NSG 552 PSYCHOPHARMACOLOGY
ADVANCED EXAM QUESTIONS AND
ANSWERS
1. Which dopamine pathway is primarily responsible for the negative symptoms of
schizophrenia and cognitive impairment when dopamine levels are low?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: The mesocortical pathway projects to the prefrontal cortex.
Hypofunction of dopamine in this area is associated with cognitive symptoms and negative
symptoms such as alogia and avolition.
2. A patient taking Clozapine presents with a sudden decrease in Absolute Neutrophil Count
(ANC) to 450/mm³. What is the required clinical action?
A. Continue treatment but monitor ANC daily
B. Reduce the dose by 50% and retest in 48 hours
,C. Immediately discontinue Clozapine and do not rechallenge
D. Administer Vitamin B12 and continue the medication
Answer: C
Conceptual Explanation: An ANC below 500/mm³ is classified as severe neutropenia
(agranulocytosis). Clozapine must be stopped immediately and the patient should generally
not be rechallenged due to the high risk of mortality.
3. Which antidepressant is uniquely characterized by its mechanism as an alpha-2 antagonist,
thereby increasing both serotonin and norepinephrine release?
A. Mirtazapine
B. Venlafaxine
C. Duloxetine
D. Bupropion
Answer: A
Conceptual Explanation: Mirtazapine is a Noradrenergic and Specific Serotonergic
Antidepressant (NaSSA) that works by blocking alpha-2 presynaptic autoreceptors and
heteroreceptors.
4. In the treatment of Bipolar Disorder, which medication requires a slow titration to
minimize the risk of Stevens-Johnson Syndrome?
A. Lamotrigine
, B. Valproate
C. Lithium
D. Quetiapine
Answer: A
Conceptual Explanation: Lamotrigine carries a black box warning for serious rashes,
including Stevens-Johnson Syndrome. Slow titration is essential to mitigate this risk,
especially when combined with valproate.
5. Which cytochrome P450 enzyme is significantly induced by cigarette smoking, potentially
lowering the serum levels of Olanzapine and Clozapine?
A. CYP2D6
B. CYP3A4
C. CYP1A2
D. CYP2C19
Answer: C
Conceptual Explanation: Polycyclic aromatic hydrocarbons in cigarette smoke induce
CYP1A2, which metabolizes clozapine and olanzapine. Quitting smoking can lead to toxic
levels if the dose is not adjusted.
ADVANCED EXAM QUESTIONS AND
ANSWERS
1. Which dopamine pathway is primarily responsible for the negative symptoms of
schizophrenia and cognitive impairment when dopamine levels are low?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: The mesocortical pathway projects to the prefrontal cortex.
Hypofunction of dopamine in this area is associated with cognitive symptoms and negative
symptoms such as alogia and avolition.
2. A patient taking Clozapine presents with a sudden decrease in Absolute Neutrophil Count
(ANC) to 450/mm³. What is the required clinical action?
A. Continue treatment but monitor ANC daily
B. Reduce the dose by 50% and retest in 48 hours
,C. Immediately discontinue Clozapine and do not rechallenge
D. Administer Vitamin B12 and continue the medication
Answer: C
Conceptual Explanation: An ANC below 500/mm³ is classified as severe neutropenia
(agranulocytosis). Clozapine must be stopped immediately and the patient should generally
not be rechallenged due to the high risk of mortality.
3. Which antidepressant is uniquely characterized by its mechanism as an alpha-2 antagonist,
thereby increasing both serotonin and norepinephrine release?
A. Mirtazapine
B. Venlafaxine
C. Duloxetine
D. Bupropion
Answer: A
Conceptual Explanation: Mirtazapine is a Noradrenergic and Specific Serotonergic
Antidepressant (NaSSA) that works by blocking alpha-2 presynaptic autoreceptors and
heteroreceptors.
4. In the treatment of Bipolar Disorder, which medication requires a slow titration to
minimize the risk of Stevens-Johnson Syndrome?
A. Lamotrigine
, B. Valproate
C. Lithium
D. Quetiapine
Answer: A
Conceptual Explanation: Lamotrigine carries a black box warning for serious rashes,
including Stevens-Johnson Syndrome. Slow titration is essential to mitigate this risk,
especially when combined with valproate.
5. Which cytochrome P450 enzyme is significantly induced by cigarette smoking, potentially
lowering the serum levels of Olanzapine and Clozapine?
A. CYP2D6
B. CYP3A4
C. CYP1A2
D. CYP2C19
Answer: C
Conceptual Explanation: Polycyclic aromatic hydrocarbons in cigarette smoke induce
CYP1A2, which metabolizes clozapine and olanzapine. Quitting smoking can lead to toxic
levels if the dose is not adjusted.
