NU 643 Exam 2 V2 | NU 643 Advanced
Psychopharmacology | Actual Q&A with
Rationale (NU643 Exam 2) | Regis
University
1. A 24-year-old female patient is being started on Lamotrigine for Bipolar II disorder. What is
the most critical education point regarding the titration schedule?
A. The medication should be taken with high-fat meals to increase absorption.
B. The patient must avoid all tyramine-containing foods while on this drug.
C. Monthly blood draws are required to check therapeutic serum levels.
D. Slow titration is necessary to minimize the risk of Stevens-Johnson Syndrome.
Answer: D
Rationale: Lamotrigine requires a very specific slow titration schedule to mitigate the risk
of life-threatening rashes, specifically Stevens-Johnson Syndrome (SJS). If a patient misses
more than five days of the medication, the titration process must be restarted from the
beginning. This educational point is vital for patient safety and medication adherence in
clinical practice.
2. Which neurotransmitter system is primarily targeted by First-Generation Antipsychotics
(FGAs) to reduce positive symptoms of schizophrenia?
A. Serotonin 5-HT2A receptor antagonism
,B. GABA-A receptor agonism
C. Norepinephrine reuptake inhibition
D. Dopamine D2 receptor antagonism
Answer: D
Rationale: First-generation antipsychotics work primarily by blocking D2 receptors in the
mesolimbic pathway, which reduces positive symptoms like hallucinations. However, this
non-selective blockade in the nigrostriatal pathway often leads to extrapyramidal
symptoms (EPS). Understanding the D2 occupancy threshold is key to balancing efficacy
and side effects.
3. A patient taking Clozapine presents for a routine follow-up. Which laboratory value
requires immediate discontinuation of the medication according to the Clozapine REMS
program?
A. An Absolute Neutrophil Count (ANC) less than 1000/uL
B. A total white blood cell count of 4500/uL
C. Serum glucose level of 126 mg/dL
D. Platelet count of 150,000/uL
Answer: A
Rationale: Clozapine is associated with a risk of severe neutropenia, formerly known as
agranulocytosis. The REMS program mandates strict monitoring of the Absolute Neutrophil
, Count (ANC) rather than the total WBC count. An ANC below 1000/uL in a non-benign
ethnic neutropenia patient necessitates immediate cessation of the drug and hematological
consultation.
4. A patient is prescribed Venlafaxine (Effexor) for Major Depressive Disorder. Which vital
sign must be monitored closely due to the drug’s mechanism at higher doses?
A. Temperature
B. Respiratory rate
C. Blood pressure
D. Oxygen saturation
Answer: C
Rationale: Venlafaxine is a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) that
exhibits dose-dependent pharmacology. At higher doses (typically above 150mg), the
inhibition of norepinephrine reuptake becomes significant, which can lead to sustained
increases in diastolic blood pressure. Providers must establish a baseline blood pressure
and monitor it regularly during treatment.
5. Which antidepressant is contraindicated in patients with a history of seizure disorders or
eating disorders?
A. Sertraline
B. Bupropion
C. Mirtazapine
Psychopharmacology | Actual Q&A with
Rationale (NU643 Exam 2) | Regis
University
1. A 24-year-old female patient is being started on Lamotrigine for Bipolar II disorder. What is
the most critical education point regarding the titration schedule?
A. The medication should be taken with high-fat meals to increase absorption.
B. The patient must avoid all tyramine-containing foods while on this drug.
C. Monthly blood draws are required to check therapeutic serum levels.
D. Slow titration is necessary to minimize the risk of Stevens-Johnson Syndrome.
Answer: D
Rationale: Lamotrigine requires a very specific slow titration schedule to mitigate the risk
of life-threatening rashes, specifically Stevens-Johnson Syndrome (SJS). If a patient misses
more than five days of the medication, the titration process must be restarted from the
beginning. This educational point is vital for patient safety and medication adherence in
clinical practice.
2. Which neurotransmitter system is primarily targeted by First-Generation Antipsychotics
(FGAs) to reduce positive symptoms of schizophrenia?
A. Serotonin 5-HT2A receptor antagonism
,B. GABA-A receptor agonism
C. Norepinephrine reuptake inhibition
D. Dopamine D2 receptor antagonism
Answer: D
Rationale: First-generation antipsychotics work primarily by blocking D2 receptors in the
mesolimbic pathway, which reduces positive symptoms like hallucinations. However, this
non-selective blockade in the nigrostriatal pathway often leads to extrapyramidal
symptoms (EPS). Understanding the D2 occupancy threshold is key to balancing efficacy
and side effects.
3. A patient taking Clozapine presents for a routine follow-up. Which laboratory value
requires immediate discontinuation of the medication according to the Clozapine REMS
program?
A. An Absolute Neutrophil Count (ANC) less than 1000/uL
B. A total white blood cell count of 4500/uL
C. Serum glucose level of 126 mg/dL
D. Platelet count of 150,000/uL
Answer: A
Rationale: Clozapine is associated with a risk of severe neutropenia, formerly known as
agranulocytosis. The REMS program mandates strict monitoring of the Absolute Neutrophil
, Count (ANC) rather than the total WBC count. An ANC below 1000/uL in a non-benign
ethnic neutropenia patient necessitates immediate cessation of the drug and hematological
consultation.
4. A patient is prescribed Venlafaxine (Effexor) for Major Depressive Disorder. Which vital
sign must be monitored closely due to the drug’s mechanism at higher doses?
A. Temperature
B. Respiratory rate
C. Blood pressure
D. Oxygen saturation
Answer: C
Rationale: Venlafaxine is a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) that
exhibits dose-dependent pharmacology. At higher doses (typically above 150mg), the
inhibition of norepinephrine reuptake becomes significant, which can lead to sustained
increases in diastolic blood pressure. Providers must establish a baseline blood pressure
and monitor it regularly during treatment.
5. Which antidepressant is contraindicated in patients with a history of seizure disorders or
eating disorders?
A. Sertraline
B. Bupropion
C. Mirtazapine
