NR 546 ADVANCED
PSYCHOPHARMACOLOGY FINAL
EXAM COMPREHENSIVE GUIDE
1. A patient on Clozapine therapy presents for a routine check-up. Which Absolute Neutrophil
Count (ANC) value requires immediate suspension of the medication and consultation with a
hematologist?
A. ANC < 2000/mm³
B. ANC < 1500/mm³
C. ANC < 1000/mm³
D. ANC < 500/mm³
Answer: C
Conceptual Explanation: For Clozapine, the REMS program specifies that an ANC <
1000/mm³ indicates severe neutropenia, necessitating immediate drug cessation and daily
monitoring until recovery.
2. Which mechanism of action distinguishes Second-Generation Antipsychotics (SGAs) from
First-Generation Antipsychotics (FGAs) in their treatment of schizophrenia?
A. Pure D2 receptor antagonism
,B. D1 receptor stimulation and 5-HT1A antagonism
C. 5-HT2A receptor antagonism coupled with D2 antagonism
D. GABA-A receptor modulation
Answer: C
Conceptual Explanation: SGAs (atypicals) are characterized by their ability to block both
D2 receptors and 5-HT2A serotonin receptors, which helps reduce Extrapyramidal
Symptoms (EPS) and treats negative symptoms.
3. A 28-year-old female patient is being started on Lamotrigine for Bipolar II disorder. Which
titration schedule is most appropriate to minimize the risk of Stevens-Johnson Syndrome
(SJS)?
A. 25 mg every other day for 4 weeks
B. 50 mg daily for 1 week, then 100 mg daily for 1 week, then 200 mg daily
C. 100 mg daily starting immediately
D. 25 mg daily for 2 weeks, then 50 mg daily for 2 weeks, then increase by 50 mg weekly
Answer: D
Conceptual Explanation: Standard titration for Lamotrigine is 25 mg/day for weeks 1-2,
then 50 mg/day for weeks 3-4, then 100 mg/day for week 5 to reduce the risk of life-
threatening rashes like SJS.
, 4. Which antidepressant is uniquely contraindicated in patients with a history of seizures or
eating disorders such as Bulimia or Anorexia Nervosa?
A. Fluoxetine
B. Venlafaxine
C. Bupropion
D. Mirtazapine
Answer: C
Conceptual Explanation: Bupropion lowers the seizure threshold and is strictly
contraindicated in patients with seizure disorders or active/past eating disorders due to
increased seizure risk.
5. A patient taking Lithium for Bipolar I disorder presents with a coarse tremor, ataxia, and
confusion. The most recent serum level is 2.1 mEq/L. What is the most likely diagnosis?
A. Therapeutic response
B. Mild lithium toxicity
C. Serotonin syndrome
D. Moderate to severe lithium toxicity
Answer: D
PSYCHOPHARMACOLOGY FINAL
EXAM COMPREHENSIVE GUIDE
1. A patient on Clozapine therapy presents for a routine check-up. Which Absolute Neutrophil
Count (ANC) value requires immediate suspension of the medication and consultation with a
hematologist?
A. ANC < 2000/mm³
B. ANC < 1500/mm³
C. ANC < 1000/mm³
D. ANC < 500/mm³
Answer: C
Conceptual Explanation: For Clozapine, the REMS program specifies that an ANC <
1000/mm³ indicates severe neutropenia, necessitating immediate drug cessation and daily
monitoring until recovery.
2. Which mechanism of action distinguishes Second-Generation Antipsychotics (SGAs) from
First-Generation Antipsychotics (FGAs) in their treatment of schizophrenia?
A. Pure D2 receptor antagonism
,B. D1 receptor stimulation and 5-HT1A antagonism
C. 5-HT2A receptor antagonism coupled with D2 antagonism
D. GABA-A receptor modulation
Answer: C
Conceptual Explanation: SGAs (atypicals) are characterized by their ability to block both
D2 receptors and 5-HT2A serotonin receptors, which helps reduce Extrapyramidal
Symptoms (EPS) and treats negative symptoms.
3. A 28-year-old female patient is being started on Lamotrigine for Bipolar II disorder. Which
titration schedule is most appropriate to minimize the risk of Stevens-Johnson Syndrome
(SJS)?
A. 25 mg every other day for 4 weeks
B. 50 mg daily for 1 week, then 100 mg daily for 1 week, then 200 mg daily
C. 100 mg daily starting immediately
D. 25 mg daily for 2 weeks, then 50 mg daily for 2 weeks, then increase by 50 mg weekly
Answer: D
Conceptual Explanation: Standard titration for Lamotrigine is 25 mg/day for weeks 1-2,
then 50 mg/day for weeks 3-4, then 100 mg/day for week 5 to reduce the risk of life-
threatening rashes like SJS.
, 4. Which antidepressant is uniquely contraindicated in patients with a history of seizures or
eating disorders such as Bulimia or Anorexia Nervosa?
A. Fluoxetine
B. Venlafaxine
C. Bupropion
D. Mirtazapine
Answer: C
Conceptual Explanation: Bupropion lowers the seizure threshold and is strictly
contraindicated in patients with seizure disorders or active/past eating disorders due to
increased seizure risk.
5. A patient taking Lithium for Bipolar I disorder presents with a coarse tremor, ataxia, and
confusion. The most recent serum level is 2.1 mEq/L. What is the most likely diagnosis?
A. Therapeutic response
B. Mild lithium toxicity
C. Serotonin syndrome
D. Moderate to severe lithium toxicity
Answer: D
