Nr546 Advanced Psychopharmacology For The Pmhnp: A 200-Question Comprehensive Final Exam Q-Bank Covering Neurobiology, Antidepressants (Ssris, Snris, Tcas, Maois), Antipsychotics (Typical & Atypical), Mood Stabilizers (Lithium, Anticonvulsants), Adhd Ther

NR546 ADVANCED PSYCHOPHARMACOLOGY FOR THE PMHNP: A 200-QUESTION COMPREHENSIVE FINAL EXAM Q-BANK COVERING NEUROBIOLOGY, ANTIDEPRESSANTS (SSRIS, SNRIS, TCAS, MAOIS), ANTIPSYCHOTICS (TYPICAL & ATYPICAL), MOOD STABILIZERS (LITHIUM, ANTICONVULSANTS), ADHD THERAPIES, SUBSTANCE USE DISORDERS, SLEEP AIDS, ALZHEIMER'S TREATMENTS, MOVEMENT DISORDERS, PHARMACOKINETICS (CYP450), DRUG INTERACTIONS, BLACK BOX WARNINGS, SPECIAL POPULATIONS (PREGNANCY, GERIATRICS, PEDIATRICS), AND CLINICAL PRESCRIBING PRINCIPLES WITH DETAILED CLINICAL RATIONALES. Question 1 A 28-year-old with major depressive disorder (MDD) has been taking sertraline 50 mg daily for 6 weeks and reports no change in mood. What is the most appropriate next step? A) Increase the dose to 100 mg daily. B) Add trazodone 50 mg at bedtime. C) Switch to fluoxetine 20 mg daily. D) Obtain a serum drug level. Correct answer: A Rationale: Sertraline's typical therapeutic dose for MDD is 100-200 mg/day. A 6-week trial at a subtherapeutic dose warrants a dose increase before considering a switch. Serum drug levels are not routinely used for SSRIs, and adding trazodone is not first-line for nonresponse. ________________________________________ Question 2 A 45-year-old patient with chronic insomnia asks for medication. According to current guidelines, which of the following is the preferred first-line pharmacological intervention? A) Zolpidem 10 mg at bedtime. B) Trazodone 50 mg at bedtime. C) Diphenhydramine 50 mg at bedtime. D) Melatonin 5 mg at bedtime. Correct answer: B Rationale: Trazodone at low doses (25-100 mg) is commonly used off-label for sleep maintenance, with low abuse potential and minimal tolerance. Zolpidem is generally reserved for second-line use due to risks of dependence and next-day impairment. Antihistamines and melatonin have weaker evidence. ________________________________________ Question 3 A PMHNP is prescribing a controlled substance for a patient with anxiety. Under the Ryan Haight Act, what is required before an initial prescription of a Schedule II medication via telemedicine? A) A valid DEA registration and an in-person evaluation (with limited exceptions). B) A verbal consent from the patient recorded in the chart. C) A written prescription mailed to the patient. D) A concurrent prescription for naloxone. Correct answer: A Rationale: The Ryan Haight Online Pharmacy Consumer Protection Act generally requires an in-person medical evaluation before prescribing controlled substances via telemedicine, though some exceptions have temporarily modified this rule. ________________________________________ Question 4 A patient develops fever, muscle rigidity, altered mental status, and autonomic instability 10 days after starting haloperidol. What is the most likely diagnosis? A) Serotonin syndrome. B) Neuroleptic malignant syndrome (NMS). C) Acute dystonic reaction. D) Tardive dyskinesia. Correct answer: B Rationale: NMS presents with fever, rigidity, altered mental status, and autonomic dysfunction, typically occurring within weeks of antipsychotic initiation. Serotonin syndrome is associated with serotonergic agents and includes hyperreflexia and clonus. ________________________________________ Question 5 Which of the following CYP450 enzymes is primarily responsible for the metabolism of most SSRIs? A) CYP2D6. B) CYP3A4. C) CYP1A2. D) CYP2C19. Correct answer: A Rationale: CYP2D6 is a major pathway for many SSRIs (fluoxetine, paroxetine, fluvoxamine) and other psychotropics. CYP3A4 metabolizes some benzodiazepines and antipsychotics; CYP1A2 metabolizes clozapine; CYP2C19 metabolizes citalopram and escitalopram. ________________________________________ Question 6 A 32-year-old patient with bipolar I disorder and a history of substance use disorder is prescribed a long-acting injectable antipsychotic. What is the primary advantage of this formulation? A) Improved tolerability compared to oral agents. B) Reduced risk of metabolic side effects. C) Enhanced adherence and reduced relapse rates. D) Faster onset of therapeutic action. Correct answer: C Rationale: Long-acting injectable antipsychotics are primarily used to improve adherence, which is a critical issue in bipolar and schizophrenia, thereby reducing hospitalizations and relapse rates. ________________________________________ Question 7 A 65-year-old with Parkinson's disease develops visual hallucinations. The family reports he is not agitated. What is the most appropriate antipsychotic? A) Haloperidol. B) Risperidone. C) Quetiapine. D) Olanzapine. Correct answer: C Rationale: Quetiapine is preferred in Parkinson's disease patients with hallucinations due to its lower D2 receptor affinity and lower risk of worsening motor symptoms. Haloperidol and risperidone have higher D2 affinity and can worsen Parkinsonism. ________________________________________ Question 8 What are the three monoamine neurotransmitters? A) Acetylcholine, GABA, Glutamate. B) Dopamine, Epinephrine, Melatonin. C) Dopamine, Norepinephrine, Serotonin. D) Norepinephrine, Histamine, Oxytocin. Correct answer: C Rationale: These three are the classical monoamines involved in mood regulation. The monoamine hypothesis posits that depression stems from a deficiency in one or all of these, while mania may result from an excess.