WGU — D345 Pharmacology
MRAHP · 543D
WGU
D345 Psychopharmacology, Drug Reactions & Toxicology
PHARM A NEW KIND OF U — EVIDENCE-BASED PHARMACOLOGY
WGU D345 — Pharmacology: Psychopharmacology &
Drug Reactions
CO M P L E T E Q U E ST I O N S & V E R I F I E D A N S W E RS | 1 9 3 Q U E ST I O N S | CO M P R E H E N S I V E
EXAM REVIEW
INSTITUTION Western Governors University COURSE CODE D345 — Pharmacology
(WGU)
PROGRAM Nursing / Advanced Pharmacology ACADEMIC YEAR
EXAM TITLE WGU D345 — Pharmacology | TOTAL QUESTIONS 193 Questions
Complete Questions & Verified
Answers
COURSE TITLE Advanced Psychopharmacology & FORMAT Multiple Choice — Select the
Drug Reactions Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover DRESS/TEN/SJS, antipsychotics, mood stabilizers, anxiolytics, ADHD medications,
dementia treatments, substance abuse, and CYP450 interactions.
▸ Correct answers and detailed clinical rationales appear below each question.
▸ Content sourced from Stahl, Carlat, and evidence-based psychopharmacology guidelines. Verify all
dosages with current prescribing references.
, SECTION I — WGU D345 COMPREHENSIVE
Questions 1 – 193
PHARMACOLOGY EXAMINATION
1. What D2 occupancy is associated with antipsychotic efficacy?
A. Approximately 30%-50%
B. Approximately 60%-80%
C. Approximately 90%-100%
D. Approximately 10%-20%
CORRECT ANSWER B — Approximately 60%-80%
RATIONALE Antipsychotic efficacy correlates with striatal D2 receptor occupancy of
approximately 60-80%. Below 60% occupancy, antipsychotic effect is typically
insufficient. This therapeutic window was established through PET imaging
studies. Most antipsychotics achieve this range at standard therapeutic doses.
This is a high-yield D345 concept linking receptor pharmacology to clinical
response.
2. What happens when D2 occupancy exceeds 80%?
A. Antipsychotic efficacy improves dramatically without adverse effects
B. EPS and hyperprolactinemia become more likely
C. Negative symptoms of schizophrenia resolve completely
D. Cognitive function significantly improves
CORRECT ANSWER B — EPS and hyperprolactinemia become more likely
RATIONALE D2 occupancy exceeding 80% in the nigrostriatal pathway causes extrapyramidal
symptoms (EPS), while excessive blockade in the tuberoinfundibular pathway
elevates prolactin (hyperprolactinemia). This ceiling effect explains why higher
antipsychotic doses do not produce greater efficacy but significantly increase
adverse effects. The narrow therapeutic window of 60-80% D2 occupancy is a
fundamental concept in antipsychotic pharmacology.
,3. What are extrapyramidal symptoms (EPS)?
A. Metabolic side effects of antipsychotics
B. Movement disorders caused by dopamine blockade in the nigrostriatal pathway
C. Gastrointestinal effects of SSRIs
D. Cardiac conduction abnormalities
CORRECT ANSWER B — Movement disorders caused by dopamine blockade in the
nigrostriatal pathway
RATIONALE EPS are movement disorders resulting from antipsychotic blockade of dopamine
D2 receptors in the nigrostriatal pathway. This disrupts the normal balance
between dopamine and acetylcholine in the basal ganglia. The four major EPS
syndromes are acute dystonia, pseudoparkinsonism, akathisia, and tardive
dyskinesia. EPS are more common with high-potency first-generation
antipsychotics (haloperidol, fluphenazine).
4. What are the four major EPS syndromes?
A. Serotonin syndrome, NMS, anticholinergic toxicity, and lithium toxicity
B. Acute dystonia, pseudoparkinsonism, akathisia, and tardive dyskinesia
C. Agranulocytosis, myocarditis, seizures, and ileus
D. Weight gain, diabetes, hyperlipidemia, and hypertension
CORRECT ANSWER B — Acute dystonia, pseudoparkinsonism, akathisia, and tardive
dyskinesia
RATIONALE The four major EPS syndromes are: (1) Acute dystonia — sudden sustained
muscle contractions (hours to days); (2) Pseudoparkinsonism — tremor, rigidity,
bradykinesia (days to weeks); (3) Akathisia — inner restlessness with inability to
remain still; (4) Tardive dyskinesia — late-onset involuntary repetitive
movements (months to years, may be irreversible). This classification is high-
yield for D345 and all psychopharmacology examinations.
, 5. What is acute dystonia?
A. Gradual onset of tremor and rigidity over weeks
B. Sudden sustained muscle contractions causing abnormal postures
C. Inner restlessness with pacing
D. Late-onset oral-facial movements
CORRECT ANSWER B — Sudden sustained muscle contractions causing abnormal postures
RATIONALE Acute dystonia is characterized by sudden, sustained, painful muscle
contractions causing abnormal postures — often involving the neck (torticollis),
eyes (oculogyric crisis), tongue, jaw, or back. It typically occurs within hours to
days of initiating or increasing antipsychotic dose, more commonly in young
males and with high-potency FGAs. Treatment is anticholinergics (benztropine
or diphenhydramine), which provide rapid relief.
6. What is oculogyric crisis?
A. Uncontrollable blinking
B. Upward deviation of the eyes due to dystonia
C. Rapid eye movements during sleep
D. Double vision from anticholinergic effects
CORRECT ANSWER B — Upward deviation of the eyes due to dystonia
RATIONALE Oculogyric crisis is a classic acute dystonic reaction where the eyes deviate
upward (or occasionally laterally or downward) and are fixed in that position due
to sustained contraction of extraocular muscles. It is distressing and frightening
for patients. It responds rapidly to anticholinergic treatment (benztropine or
diphenhydramine). Recognition is critical — it may be mistaken for a psychiatric
or neurological emergency when it is actually a readily treatable medication side
effect.
MRAHP · 543D
WGU
D345 Psychopharmacology, Drug Reactions & Toxicology
PHARM A NEW KIND OF U — EVIDENCE-BASED PHARMACOLOGY
WGU D345 — Pharmacology: Psychopharmacology &
Drug Reactions
CO M P L E T E Q U E ST I O N S & V E R I F I E D A N S W E RS | 1 9 3 Q U E ST I O N S | CO M P R E H E N S I V E
EXAM REVIEW
INSTITUTION Western Governors University COURSE CODE D345 — Pharmacology
(WGU)
PROGRAM Nursing / Advanced Pharmacology ACADEMIC YEAR
EXAM TITLE WGU D345 — Pharmacology | TOTAL QUESTIONS 193 Questions
Complete Questions & Verified
Answers
COURSE TITLE Advanced Psychopharmacology & FORMAT Multiple Choice — Select the
Drug Reactions Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover DRESS/TEN/SJS, antipsychotics, mood stabilizers, anxiolytics, ADHD medications,
dementia treatments, substance abuse, and CYP450 interactions.
▸ Correct answers and detailed clinical rationales appear below each question.
▸ Content sourced from Stahl, Carlat, and evidence-based psychopharmacology guidelines. Verify all
dosages with current prescribing references.
, SECTION I — WGU D345 COMPREHENSIVE
Questions 1 – 193
PHARMACOLOGY EXAMINATION
1. What D2 occupancy is associated with antipsychotic efficacy?
A. Approximately 30%-50%
B. Approximately 60%-80%
C. Approximately 90%-100%
D. Approximately 10%-20%
CORRECT ANSWER B — Approximately 60%-80%
RATIONALE Antipsychotic efficacy correlates with striatal D2 receptor occupancy of
approximately 60-80%. Below 60% occupancy, antipsychotic effect is typically
insufficient. This therapeutic window was established through PET imaging
studies. Most antipsychotics achieve this range at standard therapeutic doses.
This is a high-yield D345 concept linking receptor pharmacology to clinical
response.
2. What happens when D2 occupancy exceeds 80%?
A. Antipsychotic efficacy improves dramatically without adverse effects
B. EPS and hyperprolactinemia become more likely
C. Negative symptoms of schizophrenia resolve completely
D. Cognitive function significantly improves
CORRECT ANSWER B — EPS and hyperprolactinemia become more likely
RATIONALE D2 occupancy exceeding 80% in the nigrostriatal pathway causes extrapyramidal
symptoms (EPS), while excessive blockade in the tuberoinfundibular pathway
elevates prolactin (hyperprolactinemia). This ceiling effect explains why higher
antipsychotic doses do not produce greater efficacy but significantly increase
adverse effects. The narrow therapeutic window of 60-80% D2 occupancy is a
fundamental concept in antipsychotic pharmacology.
,3. What are extrapyramidal symptoms (EPS)?
A. Metabolic side effects of antipsychotics
B. Movement disorders caused by dopamine blockade in the nigrostriatal pathway
C. Gastrointestinal effects of SSRIs
D. Cardiac conduction abnormalities
CORRECT ANSWER B — Movement disorders caused by dopamine blockade in the
nigrostriatal pathway
RATIONALE EPS are movement disorders resulting from antipsychotic blockade of dopamine
D2 receptors in the nigrostriatal pathway. This disrupts the normal balance
between dopamine and acetylcholine in the basal ganglia. The four major EPS
syndromes are acute dystonia, pseudoparkinsonism, akathisia, and tardive
dyskinesia. EPS are more common with high-potency first-generation
antipsychotics (haloperidol, fluphenazine).
4. What are the four major EPS syndromes?
A. Serotonin syndrome, NMS, anticholinergic toxicity, and lithium toxicity
B. Acute dystonia, pseudoparkinsonism, akathisia, and tardive dyskinesia
C. Agranulocytosis, myocarditis, seizures, and ileus
D. Weight gain, diabetes, hyperlipidemia, and hypertension
CORRECT ANSWER B — Acute dystonia, pseudoparkinsonism, akathisia, and tardive
dyskinesia
RATIONALE The four major EPS syndromes are: (1) Acute dystonia — sudden sustained
muscle contractions (hours to days); (2) Pseudoparkinsonism — tremor, rigidity,
bradykinesia (days to weeks); (3) Akathisia — inner restlessness with inability to
remain still; (4) Tardive dyskinesia — late-onset involuntary repetitive
movements (months to years, may be irreversible). This classification is high-
yield for D345 and all psychopharmacology examinations.
, 5. What is acute dystonia?
A. Gradual onset of tremor and rigidity over weeks
B. Sudden sustained muscle contractions causing abnormal postures
C. Inner restlessness with pacing
D. Late-onset oral-facial movements
CORRECT ANSWER B — Sudden sustained muscle contractions causing abnormal postures
RATIONALE Acute dystonia is characterized by sudden, sustained, painful muscle
contractions causing abnormal postures — often involving the neck (torticollis),
eyes (oculogyric crisis), tongue, jaw, or back. It typically occurs within hours to
days of initiating or increasing antipsychotic dose, more commonly in young
males and with high-potency FGAs. Treatment is anticholinergics (benztropine
or diphenhydramine), which provide rapid relief.
6. What is oculogyric crisis?
A. Uncontrollable blinking
B. Upward deviation of the eyes due to dystonia
C. Rapid eye movements during sleep
D. Double vision from anticholinergic effects
CORRECT ANSWER B — Upward deviation of the eyes due to dystonia
RATIONALE Oculogyric crisis is a classic acute dystonic reaction where the eyes deviate
upward (or occasionally laterally or downward) and are fixed in that position due
to sustained contraction of extraocular muscles. It is distressing and frightening
for patients. It responds rapidly to anticholinergic treatment (benztropine or
diphenhydramine). Recognition is critical — it may be mistaken for a psychiatric
or neurological emergency when it is actually a readily treatable medication side
effect.
