer: B
Rationale: Disulfiram is an aversive agent that causes a build-up of acetaldehyde when
alcohol is ingested. This results in unpleasant symptoms including flushing, nausea, and
tachycardia, which serves as a deterrent. It is most effective when administered under
supervision in highly motivated patients.
6. In the geriatric population, which antidepressant is often avoided due to its high
anticholinergic activity and risk of causing orthostatic hypotension?
A. Escitalopram (Lexapro)
B. Bupropion (Wellbutrin)
C. Amitriptyline (Elavil)
D. Venlafaxine (Effexor)
Answer: C
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 4 2026)
1. Which of the following stimulants is classified as a prodrug, designed to minimize abuse
potential by requiring enzymatic conversion in the blood?
A. Methylphenidate (Ritalin)
B. Lisdexamfetamine (Vyvanse)
C. Mixed Amphetamine Salts (Adderall)
D. Dexmethylphenidate (Focalin)
Answer: B
Rationale: Lisdexamfetamine is a prodrug that is inactive until it is converted to l-lysine
and d-amphetamine by red blood cell enzymes. This pharmacokinetic property results in a
slower onset of action and reduces the likelihood of a ‘high’ if the medication is snorted or
injected. Because the conversion process is rate-limited by the body’s internal enzymes, it
provides a consistent therapeutic effect throughout the day.
,2. A 72-year-old patient with Alzheimer’s dementia and a history of bradycardia is being
considered for cognitive enhancement therapy. Which medication should be used with
extreme caution due to its side effect profile?
A. Donepezil (Aricept)
B. Memantine (Namenda)
C. Aripiprazole (Abilify)
D. Sertraline (Zoloft)
Answer: A
Rationale: Donepezil is a cholinesterase inhibitor that increases vagal tone and can cause
significant bradycardia or heart block. In geriatric patients with pre-existing conduction
issues, this can lead to syncope or falls. Clinical guidelines recommend monitoring the
pulse and performing an EKG if cardiac history is significant before starting this class of
medication.
3. Which non-stimulant medication for ADHD acts as a selective norepinephrine reuptake
inhibitor (SNRI) and is not classified as a controlled substance?
A. Guanfacine (Intuniv)
B. Modafinil (Provigil)
C. Clonidine (Kapvay)
D. Atomoxetine (Strattera)
,Answer: D
Rationale: Atomoxetine works by selectively inhibiting the presynaptic norepinephrine
transporter in the prefrontal cortex. Unlike stimulants, it does not increase dopamine in the
nucleus accumbens, which explains its lack of abuse potential. It is often a first-line choice
for patients with ADHD who also have a history of substance use disorders.
4. A 10-year-old child is being treated for irritability associated with Autism Spectrum
Disorder (ASD). Which medication is FDA-approved specifically for this indication in pediatric
patients?
A. Fluoxetine (Prozac)
B. Lithium
C. Risperidone (Risperdal)
D. Methylphenidate (Concert)
Answer: C
Rationale: Risperidone and Aripiprazole are the only two atypical antipsychotics FDA-
approved for the treatment of irritability and aggression in children with Autism. These
medications help manage symptoms such as temper tantrums, self-injurious behavior, and
aggression toward others. Close monitoring for metabolic side effects like weight gain and
hyperprolactinemia is required.
, 5. Which medication used for Alcohol Use Disorder (AUD) acts by inhibiting aldehyde
dehydrogenase, leading to a physical reaction if alcohol is consumed?
A. Naltrexone (ReVia)
B. Disulfiram (Antabuse)
C. Acamprosate (Campral)
D. Topiramate (Topamax)
Answer: B
Rationale: Disulfiram is an aversive agent that causes a build-up of acetaldehyde when
alcohol is ingested. This results in unpleasant symptoms including flushing, nausea, and
tachycardia, which serves as a deterrent. It is most effective when administered under
supervision in highly motivated patients.
6. In the geriatric population, which antidepressant is often avoided due to its high
anticholinergic activity and risk of causing orthostatic hypotension?
A. Escitalopram (Lexapro)
B. Bupropion (Wellbutrin)
C. Amitriptyline (Elavil)
D. Venlafaxine (Effexor)
Answer: C
