,NR 546 Advanced Psychopharmacology PMHNP Week 6 | Study Questions
and Answers + Rationales | 2026/27 Updates | 100% correct
1. According to NR546 Week 6 content, which brain region is considered the reward "pleasure
center" and is a key site of dopamine release in addiction?
A) Ventral tegmental area (VTA)
B) Nucleus accumbens (NAc)
C) Prefrontal cortex (PFC)
D) Amygdala
Correct Answer: Nucleus accumbens (NAc)
Rationale: The nucleus accumbens is the brain's reward "pleasure center." It receives
dopamine projections from the VTA and is central to the experience of reward and
reinforcement in addiction. While the VTA is the origin of dopamine neurons, the NAc is the
primary site of dopamine release that produces the euphoric high. The PFC is involved in
decision-making and impulse control, and the amygdala is involved in conditioned cues and
emotional memory .
2. Which neurotransmitter is considered the primary mediator of reward and reinforcement in
the neurobiology of addiction?
A) Serotonin
B) Glutamate
C) Dopamine
D) GABA
Correct Answer: Dopamine
, Rationale: Dopamine is the primary neurotransmitter that mediates reward and
reinforcement. Addictive substances cause rapid, supraphysiologic spikes in dopamine in the
reward pathway, which drives the reinforcement of drug-seeking behavior and rewires the
brain's reward circuitry. While serotonin, glutamate, and GABA also play roles, dopamine is the
central mediator .
3. A patient with opioid use disorder is being started on buprenorphine. What is the most
important consideration regarding the patient's withdrawal status before initiating the
medication?
A) The patient must be in mild to moderate withdrawal to avoid precipitated withdrawal
B) The patient must be completely detoxified for 7 days
C) No withdrawal is necessary; buprenorphine can be started immediately
D) The patient must be actively intoxicated to initiate treatment
Correct Answer: The patient must be in mild to moderate withdrawal to avoid precipitated
withdrawal
Rationale: Buprenorphine is a partial mu-opioid agonist with high affinity that can displace full
agonists (like heroin or methadone) from receptors. If given when a patient has significant
amounts of full agonist on their receptors (i.e., is not in withdrawal), it can precipitate severe
withdrawal. Patients should be in mild to moderate withdrawal, typically indicated by a COWS
score ≥ 8-12 .
4. Buprenorphine is unique among opioid agonists because it has a "ceiling effect." What does
this mean clinically?
A) It causes euphoria that does not increase with higher doses
B) It has a limited potential for respiratory depression, making it safer in overdose
C) It is only effective for mild opioid dependence
D) It requires daily dosing to maintain effectiveness
, Correct Answer: It has a limited potential for respiratory depression, making it safer in
overdose
Rationale: The "ceiling effect" refers to the fact that buprenorphine's effects, including
euphoria and respiratory depression, plateau at higher doses. Because it is a partial agonist, it
does not cause the full activation of the mu-opioid receptor that a full agonist like heroin does.
This makes it significantly safer in overdose .
5. Which of the following medications used for opioid use disorder is a full mu-opioid agonist?
A) Buprenorphine
B) Methadone
C) Naltrexone
D) Naloxone
Correct Answer: Methadone
Rationale: Methadone is a full mu-opioid agonist. Unlike buprenorphine, which is a partial
agonist, methadone fully activates the mu-opioid receptor. It is effective for opioid use disorder
but carries a higher risk of respiratory depression and overdose .
6. A patient who has been abstinent from opioids for 10 days is being started on naltrexone.
Why is this temporal requirement critical for this medication?
A) Naltrexone is a full agonist and will cause intoxication
B) Naltrexone is a partial agonist and will cause withdrawal if started too early
C) Naltrexone is an antagonist and will precipitate severe withdrawal if opioids are still on
receptors
D) Naltrexone's absorption is affected by the presence of opioids
and Answers + Rationales | 2026/27 Updates | 100% correct
1. According to NR546 Week 6 content, which brain region is considered the reward "pleasure
center" and is a key site of dopamine release in addiction?
A) Ventral tegmental area (VTA)
B) Nucleus accumbens (NAc)
C) Prefrontal cortex (PFC)
D) Amygdala
Correct Answer: Nucleus accumbens (NAc)
Rationale: The nucleus accumbens is the brain's reward "pleasure center." It receives
dopamine projections from the VTA and is central to the experience of reward and
reinforcement in addiction. While the VTA is the origin of dopamine neurons, the NAc is the
primary site of dopamine release that produces the euphoric high. The PFC is involved in
decision-making and impulse control, and the amygdala is involved in conditioned cues and
emotional memory .
2. Which neurotransmitter is considered the primary mediator of reward and reinforcement in
the neurobiology of addiction?
A) Serotonin
B) Glutamate
C) Dopamine
D) GABA
Correct Answer: Dopamine
, Rationale: Dopamine is the primary neurotransmitter that mediates reward and
reinforcement. Addictive substances cause rapid, supraphysiologic spikes in dopamine in the
reward pathway, which drives the reinforcement of drug-seeking behavior and rewires the
brain's reward circuitry. While serotonin, glutamate, and GABA also play roles, dopamine is the
central mediator .
3. A patient with opioid use disorder is being started on buprenorphine. What is the most
important consideration regarding the patient's withdrawal status before initiating the
medication?
A) The patient must be in mild to moderate withdrawal to avoid precipitated withdrawal
B) The patient must be completely detoxified for 7 days
C) No withdrawal is necessary; buprenorphine can be started immediately
D) The patient must be actively intoxicated to initiate treatment
Correct Answer: The patient must be in mild to moderate withdrawal to avoid precipitated
withdrawal
Rationale: Buprenorphine is a partial mu-opioid agonist with high affinity that can displace full
agonists (like heroin or methadone) from receptors. If given when a patient has significant
amounts of full agonist on their receptors (i.e., is not in withdrawal), it can precipitate severe
withdrawal. Patients should be in mild to moderate withdrawal, typically indicated by a COWS
score ≥ 8-12 .
4. Buprenorphine is unique among opioid agonists because it has a "ceiling effect." What does
this mean clinically?
A) It causes euphoria that does not increase with higher doses
B) It has a limited potential for respiratory depression, making it safer in overdose
C) It is only effective for mild opioid dependence
D) It requires daily dosing to maintain effectiveness
, Correct Answer: It has a limited potential for respiratory depression, making it safer in
overdose
Rationale: The "ceiling effect" refers to the fact that buprenorphine's effects, including
euphoria and respiratory depression, plateau at higher doses. Because it is a partial agonist, it
does not cause the full activation of the mu-opioid receptor that a full agonist like heroin does.
This makes it significantly safer in overdose .
5. Which of the following medications used for opioid use disorder is a full mu-opioid agonist?
A) Buprenorphine
B) Methadone
C) Naltrexone
D) Naloxone
Correct Answer: Methadone
Rationale: Methadone is a full mu-opioid agonist. Unlike buprenorphine, which is a partial
agonist, methadone fully activates the mu-opioid receptor. It is effective for opioid use disorder
but carries a higher risk of respiratory depression and overdose .
6. A patient who has been abstinent from opioids for 10 days is being started on naltrexone.
Why is this temporal requirement critical for this medication?
A) Naltrexone is a full agonist and will cause intoxication
B) Naltrexone is a partial agonist and will cause withdrawal if started too early
C) Naltrexone is an antagonist and will precipitate severe withdrawal if opioids are still on
receptors
D) Naltrexone's absorption is affected by the presence of opioids
