,NSG 552 Exam 2 - Psychopharmacology - Wilkes
1. A patient with PTSD is started on prazosin for trauma-related nightmares. Which monitoring
parameter is most important during therapy?
A) Serum creatinine
B) Blood pressure
C) Liver function tests
D) Complete blood count
Correct Answer: Blood pressure
Rationale: Prazosin is an alpha-1 adrenergic antagonist that can cause orthostatic hypotension,
particularly during dose initiation and titration. Blood pressure monitoring, including supine and
standing readings, is essential to prevent falls and symptomatic hypotension. Renal function, LFTs,
and CBC are not the primary monitoring parameters for prazosin.
2. A patient with dissociative identity disorder engages in frequent self-injurious behaviors. Which
medication may be used off-label to reduce these behaviors?
A) Naltrexone
B) Fluoxetine
C) Quetiapine
D) Lamotrigine
Correct Answer: Naltrexone
Rationale: Naltrexone, an opioid antagonist, has been used off-label to reduce self-injurious behaviors
in patients with dissociative identity disorder by mitigating the underlying drives that lead to self-
harm. SSRIs, atypical antipsychotics, and mood stabilizers are not specifically indicated for this
purpose in DID.
3. A patient on an MAOI consumes aged cheese and develops a severe headache and hypertension.
Which medication is the first-line treatment for this hypertensive crisis?
A) Naloxone
B) Phentolamine
C) Flumazenil
D) Propranolol
,Correct Answer: Phentolamine
Rationale: Phentolamine is an alpha-1 antagonist that is the first-line treatment for MAOI-induced
hypertensive crisis. It reverses the alpha-mediated vasoconstriction caused by excess tyramine.
Propranolol can worsen unopposed alpha stimulation and is contraindicated. Naloxone and flumazenil
are not appropriate for this condition.
4. An Asian patient is being considered for carbamazepine therapy. Which genetic screening is
recommended before initiation to prevent serious adverse effects?
A) CYP2D6 genotyping
B) HLA-B*1502 screening
C) TPMT genotyping
D) CYP2C19 genotyping
Correct Answer: HLA-B*1502 screening
Rationale: The HLA-B*1502 allele is strongly associated with Stevens-Johnson syndrome and toxic
epidermal necrolysis in Han Chinese, Thai, and other Asian populations taking carbamazepine.
Screening for this allele is recommended before initiating carbamazepine in at-risk populations.
CYP2D6, TPMT, and CYP2C19 are relevant for other medications.
5. A patient with PTSD is started on sertraline. Which statement correctly describes the role of SSRIs in
PTSD treatment?
A) SSRIs are second-line agents for PTSD
B) SSRIs are first-line pharmacological treatment for PTSD
C) SSRIs are contraindicated in PTSD
D) SSRIs are only effective for depression, not PTSD
Correct Answer: SSRIs are first-line pharmacological treatment for PTSD
Rationale: SSRIs, specifically sertraline and paroxetine, are FDA-approved and first-line
pharmacological treatments for PTSD. They work by increasing serotonin levels in the brain, which can
enhance mood and reduce anxiety symptoms associated with PTSD. They are not contraindicated and
are effective for PTSD.
6. Benzodiazepines are generally contraindicated in PTSD treatment for which primary reason?
A) They are ineffective for anxiety symptoms
B) They interfere with cognitive processes necessary for CBT and carry a high risk of dependence
, C) They cause excessive sedation that improves PTSD symptoms
D) They are not FDA-approved for any psychiatric condition
Correct Answer: They interfere with cognitive processes necessary for CBT and carry a high risk of
dependence
Rationale: Benzodiazepines are contraindicated in PTSD because they interfere with cognitive
processes necessary for cognitive-behavioral therapy and carry a high risk of dependence, particularly
in patients with comorbid substance use disorders. While they may provide short-term anxiety relief,
their sedative effects can hinder emotional processing critical for recovery.
7. Which of the following medications is FDA-approved for the treatment of PTSD?
A) Fluoxetine
B) Paroxetine
C) Venlafaxine
D) Duloxetine
Correct Answer: Paroxetine
Rationale: Sertraline and paroxetine are the two SSRIs that are FDA-approved for the treatment of
PTSD. Fluoxetine, venlafaxine, and duloxetine are not FDA-approved for PTSD, though they may be
used off-label.
8. A patient with treatment-resistant PTSD is considered for augmentation with an atypical
antipsychotic. In which scenario is this most appropriate?
A) As first-line monotherapy
B) Only in severe cases where standard treatments have failed
C) For all patients with PTSD
D) As a replacement for SSRIs
Correct Answer: Only in severe cases where standard treatments have failed
Rationale: Augmentation with an atypical antipsychotic is considered only in severe cases of PTSD
where standard treatments (SSRIs, psychotherapy) have been inadequate. It is not first-line therapy,
not for all patients, and not a replacement for SSRIs.
9. A patient with PTSD is prescribed prazosin. Which adverse effect should the patient be counseled
about?
1. A patient with PTSD is started on prazosin for trauma-related nightmares. Which monitoring
parameter is most important during therapy?
A) Serum creatinine
B) Blood pressure
C) Liver function tests
D) Complete blood count
Correct Answer: Blood pressure
Rationale: Prazosin is an alpha-1 adrenergic antagonist that can cause orthostatic hypotension,
particularly during dose initiation and titration. Blood pressure monitoring, including supine and
standing readings, is essential to prevent falls and symptomatic hypotension. Renal function, LFTs,
and CBC are not the primary monitoring parameters for prazosin.
2. A patient with dissociative identity disorder engages in frequent self-injurious behaviors. Which
medication may be used off-label to reduce these behaviors?
A) Naltrexone
B) Fluoxetine
C) Quetiapine
D) Lamotrigine
Correct Answer: Naltrexone
Rationale: Naltrexone, an opioid antagonist, has been used off-label to reduce self-injurious behaviors
in patients with dissociative identity disorder by mitigating the underlying drives that lead to self-
harm. SSRIs, atypical antipsychotics, and mood stabilizers are not specifically indicated for this
purpose in DID.
3. A patient on an MAOI consumes aged cheese and develops a severe headache and hypertension.
Which medication is the first-line treatment for this hypertensive crisis?
A) Naloxone
B) Phentolamine
C) Flumazenil
D) Propranolol
,Correct Answer: Phentolamine
Rationale: Phentolamine is an alpha-1 antagonist that is the first-line treatment for MAOI-induced
hypertensive crisis. It reverses the alpha-mediated vasoconstriction caused by excess tyramine.
Propranolol can worsen unopposed alpha stimulation and is contraindicated. Naloxone and flumazenil
are not appropriate for this condition.
4. An Asian patient is being considered for carbamazepine therapy. Which genetic screening is
recommended before initiation to prevent serious adverse effects?
A) CYP2D6 genotyping
B) HLA-B*1502 screening
C) TPMT genotyping
D) CYP2C19 genotyping
Correct Answer: HLA-B*1502 screening
Rationale: The HLA-B*1502 allele is strongly associated with Stevens-Johnson syndrome and toxic
epidermal necrolysis in Han Chinese, Thai, and other Asian populations taking carbamazepine.
Screening for this allele is recommended before initiating carbamazepine in at-risk populations.
CYP2D6, TPMT, and CYP2C19 are relevant for other medications.
5. A patient with PTSD is started on sertraline. Which statement correctly describes the role of SSRIs in
PTSD treatment?
A) SSRIs are second-line agents for PTSD
B) SSRIs are first-line pharmacological treatment for PTSD
C) SSRIs are contraindicated in PTSD
D) SSRIs are only effective for depression, not PTSD
Correct Answer: SSRIs are first-line pharmacological treatment for PTSD
Rationale: SSRIs, specifically sertraline and paroxetine, are FDA-approved and first-line
pharmacological treatments for PTSD. They work by increasing serotonin levels in the brain, which can
enhance mood and reduce anxiety symptoms associated with PTSD. They are not contraindicated and
are effective for PTSD.
6. Benzodiazepines are generally contraindicated in PTSD treatment for which primary reason?
A) They are ineffective for anxiety symptoms
B) They interfere with cognitive processes necessary for CBT and carry a high risk of dependence
, C) They cause excessive sedation that improves PTSD symptoms
D) They are not FDA-approved for any psychiatric condition
Correct Answer: They interfere with cognitive processes necessary for CBT and carry a high risk of
dependence
Rationale: Benzodiazepines are contraindicated in PTSD because they interfere with cognitive
processes necessary for cognitive-behavioral therapy and carry a high risk of dependence, particularly
in patients with comorbid substance use disorders. While they may provide short-term anxiety relief,
their sedative effects can hinder emotional processing critical for recovery.
7. Which of the following medications is FDA-approved for the treatment of PTSD?
A) Fluoxetine
B) Paroxetine
C) Venlafaxine
D) Duloxetine
Correct Answer: Paroxetine
Rationale: Sertraline and paroxetine are the two SSRIs that are FDA-approved for the treatment of
PTSD. Fluoxetine, venlafaxine, and duloxetine are not FDA-approved for PTSD, though they may be
used off-label.
8. A patient with treatment-resistant PTSD is considered for augmentation with an atypical
antipsychotic. In which scenario is this most appropriate?
A) As first-line monotherapy
B) Only in severe cases where standard treatments have failed
C) For all patients with PTSD
D) As a replacement for SSRIs
Correct Answer: Only in severe cases where standard treatments have failed
Rationale: Augmentation with an atypical antipsychotic is considered only in severe cases of PTSD
where standard treatments (SSRIs, psychotherapy) have been inadequate. It is not first-line therapy,
not for all patients, and not a replacement for SSRIs.
9. A patient with PTSD is prescribed prazosin. Which adverse effect should the patient be counseled
about?
