NU 643 Exam 4 V2 | NU 643 Advanced
Psychopharmacology | Actual Q&A with
Rationale (NU643 Exam 4) | Regis
University
1. Which of the following is the primary mechanism of action for Methylphenidate in the
treatment of ADHD?
A. Blockade of dopamine and norepinephrine reuptake via their respective transporters.
B. Selective inhibition of the norepinephrine transporter only.
C. Promotion of dopamine release from presynaptic storage vesicles.
D. Agonism at the alpha-2A adrenergic receptors in the prefrontal cortex.
Answer: A
Rationale: Methylphenidate works primarily by blocking the reuptake of dopamine and
norepinephrine into the presynaptic neuron. By inhibiting these transporters, it increases
the concentration of these neurotransmitters in the synaptic cleft. Unlike amphetamines,
methylphenidate does not significantly stimulate the release of neurotransmitters from
storage vesicles, which differentiates its pharmacodynamic profile.
2. Atomoxetine (Strattera) carries a specific boxed warning in the pediatric population for
which of the following risks?
A. Severe hepatotoxicity and liver failure.
,B. Development of motor and vocal tics.
C. Sudden cardiac death due to QTc prolongation.
D. Suicidal ideation and behaviors.
Answer: D
Rationale: Atomoxetine is a selective norepinephrine reuptake inhibitor that was the first
non-stimulant approved for ADHD. The FDA requires a boxed warning because clinical
trials showed a small but significant increase in suicidal ideation among children and
adolescents. Healthcare providers must monitor patients closely for clinical worsening,
suicidality, or unusual changes in behavior when initiating therapy.
3. A 72-year-old patient is diagnosed with Alzheimer’s disease. Which medication works as an
NMDA receptor antagonist to regulate glutamate activity?
A. Donepezil
B. Memantine
C. Rivastigmine
D. Galantamine
Answer: B
Rationale: Memantine is uniquely classified as a low-to-moderate affinity non-competitive
NMDA receptor antagonist. It works by blocking the excessive activity of glutamate, which
can lead to excitotoxicity and neuronal cell death in Alzheimer’s patients. This mechanism
,differs from cholinesterase inhibitors, making it appropriate for use in moderate to severe
stages of the disease.
4. When prescribing stimulants for a child with ADHD, which physiological parameters must
be monitored at every visit according to standard guidelines?
A. Blood glucose and lipid panels.
B. Height, weight, blood pressure, and heart rate.
C. Liver enzymes and serum creatinine.
D. Vision acuity and hearing thresholds.
Answer: B
Rationale: Stimulants can lead to suppression of appetite and potential growth delays in
pediatric patients, necessitating regular monitoring of height and weight. Furthermore,
because stimulants increase sympathetic tone, heart rate and blood pressure must be
assessed to ensure cardiovascular safety. These assessments help the clinician decide if a
‘drug holiday’ or dose adjustment is required to mitigate side effects.
5. Which of the following antidepressants is currently the only one FDA-approved for the
treatment of depression in children (ages 8 and older)?
A. Fluoxetine
B. Sertraline
C. Escitalopram
, D. Paroxetine
Answer: A
Rationale: Fluoxetine is the primary SSRI approved for pediatric depression, while others
like Escitalopram are approved for adolescents. The robust evidence from the TADS study
supported its efficacy and safety profile relative to other agents. Clinicians should be aware
that while other SSRIs are used off-label, Fluoxetine remains the gold standard for starting
treatment in younger children.
6. A woman in her second trimester of pregnancy requires treatment for bipolar disorder.
Which medication is associated with the highest risk of neural tube defects?
A. Valproic Acid
B. Lamotrigine
C. Lithium
D. Quetiapine
Answer: A
Rationale: Valproic acid is highly teratogenic and is associated with a significantly
increased risk of neural tube defects, such as spina bifida, particularly when taken during
the first trimester. It is also linked to lower IQ scores and cognitive delays in children
exposed in utero. Current guidelines recommend avoiding valproate in women of
childbearing potential unless no other treatments are effective.
Psychopharmacology | Actual Q&A with
Rationale (NU643 Exam 4) | Regis
University
1. Which of the following is the primary mechanism of action for Methylphenidate in the
treatment of ADHD?
A. Blockade of dopamine and norepinephrine reuptake via their respective transporters.
B. Selective inhibition of the norepinephrine transporter only.
C. Promotion of dopamine release from presynaptic storage vesicles.
D. Agonism at the alpha-2A adrenergic receptors in the prefrontal cortex.
Answer: A
Rationale: Methylphenidate works primarily by blocking the reuptake of dopamine and
norepinephrine into the presynaptic neuron. By inhibiting these transporters, it increases
the concentration of these neurotransmitters in the synaptic cleft. Unlike amphetamines,
methylphenidate does not significantly stimulate the release of neurotransmitters from
storage vesicles, which differentiates its pharmacodynamic profile.
2. Atomoxetine (Strattera) carries a specific boxed warning in the pediatric population for
which of the following risks?
A. Severe hepatotoxicity and liver failure.
,B. Development of motor and vocal tics.
C. Sudden cardiac death due to QTc prolongation.
D. Suicidal ideation and behaviors.
Answer: D
Rationale: Atomoxetine is a selective norepinephrine reuptake inhibitor that was the first
non-stimulant approved for ADHD. The FDA requires a boxed warning because clinical
trials showed a small but significant increase in suicidal ideation among children and
adolescents. Healthcare providers must monitor patients closely for clinical worsening,
suicidality, or unusual changes in behavior when initiating therapy.
3. A 72-year-old patient is diagnosed with Alzheimer’s disease. Which medication works as an
NMDA receptor antagonist to regulate glutamate activity?
A. Donepezil
B. Memantine
C. Rivastigmine
D. Galantamine
Answer: B
Rationale: Memantine is uniquely classified as a low-to-moderate affinity non-competitive
NMDA receptor antagonist. It works by blocking the excessive activity of glutamate, which
can lead to excitotoxicity and neuronal cell death in Alzheimer’s patients. This mechanism
,differs from cholinesterase inhibitors, making it appropriate for use in moderate to severe
stages of the disease.
4. When prescribing stimulants for a child with ADHD, which physiological parameters must
be monitored at every visit according to standard guidelines?
A. Blood glucose and lipid panels.
B. Height, weight, blood pressure, and heart rate.
C. Liver enzymes and serum creatinine.
D. Vision acuity and hearing thresholds.
Answer: B
Rationale: Stimulants can lead to suppression of appetite and potential growth delays in
pediatric patients, necessitating regular monitoring of height and weight. Furthermore,
because stimulants increase sympathetic tone, heart rate and blood pressure must be
assessed to ensure cardiovascular safety. These assessments help the clinician decide if a
‘drug holiday’ or dose adjustment is required to mitigate side effects.
5. Which of the following antidepressants is currently the only one FDA-approved for the
treatment of depression in children (ages 8 and older)?
A. Fluoxetine
B. Sertraline
C. Escitalopram
, D. Paroxetine
Answer: A
Rationale: Fluoxetine is the primary SSRI approved for pediatric depression, while others
like Escitalopram are approved for adolescents. The robust evidence from the TADS study
supported its efficacy and safety profile relative to other agents. Clinicians should be aware
that while other SSRIs are used off-label, Fluoxetine remains the gold standard for starting
treatment in younger children.
6. A woman in her second trimester of pregnancy requires treatment for bipolar disorder.
Which medication is associated with the highest risk of neural tube defects?
A. Valproic Acid
B. Lamotrigine
C. Lithium
D. Quetiapine
Answer: A
Rationale: Valproic acid is highly teratogenic and is associated with a significantly
increased risk of neural tube defects, such as spina bifida, particularly when taken during
the first trimester. It is also linked to lower IQ scores and cognitive delays in children
exposed in utero. Current guidelines recommend avoiding valproate in women of
childbearing potential unless no other treatments are effective.
