NSG552 ADVANCED
PSYCHOPHARMACOLOGY FINAL
EXAM QUESTIONS AND ANSWERS
1. A patient is prescribed a drug that is a known substrate of CYP450 3A4. If the patient starts
consuming grapefruit juice daily, what is the most likely pharmacological outcome?
A. Decreased plasma concentration of the drug due to induction.
B. Reduced bioavailability due to first-pass metabolism enhancement.
C. Increased plasma concentration of the drug due to inhibition.
D. No change in drug levels as grapefruit juice affects 2D6 only.
Answer: C
Conceptual Explanation: Grapefruit juice is a potent inhibitor of the CYP3A4 enzyme in
the gut wall. Inhibiting the enzyme leads to decreased metabolism and consequently
increased plasma concentrations of the substrate drug.
2. Which dopamine pathway is primarily associated with the negative and cognitive
symptoms of schizophrenia 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 (low dopamine) in this area is linked to negative symptoms (apathy,
withdrawal) and cognitive impairment in schizophrenia.
3. A patient on Lithium therapy presents with coarse hand tremors, ataxia, and confusion.
Their serum lithium level is 2.2 mEq/L. What is the appropriate classification of this toxicity?
A. Therapeutic range
B. Mild toxicity
C. Moderate to Severe toxicity
D. Standard side effect profile
Answer: C
Conceptual Explanation: Serum lithium levels between 1.5 and 2.5 mEq/L are considered
moderate to severe toxicity, characterized by neurological signs like ataxia and coarse
tremors.
, 4. What is the absolute neutrophil count (ANC) threshold required to initiate Clozapine
therapy in a non-benign ethnic neutropenia (non-BEN) patient?
A. Greater than or equal to 500/uL
B. Greater than or equal to 1,000/uL
C. Greater than or equal to 1,500/uL
D. Greater than or equal to 2,000/uL
Answer: C
Conceptual Explanation: For the general population, the ANC must be at least 1,500/uL to
start Clozapine. For patients with Benign Ethnic Neutropenia (BEN), the threshold is
1,000/uL.
5. Which clinical feature most specifically distinguishes Neuroleptic Malignant Syndrome
(NMS) from Serotonin Syndrome?
A. Hyperthermia
B. Autonomic instability
C. Lead-pipe muscle rigidity
D. Altered mental status
Answer: C
PSYCHOPHARMACOLOGY FINAL
EXAM QUESTIONS AND ANSWERS
1. A patient is prescribed a drug that is a known substrate of CYP450 3A4. If the patient starts
consuming grapefruit juice daily, what is the most likely pharmacological outcome?
A. Decreased plasma concentration of the drug due to induction.
B. Reduced bioavailability due to first-pass metabolism enhancement.
C. Increased plasma concentration of the drug due to inhibition.
D. No change in drug levels as grapefruit juice affects 2D6 only.
Answer: C
Conceptual Explanation: Grapefruit juice is a potent inhibitor of the CYP3A4 enzyme in
the gut wall. Inhibiting the enzyme leads to decreased metabolism and consequently
increased plasma concentrations of the substrate drug.
2. Which dopamine pathway is primarily associated with the negative and cognitive
symptoms of schizophrenia 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 (low dopamine) in this area is linked to negative symptoms (apathy,
withdrawal) and cognitive impairment in schizophrenia.
3. A patient on Lithium therapy presents with coarse hand tremors, ataxia, and confusion.
Their serum lithium level is 2.2 mEq/L. What is the appropriate classification of this toxicity?
A. Therapeutic range
B. Mild toxicity
C. Moderate to Severe toxicity
D. Standard side effect profile
Answer: C
Conceptual Explanation: Serum lithium levels between 1.5 and 2.5 mEq/L are considered
moderate to severe toxicity, characterized by neurological signs like ataxia and coarse
tremors.
, 4. What is the absolute neutrophil count (ANC) threshold required to initiate Clozapine
therapy in a non-benign ethnic neutropenia (non-BEN) patient?
A. Greater than or equal to 500/uL
B. Greater than or equal to 1,000/uL
C. Greater than or equal to 1,500/uL
D. Greater than or equal to 2,000/uL
Answer: C
Conceptual Explanation: For the general population, the ANC must be at least 1,500/uL to
start Clozapine. For patients with Benign Ethnic Neutropenia (BEN), the threshold is
1,000/uL.
5. Which clinical feature most specifically distinguishes Neuroleptic Malignant Syndrome
(NMS) from Serotonin Syndrome?
A. Hyperthermia
B. Autonomic instability
C. Lead-pipe muscle rigidity
D. Altered mental status
Answer: C
