NR 546 Exam 4 V2 | NR 546 Advanced
Psychopharmacology | Chamberlain | Q&A
with Rationale (Chamberlain NR546 Exam
4)
1. A 24-year-old male is seeking treatment for opioid use disorder. Which statement correctly
describes the mechanism of action of buprenorphine?
A. It is a full mu-opioid agonist with a long half-life.
B. It is a pure opioid antagonist that blocks all receptors.
C. It is a partial mu-opioid agonist with high binding affinity.
D. It is a non-selective kappa-opioid agonist.
Answer: C
Rationale: Buprenorphine acts as a partial agonist at the mu-opioid receptor, which
provides a ceiling effect on respiratory depression and euphoria. Its high binding affinity
allows it to displace full agonists, which can potentially precipitate withdrawal if
administered too soon after a full agonist. This unique profile makes it a cornerstone in the
office-based treatment of opioid dependence.
2. When treating a patient with Alcohol Use Disorder, which medication is contraindicated in
a patient with severe renal impairment (CrCl < 30 mL/min)?
A. Naltrexone
,B. Disulfiram
C. Topiramate
D. Acamprosate
Answer: D
Rationale: Acamprosate is primarily excreted through the kidneys and is strictly
contraindicated in patients with a creatinine clearance of less than 30 mL/min. For patients
with moderate renal impairment (CrCl 30-50 mL/min), a dose reduction is required. It is,
however, an excellent option for patients with liver disease since it is not hepatically
metabolized.
3. A 10-year-old child is diagnosed with ADHD, Predominantly Inattentive Presentation. What
is the primary mechanism of action of methylphenidate?
A. It increases the release of dopamine from presynaptic vesicles.
B. It irreversibly inhibits monoamine oxidase enzymes.
C. It acts as a direct agonist at the alpha-2A adrenergic receptor.
D. It inhibits the reuptake of dopamine and norepinephrine via transporter blockade.
Answer: D
Rationale: Methylphenidate primarily works by blocking the reuptake of dopamine (DAT)
and norepinephrine (NET) in the prefrontal cortex. Unlike amphetamines, it does not
significantly increase the release of dopamine from storage vesicles. This blockade
,increases the availability of these neurotransmitters in the synaptic cleft to improve focus
and attention.
4. Which medication used for the treatment of insomnia acts as a dual orexin receptor
antagonist (DORA)?
A. Zolpidem
B. Suvorexant
C. Ramelteon
D. Eszopiclone
Answer: B
Rationale: Suvorexant is a dual orexin receptor antagonist that works by blocking OX1R
and OX2R, which are responsible for promoting wakefulness. By inhibiting the wake-
promoting system rather than just stimulating the sleep-promoting system, it helps
patients fall asleep and stay asleep. This represents a distinct pharmacological approach
compared to GABA-A receptor modulators like zolpidem.
5. A 75-year-old patient with Alzheimer’s disease is prescribed Memantine. What is the
mechanism of action for this medication?
A. Selective serotonin reuptake inhibition
B. Acetylcholinesterase inhibition in the synaptic cleft
C. Potentiation of GABAergic neurotransmission
, D. Uncompetitive NMDA receptor antagonism
Answer: D
Rationale: Memantine works as an uncompetitive, moderate-affinity NMDA receptor
antagonist. It blocks the low-level, pathological ‘noise’ of glutamate signaling that
contributes to excitotoxicity in Alzheimer’s disease. By allowing for normal physiological
signaling while preventing excessive calcium influx, it helps stabilize cognitive decline in
moderate to severe cases.
6. Which of the following is a potential side effect of Varenicline (Chantix) that requires
careful monitoring?
A. Severe weight gain and metabolic syndrome
B. Irreversible tardive dyskinesia
C. Neuropsychiatric symptoms including suicidal ideation
D. Acute angle-closure glaucoma
Answer: C
Rationale: Varenicline, a partial agonist at the alpha-4-beta-2 nicotinic acetylcholine
receptor, has been associated with neuropsychiatric side effects. Clinicians must monitor
patients for changes in behavior, hostility, agitation, and suicidal thoughts or actions. While
the black box warning was removed in 2016, vigilance remains a standard of care during
smoking cessation treatment.
Psychopharmacology | Chamberlain | Q&A
with Rationale (Chamberlain NR546 Exam
4)
1. A 24-year-old male is seeking treatment for opioid use disorder. Which statement correctly
describes the mechanism of action of buprenorphine?
A. It is a full mu-opioid agonist with a long half-life.
B. It is a pure opioid antagonist that blocks all receptors.
C. It is a partial mu-opioid agonist with high binding affinity.
D. It is a non-selective kappa-opioid agonist.
Answer: C
Rationale: Buprenorphine acts as a partial agonist at the mu-opioid receptor, which
provides a ceiling effect on respiratory depression and euphoria. Its high binding affinity
allows it to displace full agonists, which can potentially precipitate withdrawal if
administered too soon after a full agonist. This unique profile makes it a cornerstone in the
office-based treatment of opioid dependence.
2. When treating a patient with Alcohol Use Disorder, which medication is contraindicated in
a patient with severe renal impairment (CrCl < 30 mL/min)?
A. Naltrexone
,B. Disulfiram
C. Topiramate
D. Acamprosate
Answer: D
Rationale: Acamprosate is primarily excreted through the kidneys and is strictly
contraindicated in patients with a creatinine clearance of less than 30 mL/min. For patients
with moderate renal impairment (CrCl 30-50 mL/min), a dose reduction is required. It is,
however, an excellent option for patients with liver disease since it is not hepatically
metabolized.
3. A 10-year-old child is diagnosed with ADHD, Predominantly Inattentive Presentation. What
is the primary mechanism of action of methylphenidate?
A. It increases the release of dopamine from presynaptic vesicles.
B. It irreversibly inhibits monoamine oxidase enzymes.
C. It acts as a direct agonist at the alpha-2A adrenergic receptor.
D. It inhibits the reuptake of dopamine and norepinephrine via transporter blockade.
Answer: D
Rationale: Methylphenidate primarily works by blocking the reuptake of dopamine (DAT)
and norepinephrine (NET) in the prefrontal cortex. Unlike amphetamines, it does not
significantly increase the release of dopamine from storage vesicles. This blockade
,increases the availability of these neurotransmitters in the synaptic cleft to improve focus
and attention.
4. Which medication used for the treatment of insomnia acts as a dual orexin receptor
antagonist (DORA)?
A. Zolpidem
B. Suvorexant
C. Ramelteon
D. Eszopiclone
Answer: B
Rationale: Suvorexant is a dual orexin receptor antagonist that works by blocking OX1R
and OX2R, which are responsible for promoting wakefulness. By inhibiting the wake-
promoting system rather than just stimulating the sleep-promoting system, it helps
patients fall asleep and stay asleep. This represents a distinct pharmacological approach
compared to GABA-A receptor modulators like zolpidem.
5. A 75-year-old patient with Alzheimer’s disease is prescribed Memantine. What is the
mechanism of action for this medication?
A. Selective serotonin reuptake inhibition
B. Acetylcholinesterase inhibition in the synaptic cleft
C. Potentiation of GABAergic neurotransmission
, D. Uncompetitive NMDA receptor antagonism
Answer: D
Rationale: Memantine works as an uncompetitive, moderate-affinity NMDA receptor
antagonist. It blocks the low-level, pathological ‘noise’ of glutamate signaling that
contributes to excitotoxicity in Alzheimer’s disease. By allowing for normal physiological
signaling while preventing excessive calcium influx, it helps stabilize cognitive decline in
moderate to severe cases.
6. Which of the following is a potential side effect of Varenicline (Chantix) that requires
careful monitoring?
A. Severe weight gain and metabolic syndrome
B. Irreversible tardive dyskinesia
C. Neuropsychiatric symptoms including suicidal ideation
D. Acute angle-closure glaucoma
Answer: C
Rationale: Varenicline, a partial agonist at the alpha-4-beta-2 nicotinic acetylcholine
receptor, has been associated with neuropsychiatric side effects. Clinicians must monitor
patients for changes in behavior, hostility, agitation, and suicidal thoughts or actions. While
the black box warning was removed in 2016, vigilance remains a standard of care during
smoking cessation treatment.
