NU664 ADVANCED
PSYCHOPHARMACOLOGY
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. Which cytochrome P450 enzyme is primarily responsible for the metabolism of about 25%
of all psychotropic medications, including many SSRIs and TCAs?
A. CYP1A2
B. CYP2C19
C. CYP3A4
D. CYP2D6
Answer: D
Conceptual Explanation: CYP2D6 is a major enzyme for psychotropic metabolism. Genetic
polymorphisms in this enzyme can lead to ultra-rapid or poor metabolizer phenotypes,
significantly affecting drug serum levels.
,2. A patient taking Clozapine presents with an Absolute Neutrophil Count (ANC) of 800/mm³.
What is the appropriate clinical action according to REMS guidelines?
A. Continue current dose and re-test in one month
B. Increase the dose to manage agitation
C. Interrupt treatment and monitor ANC daily until it returns to >1000/mm³
D. Permanently discontinue Clozapine and never rechallenge
Answer: C
Conceptual Explanation: An ANC between 500-999/mm³ (moderate neutropenia)
requires interrupting treatment and daily monitoring until the ANC rises, per the Clozapine
REMS protocol.
3. Which mechanism of action best describes the effect of Aripiprazole at the D2 receptor?
A. Partial agonist
B. Potent antagonist
C. Full agonist
D. Inverse agonist
Answer: A
Conceptual Explanation: Aripiprazole is a D2 partial agonist, often referred to as a
‘dopamine stabilizer’ because it modulates dopamine activity depending on the
surrounding dopamine concentration.
, 4. A 28-year-old female patient on Lithium for Bipolar I Disorder reports she is planning to
become pregnant. Which fetal malformation is most associated with Lithium use in the first
trimester?
A. Neural tube defects
B. Ebstein’s anomaly
C. Cleft palate
D. Spina bifida
Answer: B
Conceptual Explanation: Ebstein’s anomaly is a rare cardiac defect involving the tricuspid
valve that is specifically associated with first-trimester lithium exposure.
5. Which antidepressant is contraindicated in patients with a history of seizure disorders or
eating disorders like bulimia?
A. Fluoxetine
B. Venlafaxine
C. Mirtazapine
D. Bupropion
Answer: D
PSYCHOPHARMACOLOGY
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. Which cytochrome P450 enzyme is primarily responsible for the metabolism of about 25%
of all psychotropic medications, including many SSRIs and TCAs?
A. CYP1A2
B. CYP2C19
C. CYP3A4
D. CYP2D6
Answer: D
Conceptual Explanation: CYP2D6 is a major enzyme for psychotropic metabolism. Genetic
polymorphisms in this enzyme can lead to ultra-rapid or poor metabolizer phenotypes,
significantly affecting drug serum levels.
,2. A patient taking Clozapine presents with an Absolute Neutrophil Count (ANC) of 800/mm³.
What is the appropriate clinical action according to REMS guidelines?
A. Continue current dose and re-test in one month
B. Increase the dose to manage agitation
C. Interrupt treatment and monitor ANC daily until it returns to >1000/mm³
D. Permanently discontinue Clozapine and never rechallenge
Answer: C
Conceptual Explanation: An ANC between 500-999/mm³ (moderate neutropenia)
requires interrupting treatment and daily monitoring until the ANC rises, per the Clozapine
REMS protocol.
3. Which mechanism of action best describes the effect of Aripiprazole at the D2 receptor?
A. Partial agonist
B. Potent antagonist
C. Full agonist
D. Inverse agonist
Answer: A
Conceptual Explanation: Aripiprazole is a D2 partial agonist, often referred to as a
‘dopamine stabilizer’ because it modulates dopamine activity depending on the
surrounding dopamine concentration.
, 4. A 28-year-old female patient on Lithium for Bipolar I Disorder reports she is planning to
become pregnant. Which fetal malformation is most associated with Lithium use in the first
trimester?
A. Neural tube defects
B. Ebstein’s anomaly
C. Cleft palate
D. Spina bifida
Answer: B
Conceptual Explanation: Ebstein’s anomaly is a rare cardiac defect involving the tricuspid
valve that is specifically associated with first-trimester lithium exposure.
5. Which antidepressant is contraindicated in patients with a history of seizure disorders or
eating disorders like bulimia?
A. Fluoxetine
B. Venlafaxine
C. Mirtazapine
D. Bupropion
Answer: D
