NU664 ADVANCED
PSYCHOPHARMACOLOGY FINAL
EXAM PREP QUESTIONS AND
ANSWERS
1. A patient on Clozapine presents with a white blood cell count of 2,800/mm³ and an
absolute neutrophil count (ANC) of 1,200/mm³. Which is the most appropriate action?
A. Continue Clozapine and monitor weekly.
B. Increase the dose to manage symptoms.
C. Switch to Risperidone immediately without monitoring.
D. Interrupt treatment and monitor ANC daily.
Answer: D
Conceptual Explanation: According to REMS guidelines, an ANC between 1,000-
1,499/mm³ (mild neutropenia) requires treatment interruption and daily monitoring until
ANC stabilizes above 1,500/mm³.
2. Which antipsychotic is associated with the highest risk of QTc prolongation?
A. Aripiprazole
B. Lurasidone
,C. Thioridazine
D. Olanzapine
Answer: C
Conceptual Explanation: Thioridazine, a first-generation antipsychotic, carries a black
box warning for significant QTc prolongation compared to most other agents.
3. Which serotonin receptor antagonism is primarily responsible for the reduced risk of
Extrapyramidal Symptoms (EPS) in atypical antipsychotics?
A. 5-HT1A
B. 5-HT2C
C. 5-HT3
D. 5-HT2A
Answer: D
Conceptual Explanation: 5-HT2A antagonism increases dopamine release in the
nigrostriatal pathway, which offsets the D2 blockade, thereby reducing EPS risk.
4. A patient taking Phenelzine (an MAOI) consumes aged cheese and wine. Which
neurotransmitter surge causes the resulting hypertensive crisis?
A. Serotonin
B. Dopamine
C. Norepinephrine
, D. Glutamate
Answer: C
Conceptual Explanation: Tyramine in food displaces norepinephrine from storage
vesicles; since MAO is inhibited, norepinephrine levels rise uncontrollably, causing
vasoconstriction.
5. Which enzyme inhibition is responsible for the interaction where Fluoxetine increases the
plasma levels of Tricyclic Antidepressants (TCAs)?
A. CYP1A2
B. CYP2D6
C. CYP3A4
D. CYP2C19
Answer: B
Conceptual Explanation: Fluoxetine is a potent inhibitor of CYP2D6, the primary enzyme
responsible for metabolizing most TCAs.
6. Which medication is considered the first-line treatment for Akathisia induced by
antipsychotics?
A. Benztropine
B. Diphenhydramine
C. Lorazepam
PSYCHOPHARMACOLOGY FINAL
EXAM PREP QUESTIONS AND
ANSWERS
1. A patient on Clozapine presents with a white blood cell count of 2,800/mm³ and an
absolute neutrophil count (ANC) of 1,200/mm³. Which is the most appropriate action?
A. Continue Clozapine and monitor weekly.
B. Increase the dose to manage symptoms.
C. Switch to Risperidone immediately without monitoring.
D. Interrupt treatment and monitor ANC daily.
Answer: D
Conceptual Explanation: According to REMS guidelines, an ANC between 1,000-
1,499/mm³ (mild neutropenia) requires treatment interruption and daily monitoring until
ANC stabilizes above 1,500/mm³.
2. Which antipsychotic is associated with the highest risk of QTc prolongation?
A. Aripiprazole
B. Lurasidone
,C. Thioridazine
D. Olanzapine
Answer: C
Conceptual Explanation: Thioridazine, a first-generation antipsychotic, carries a black
box warning for significant QTc prolongation compared to most other agents.
3. Which serotonin receptor antagonism is primarily responsible for the reduced risk of
Extrapyramidal Symptoms (EPS) in atypical antipsychotics?
A. 5-HT1A
B. 5-HT2C
C. 5-HT3
D. 5-HT2A
Answer: D
Conceptual Explanation: 5-HT2A antagonism increases dopamine release in the
nigrostriatal pathway, which offsets the D2 blockade, thereby reducing EPS risk.
4. A patient taking Phenelzine (an MAOI) consumes aged cheese and wine. Which
neurotransmitter surge causes the resulting hypertensive crisis?
A. Serotonin
B. Dopamine
C. Norepinephrine
, D. Glutamate
Answer: C
Conceptual Explanation: Tyramine in food displaces norepinephrine from storage
vesicles; since MAO is inhibited, norepinephrine levels rise uncontrollably, causing
vasoconstriction.
5. Which enzyme inhibition is responsible for the interaction where Fluoxetine increases the
plasma levels of Tricyclic Antidepressants (TCAs)?
A. CYP1A2
B. CYP2D6
C. CYP3A4
D. CYP2C19
Answer: B
Conceptual Explanation: Fluoxetine is a potent inhibitor of CYP2D6, the primary enzyme
responsible for metabolizing most TCAs.
6. Which medication is considered the first-line treatment for Akathisia induced by
antipsychotics?
A. Benztropine
B. Diphenhydramine
C. Lorazepam
