NSG 552 PSYCHOPHARMACOLOGY
FINAL EXAM COMPREHENSIVE
QUESTIONS AND ANSWERS
1. Which cytochrome P450 enzyme is primarily responsible for the metabolism of
approximately 25% of all clinically used drugs, including most antidepressants and
antipsychotics, and is highly polymorphic?
A. CYP3A4
B. CYP1A2
C. CYP2D6
D. CYP2C19
Answer: C
Conceptual Explanation: CYP2D6 metabolizes many psychotropic drugs. Genetic
polymorphisms in this enzyme result in individuals being classified as poor, intermediate,
extensive, or ultra-rapid metabolizers.
,2. According to the Clozapine REMS program, what is the Absolute Neutrophil Count (ANC)
threshold for ‘Severe Neutropenia’ that requires immediate discontinuation and reporting?
A. ANC < 1500/mm³
B. ANC < 1000/mm³
C. ANC < 2000/mm³
D. ANC < 500/mm³
Answer: D
Conceptual Explanation: Severe neutropenia is defined as an ANC less than 500/mm³. In
this case, Clozapine must be stopped, and the patient usually cannot be rechallenged unless
benefits clearly outweigh risks.
3. Which of the following medications is known to increase lithium levels by reducing its renal
clearance?
A. Theophylline
B. Acetaminophen
C. Ibuprofen
D. Caffeine
Answer: C
Conceptual Explanation: NSAIDs like Ibuprofen decrease renal blood flow and
prostaglandins, leading to reduced lithium excretion and increased risk of toxicity.
, 4. A patient on a Monoamine Oxidase Inhibitor (MAOI) consumes aged cheese and red wine.
Which physiological event is most likely to occur?
A. Serotonin Syndrome
B. Hypotensive Crisis
C. Hypertensive Crisis
D. Neuroleptic Malignant Syndrome
Answer: C
Conceptual Explanation: MAOIs inhibit the breakdown of tyramine. Tyramine from diet
causes a massive release of norepinephrine, resulting in severe vasoconstriction and a
hypertensive crisis.
5. Which antidepressant is specifically contraindicated in patients with a history of seizure
disorders or eating disorders due to an increased risk of seizures?
A. Fluoxetine
B. Bupropion
C. Venlafaxine
D. Mirtazapine
Answer: B
FINAL EXAM COMPREHENSIVE
QUESTIONS AND ANSWERS
1. Which cytochrome P450 enzyme is primarily responsible for the metabolism of
approximately 25% of all clinically used drugs, including most antidepressants and
antipsychotics, and is highly polymorphic?
A. CYP3A4
B. CYP1A2
C. CYP2D6
D. CYP2C19
Answer: C
Conceptual Explanation: CYP2D6 metabolizes many psychotropic drugs. Genetic
polymorphisms in this enzyme result in individuals being classified as poor, intermediate,
extensive, or ultra-rapid metabolizers.
,2. According to the Clozapine REMS program, what is the Absolute Neutrophil Count (ANC)
threshold for ‘Severe Neutropenia’ that requires immediate discontinuation and reporting?
A. ANC < 1500/mm³
B. ANC < 1000/mm³
C. ANC < 2000/mm³
D. ANC < 500/mm³
Answer: D
Conceptual Explanation: Severe neutropenia is defined as an ANC less than 500/mm³. In
this case, Clozapine must be stopped, and the patient usually cannot be rechallenged unless
benefits clearly outweigh risks.
3. Which of the following medications is known to increase lithium levels by reducing its renal
clearance?
A. Theophylline
B. Acetaminophen
C. Ibuprofen
D. Caffeine
Answer: C
Conceptual Explanation: NSAIDs like Ibuprofen decrease renal blood flow and
prostaglandins, leading to reduced lithium excretion and increased risk of toxicity.
, 4. A patient on a Monoamine Oxidase Inhibitor (MAOI) consumes aged cheese and red wine.
Which physiological event is most likely to occur?
A. Serotonin Syndrome
B. Hypotensive Crisis
C. Hypertensive Crisis
D. Neuroleptic Malignant Syndrome
Answer: C
Conceptual Explanation: MAOIs inhibit the breakdown of tyramine. Tyramine from diet
causes a massive release of norepinephrine, resulting in severe vasoconstriction and a
hypertensive crisis.
5. Which antidepressant is specifically contraindicated in patients with a history of seizure
disorders or eating disorders due to an increased risk of seizures?
A. Fluoxetine
B. Bupropion
C. Venlafaxine
D. Mirtazapine
Answer: B
