STNASSERPEDITNA · 543D
WGU
◆ ◆
Western Governors University
College of Health Professions — Psychiatric-Mental Health Nurse
D345
Practitioner
A NEW KIND OF U
EST. 1997
WGU D345 Psychopharmacology — Antidepressants
(Memorable Psychopharmacology)
SS R I S , S N R I S , TC A S , M AO I S , ATY P I C A L AG E N TS , AU G M E N TAT I O N & T R E AT M E N T-
R E S I STA N T D E P R E SS I O N
INSTITUTION Western Governors University PROGRAM MSN — Psychiatric-Mental Health
Nurse Practitioner
COURSE CODE D345 — Psychopharmacology COURSE TITLE Advanced Psychopharmacology
Across the Lifespan
ACADEMIC YEAR EXAM TITLE D345 Antidepressants —
Memorable Psychopharmacology
TOTAL QUESTIONS 42 Questions FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Content spans SSRIs, SNRIs, TCAs, MAOIs, atypical antidepressants, augmentation strategies, and
treatment-resistant depression.
▸ Questions reflect WGU D345 antidepressant pharmacology learning objectives and competency-based
assessment format.
▸ Correct answers and clinical rationales appear below each question for comprehensive test preparation.
▸ Questions have been randomized to promote active recall and simulate authentic testing conditions.
, SECTION I — D345 ANTIDEPRESSANTS: MECHANISMS,
Questions 1 – 42
CLINICAL PROFILES & AUGMENTATION
1. What are the SIGE CAPS symptoms used to diagnose a major depressive episode?
A. Suicidal thoughts, Irritability, Guilt, Energy increased, Concentration improved, Appetite
increased, Psychomotor agitation, Sleep increased
B. Sleep disturbance, Interest decreased, Guilt/hopelessness, Energy decreased,
Concentration impaired, Appetite decreased, Psychomotor retardation, Suicidal thoughts
C. Sleep increased, Interest increased, Guilt decreased, Energy increased, Concentration
improved, Appetite increased, Psychomotor agitation, Suicidal thoughts absent
D. Social withdrawal, Irritability, Grandiosity, Euphoria, Concentration impaired, Anhedonia,
Pressured speech, Sleep decreased
CORRECT ANSWER B — Sleep disturbance, Interest decreased, Guilt/hopelessness, Energy
decreased, Concentration impaired, Appetite decreased, Psychomotor
retardation, Suicidal thoughts
RATIONALE SIGE CAPS is the classic mnemonic for major depressive episode criteria: Sleep
disturbance (insomnia or hypersomnia), Interest decreased (anhedonia),
Guilt/hopelessness (feelings of worthlessness), Energy decreased (fatigue),
Concentration impaired (diminished ability to think), Appetite decreased (or
increased, with weight change), Psychomotor retardation (or agitation), and
Suicidal thoughts (recurrent thoughts of death). A diagnosis requires at least 5 of
9 symptoms present for a minimum of 2 weeks, with at least one symptom being
either depressed mood or anhedonia. This mnemonic is essential for accurate
diagnosis and is frequently tested on D345 and PMHNP board examinations.
,2. Fluoxetine (Prozac) is distinguished from other SSRIs by which pharmacokinetic property?
A. Extremely short half-life requiring twice-daily dosing
B. Long half-life — parent drug 4-6 days, active metabolite norfluoxetine up to 16 days
C. No hepatic metabolism — exclusively renally excreted
D. Requires therapeutic drug monitoring with every dose
CORRECT ANSWER B — Long half-life — parent drug 4-6 days, active metabolite norfluoxetine
up to 16 days
RATIONALE Fluoxetine has the longest half-life of all SSRIs. This has important clinical
implications: (1) Advantage — fluoxetine is the LEAST likely to cause
discontinuation symptoms if doses are missed or the medication is stopped; it
essentially self-tapers. (2) Disadvantage — fluoxetine requires approximately 5
weeks of washout before starting an MAOI to prevent serotonin syndrome, much
longer than the 14-day washout for other SSRIs. (3) When switching from
fluoxetine to another serotonergic agent, the long half-life must be considered to
avoid overlapping serotonergic effects. Fluoxetine also inhibits CYP2D6, affecting
metabolism of other medications. This pharmacokinetic profile is high-yield for
D345 and board examinations.
, 3. Paroxetine (Paxil) is characterized by which pharmacokinetic property?
A. Longest half-life among all SSRIs
B. Short half-life (>1 day) and rapidly absorbed
C. No CYP450 interactions
D. Exclusively renally eliminated without hepatic metabolism
CORRECT ANSWER B — Short half-life (>1 day) and rapidly absorbed
RATIONALE Paroxetine has the shortest half-life among SSRIs (approximately 21 hours) and
lacks an active metabolite. Combined with its rapid absorption, this produces the
highest risk of SSRI discontinuation syndrome — characterized by dizziness, brain
zaps, flu-like symptoms, anxiety, and insomnia when doses are missed or the
medication is stopped abruptly. Paroxetine is also a potent CYP2D6 inhibitor (like
fluoxetine), which can cause significant drug-drug interactions. Additionally,
paroxetine has the highest anticholinergic activity among SSRIs, contributing to
sedation, constipation, dry mouth, and cognitive effects — it appears on the Beers
Criteria as potentially inappropriate for older adults. It is also associated with
congenital cardiac defects and is generally avoided in pregnancy.
WGU
◆ ◆
Western Governors University
College of Health Professions — Psychiatric-Mental Health Nurse
D345
Practitioner
A NEW KIND OF U
EST. 1997
WGU D345 Psychopharmacology — Antidepressants
(Memorable Psychopharmacology)
SS R I S , S N R I S , TC A S , M AO I S , ATY P I C A L AG E N TS , AU G M E N TAT I O N & T R E AT M E N T-
R E S I STA N T D E P R E SS I O N
INSTITUTION Western Governors University PROGRAM MSN — Psychiatric-Mental Health
Nurse Practitioner
COURSE CODE D345 — Psychopharmacology COURSE TITLE Advanced Psychopharmacology
Across the Lifespan
ACADEMIC YEAR EXAM TITLE D345 Antidepressants —
Memorable Psychopharmacology
TOTAL QUESTIONS 42 Questions FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Content spans SSRIs, SNRIs, TCAs, MAOIs, atypical antidepressants, augmentation strategies, and
treatment-resistant depression.
▸ Questions reflect WGU D345 antidepressant pharmacology learning objectives and competency-based
assessment format.
▸ Correct answers and clinical rationales appear below each question for comprehensive test preparation.
▸ Questions have been randomized to promote active recall and simulate authentic testing conditions.
, SECTION I — D345 ANTIDEPRESSANTS: MECHANISMS,
Questions 1 – 42
CLINICAL PROFILES & AUGMENTATION
1. What are the SIGE CAPS symptoms used to diagnose a major depressive episode?
A. Suicidal thoughts, Irritability, Guilt, Energy increased, Concentration improved, Appetite
increased, Psychomotor agitation, Sleep increased
B. Sleep disturbance, Interest decreased, Guilt/hopelessness, Energy decreased,
Concentration impaired, Appetite decreased, Psychomotor retardation, Suicidal thoughts
C. Sleep increased, Interest increased, Guilt decreased, Energy increased, Concentration
improved, Appetite increased, Psychomotor agitation, Suicidal thoughts absent
D. Social withdrawal, Irritability, Grandiosity, Euphoria, Concentration impaired, Anhedonia,
Pressured speech, Sleep decreased
CORRECT ANSWER B — Sleep disturbance, Interest decreased, Guilt/hopelessness, Energy
decreased, Concentration impaired, Appetite decreased, Psychomotor
retardation, Suicidal thoughts
RATIONALE SIGE CAPS is the classic mnemonic for major depressive episode criteria: Sleep
disturbance (insomnia or hypersomnia), Interest decreased (anhedonia),
Guilt/hopelessness (feelings of worthlessness), Energy decreased (fatigue),
Concentration impaired (diminished ability to think), Appetite decreased (or
increased, with weight change), Psychomotor retardation (or agitation), and
Suicidal thoughts (recurrent thoughts of death). A diagnosis requires at least 5 of
9 symptoms present for a minimum of 2 weeks, with at least one symptom being
either depressed mood or anhedonia. This mnemonic is essential for accurate
diagnosis and is frequently tested on D345 and PMHNP board examinations.
,2. Fluoxetine (Prozac) is distinguished from other SSRIs by which pharmacokinetic property?
A. Extremely short half-life requiring twice-daily dosing
B. Long half-life — parent drug 4-6 days, active metabolite norfluoxetine up to 16 days
C. No hepatic metabolism — exclusively renally excreted
D. Requires therapeutic drug monitoring with every dose
CORRECT ANSWER B — Long half-life — parent drug 4-6 days, active metabolite norfluoxetine
up to 16 days
RATIONALE Fluoxetine has the longest half-life of all SSRIs. This has important clinical
implications: (1) Advantage — fluoxetine is the LEAST likely to cause
discontinuation symptoms if doses are missed or the medication is stopped; it
essentially self-tapers. (2) Disadvantage — fluoxetine requires approximately 5
weeks of washout before starting an MAOI to prevent serotonin syndrome, much
longer than the 14-day washout for other SSRIs. (3) When switching from
fluoxetine to another serotonergic agent, the long half-life must be considered to
avoid overlapping serotonergic effects. Fluoxetine also inhibits CYP2D6, affecting
metabolism of other medications. This pharmacokinetic profile is high-yield for
D345 and board examinations.
, 3. Paroxetine (Paxil) is characterized by which pharmacokinetic property?
A. Longest half-life among all SSRIs
B. Short half-life (>1 day) and rapidly absorbed
C. No CYP450 interactions
D. Exclusively renally eliminated without hepatic metabolism
CORRECT ANSWER B — Short half-life (>1 day) and rapidly absorbed
RATIONALE Paroxetine has the shortest half-life among SSRIs (approximately 21 hours) and
lacks an active metabolite. Combined with its rapid absorption, this produces the
highest risk of SSRI discontinuation syndrome — characterized by dizziness, brain
zaps, flu-like symptoms, anxiety, and insomnia when doses are missed or the
medication is stopped abruptly. Paroxetine is also a potent CYP2D6 inhibitor (like
fluoxetine), which can cause significant drug-drug interactions. Additionally,
paroxetine has the highest anticholinergic activity among SSRIs, contributing to
sedation, constipation, dry mouth, and cognitive effects — it appears on the Beers
Criteria as potentially inappropriate for older adults. It is also associated with
congenital cardiac defects and is generally avoided in pregnancy.
