NU 643 Exam 4 V1 | NU 643 Advanced
Psychopharmacology | Actual Q&A with
Rationale (NU643 Exam 4) | Regis
University
1. Which of the following stimulants is a prodrug that requires enzymatic conversion in the
blood to become active, potentially lowering its abuse potential?
A. Lisdexamfetamine (Vyvanse)
B. Dexmethylphenidate (Focalin)
C. Methylphenidate (Ritalin)
D. Mixed Amphetamine Salts (Adderall)
Answer: A
Rationale: Lisdexamfetamine is a prodrug where the active dextroamphetamine is bonded
to l-lysine. It requires cleavage by enzymes in red blood cells to become active, which
results in a slower onset and longer duration of action. This pharmacokinetic profile is
intended to reduce the potential for rapid ‘highs’ associated with intravenous or intranasal
misuse.
2. In the treatment of Opioid Use Disorder (OUD), which medication acts as a partial mu-
opioid agonist and has a high affinity for the receptor, often displacing full agonists?
A. Methadone
,B. Naltrexone
C. Naloxone
D. Buprenorphine
Answer: D
Rationale: Buprenorphine is a partial agonist at the mu-opioid receptor, meaning it has a
ceiling effect on respiratory depression and euphoria. Its high binding affinity allows it to
compete effectively with other opioids, potentially precipitating withdrawal if given too
soon after a full agonist. This medication is a cornerstone of Office-Based Opioid Treatment
(OBOT).
3. A 75-year-old male with Alzheimer’s disease is prescribed Donepezil. What is the primary
mechanism of action for this drug?
A. NMDA receptor antagonism
B. Reversible inhibition of acetylcholinesterase
C. D2 receptor blockade
D. Serotonin reuptake inhibition
Answer: B
Rationale: Donepezil works by inhibiting the enzyme acetylcholinesterase, which is
responsible for breaking down acetylcholine in the synaptic cleft. By increasing the
availability of acetylcholine, it aims to improve cognitive symptoms in mild to severe
,Alzheimer’s disease. Common side effects include gastrointestinal distress, bradycardia,
and increased gastric acid secretion.
4. Which medication is FDA-approved for the treatment of irritability associated with Autism
Spectrum Disorder in children and adolescents?
A. Risperidone
B. Fluoxetine
C. Lithium
D. Methylphenidate
Answer: A
Rationale: Risperidone and Aripiprazole are the only two antipsychotics currently FDA-
approved for the treatment of irritability, including aggression and self-injury, in pediatric
patients with Autism. Clinicians must monitor for metabolic side effects like weight gain
and dyslipidemia. Regular screening for extrapyramidal symptoms and tardive dyskinesia
is also required during long-term therapy.
5. According to the Beers Criteria, which class of medications should generally be avoided in
geriatric patients due to the high risk of falls and cognitive impairment?
A. Benzodiazepines
B. Statins
C. SSRIs
, D. ACE inhibitors
Answer: A
Rationale: Benzodiazepines increase the risk of falls, fractures, and motor vehicle
accidents in the elderly due to impaired coordination and sedation. The Beers Criteria
recommends avoiding them for the treatment of insomnia or agitation in older adults
unless other treatments have failed. Long-acting agents like Diazepam are particularly
hazardous due to their prolonged half-life in older populations.
6. What is the black box warning associated with the use of Atomoxetine in pediatric
patients?
A. Risk of suicidal ideation
B. Increased risk of hepatotoxicity
C. Sudden cardiac death
D. Growth suppression
Answer: A
Rationale: Atomoxetine, a non-stimulant norepinephrine reuptake inhibitor, carries a
black box warning for increased suicidal ideation in children and adolescents. While the
absolute risk is low, patients must be monitored closely for clinical worsening or unusual
changes in behavior. This warning is consistent with the general class warnings for
antidepressants in this age group.
Psychopharmacology | Actual Q&A with
Rationale (NU643 Exam 4) | Regis
University
1. Which of the following stimulants is a prodrug that requires enzymatic conversion in the
blood to become active, potentially lowering its abuse potential?
A. Lisdexamfetamine (Vyvanse)
B. Dexmethylphenidate (Focalin)
C. Methylphenidate (Ritalin)
D. Mixed Amphetamine Salts (Adderall)
Answer: A
Rationale: Lisdexamfetamine is a prodrug where the active dextroamphetamine is bonded
to l-lysine. It requires cleavage by enzymes in red blood cells to become active, which
results in a slower onset and longer duration of action. This pharmacokinetic profile is
intended to reduce the potential for rapid ‘highs’ associated with intravenous or intranasal
misuse.
2. In the treatment of Opioid Use Disorder (OUD), which medication acts as a partial mu-
opioid agonist and has a high affinity for the receptor, often displacing full agonists?
A. Methadone
,B. Naltrexone
C. Naloxone
D. Buprenorphine
Answer: D
Rationale: Buprenorphine is a partial agonist at the mu-opioid receptor, meaning it has a
ceiling effect on respiratory depression and euphoria. Its high binding affinity allows it to
compete effectively with other opioids, potentially precipitating withdrawal if given too
soon after a full agonist. This medication is a cornerstone of Office-Based Opioid Treatment
(OBOT).
3. A 75-year-old male with Alzheimer’s disease is prescribed Donepezil. What is the primary
mechanism of action for this drug?
A. NMDA receptor antagonism
B. Reversible inhibition of acetylcholinesterase
C. D2 receptor blockade
D. Serotonin reuptake inhibition
Answer: B
Rationale: Donepezil works by inhibiting the enzyme acetylcholinesterase, which is
responsible for breaking down acetylcholine in the synaptic cleft. By increasing the
availability of acetylcholine, it aims to improve cognitive symptoms in mild to severe
,Alzheimer’s disease. Common side effects include gastrointestinal distress, bradycardia,
and increased gastric acid secretion.
4. Which medication is FDA-approved for the treatment of irritability associated with Autism
Spectrum Disorder in children and adolescents?
A. Risperidone
B. Fluoxetine
C. Lithium
D. Methylphenidate
Answer: A
Rationale: Risperidone and Aripiprazole are the only two antipsychotics currently FDA-
approved for the treatment of irritability, including aggression and self-injury, in pediatric
patients with Autism. Clinicians must monitor for metabolic side effects like weight gain
and dyslipidemia. Regular screening for extrapyramidal symptoms and tardive dyskinesia
is also required during long-term therapy.
5. According to the Beers Criteria, which class of medications should generally be avoided in
geriatric patients due to the high risk of falls and cognitive impairment?
A. Benzodiazepines
B. Statins
C. SSRIs
, D. ACE inhibitors
Answer: A
Rationale: Benzodiazepines increase the risk of falls, fractures, and motor vehicle
accidents in the elderly due to impaired coordination and sedation. The Beers Criteria
recommends avoiding them for the treatment of insomnia or agitation in older adults
unless other treatments have failed. Long-acting agents like Diazepam are particularly
hazardous due to their prolonged half-life in older populations.
6. What is the black box warning associated with the use of Atomoxetine in pediatric
patients?
A. Risk of suicidal ideation
B. Increased risk of hepatotoxicity
C. Sudden cardiac death
D. Growth suppression
Answer: A
Rationale: Atomoxetine, a non-stimulant norepinephrine reuptake inhibitor, carries a
black box warning for increased suicidal ideation in children and adolescents. While the
absolute risk is low, patients must be monitored closely for clinical worsening or unusual
changes in behavior. This warning is consistent with the general class warnings for
antidepressants in this age group.
