NR 546 Exam 1 V1 | NR 546 Advanced
Psychopharmacology | Chamberlain | Q&A
with Rationale (Chamberlain NR546 Exam
1)
1. A patient is currently taking a medication that is a known substrate of the CYP1A2 enzyme.
If the patient begins smoking heavily, how should the PMHNP adjust the dosage based on
pharmacokinetics?
A. Decrease the dose because smoking inhibits CYP1A2.
B. Increase the dose because smoking induces CYP1A2.
C. Keep the dose the same as smoking only affects CYP2D6.
D. Discontinue the medication immediately.
Answer: B
Rationale: Smoking introduces polycyclic aromatic hydrocarbons which act as potent
inducers of the CYP1A2 enzyme system. This induction increases the metabolism of drugs
that are substrates of 1A2, such as olanzapine or clozapine, leading to lower serum levels.
Therefore, an increase in dosage is often necessary to maintain therapeutic efficacy in
patients who smoke.
2. Which dopamine pathway is primarily responsible for the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Nigrostriatal pathway
,B. Tuberoinfundibular pathway
C. Mesocortical pathway
D. Mesolimbic pathway
Answer: D
Rationale: The mesolimbic dopamine pathway projects from the ventral tegmental area to
the nucleus accumbens and is associated with reward and motivation. Overactivity in this
specific pathway is hypothesized to mediate the positive symptoms of psychosis.
Antipsychotic medications typically target D2 receptors in this region to reduce these
symptoms.
3. A patient presents with high fever, muscle rigidity, and altered mental status after starting
Haloperidol. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Anticholinergic Toxicity
C. Neuroleptic Malignant Syndrome (NMS)
D. Acute Dystonia
Answer: C
Rationale: Neuroleptic Malignant Syndrome (NMS) is a rare but life-threatening reaction
to dopamine antagonists like Haloperidol. It is characterized by the ‘lead pipe’ rigidity,
, hyperpyrexia, and autonomic instability. This condition requires immediate
discontinuation of the offending agent and supportive care.
4. What is the primary mechanism of action for Selective Serotonin Reuptake Inhibitors
(SSRIs)?
A. Antagonizing 5-HT2A receptors
B. Increasing the breakdown of Serotonin by MAO
C. Inhibiting the Serotonin Transporter (SERT)
D. Agonizing Alpha-1 adrenergic receptors
Answer: C
Rationale: SSRIs work by binding to the serotonin transporter (SERT) and preventing the
reuptake of serotonin into the presynaptic neuron. This result in an increased
concentration of serotonin available in the synaptic cleft to bind to postsynaptic receptors.
Over time, this leads to downstream changes in receptor sensitivity and gene expression
that alleviate depressive symptoms.
5. Which term describes a drug that binds to a receptor and produces an effect that is
opposite to that of an agonist?
A. Partial Agonist
B. Antagonist
C. Allosteric Modulator
Psychopharmacology | Chamberlain | Q&A
with Rationale (Chamberlain NR546 Exam
1)
1. A patient is currently taking a medication that is a known substrate of the CYP1A2 enzyme.
If the patient begins smoking heavily, how should the PMHNP adjust the dosage based on
pharmacokinetics?
A. Decrease the dose because smoking inhibits CYP1A2.
B. Increase the dose because smoking induces CYP1A2.
C. Keep the dose the same as smoking only affects CYP2D6.
D. Discontinue the medication immediately.
Answer: B
Rationale: Smoking introduces polycyclic aromatic hydrocarbons which act as potent
inducers of the CYP1A2 enzyme system. This induction increases the metabolism of drugs
that are substrates of 1A2, such as olanzapine or clozapine, leading to lower serum levels.
Therefore, an increase in dosage is often necessary to maintain therapeutic efficacy in
patients who smoke.
2. Which dopamine pathway is primarily responsible for the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Nigrostriatal pathway
,B. Tuberoinfundibular pathway
C. Mesocortical pathway
D. Mesolimbic pathway
Answer: D
Rationale: The mesolimbic dopamine pathway projects from the ventral tegmental area to
the nucleus accumbens and is associated with reward and motivation. Overactivity in this
specific pathway is hypothesized to mediate the positive symptoms of psychosis.
Antipsychotic medications typically target D2 receptors in this region to reduce these
symptoms.
3. A patient presents with high fever, muscle rigidity, and altered mental status after starting
Haloperidol. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Anticholinergic Toxicity
C. Neuroleptic Malignant Syndrome (NMS)
D. Acute Dystonia
Answer: C
Rationale: Neuroleptic Malignant Syndrome (NMS) is a rare but life-threatening reaction
to dopamine antagonists like Haloperidol. It is characterized by the ‘lead pipe’ rigidity,
, hyperpyrexia, and autonomic instability. This condition requires immediate
discontinuation of the offending agent and supportive care.
4. What is the primary mechanism of action for Selective Serotonin Reuptake Inhibitors
(SSRIs)?
A. Antagonizing 5-HT2A receptors
B. Increasing the breakdown of Serotonin by MAO
C. Inhibiting the Serotonin Transporter (SERT)
D. Agonizing Alpha-1 adrenergic receptors
Answer: C
Rationale: SSRIs work by binding to the serotonin transporter (SERT) and preventing the
reuptake of serotonin into the presynaptic neuron. This result in an increased
concentration of serotonin available in the synaptic cleft to bind to postsynaptic receptors.
Over time, this leads to downstream changes in receptor sensitivity and gene expression
that alleviate depressive symptoms.
5. Which term describes a drug that binds to a receptor and produces an effect that is
opposite to that of an agonist?
A. Partial Agonist
B. Antagonist
C. Allosteric Modulator
