PSYCHOPHARMACOLOGY & EVIDENCE-BASED PSYCHIATRIC
TREATMENT
,TABLE OF CONTEXT
• Sec on 1 (Ques ons 1–80):
• Sec on 2 (Ques ons 81–150):
• Sec on 3 (Ques ons 151–230
• Sec on 4 (Ques ons 231–300
.
NR 668 Midterm Examina on – Psychopharmacology & Evidence-Based Psychiatric Treatment
SECTION 1: FUNDAMENTAL NEUROPHARMACOLOGY &
PHARMACOKINETICS (QUESTIONS 1–80)
1. A pa ent is prescribed a medica on that acts as a full agonist at the dopamine D2 receptor.
Which of the following effects would you expect?
• A. Decreased dopaminergic transmission
• B. Maximum intrinsic ac vity at the receptor
• C. Antagonism of dopamine effects
• D. Par al s mula on of the receptor
, • Answer: B. A full agonist binds to the receptor and produces a maximal response (100%
intrinsic ac vity) . Full D2 agonists (like some dopamine precursors) ac vate the
receptor completely, unlike par al agonists or antagonists.
2. A pa ent is started on a medica on with a high affinity for the serotonin transporter (SERT)
and low affinity for histaminergic, cholinergic, and alpha-adrenergic receptors. This
medica on is most likely from which class?
• A. Tricyclic An depressant (TCA)
• B. Selec ve Serotonin Reuptake Inhibitor (SSRI)
• C. Atypical An psycho c
• D. Monoamine Oxidase Inhibitor (MAOI)
• Answer: B. SSRIs are highly selec ve for SERT and generally lack significant affinity for
histamine (H1), muscarinic, and alpha-1 receptors, which is why they have fewer
seda ng, an cholinergic, and orthosta c side effects compared to TCAs.
3. A PMHNP is explaining the cytochrome P450 (CYP450) system to a pa ent. Which
statement accurately describes the role of CYP450 enzymes?
• A. They are responsible for binding to drug receptors in the brain.
• B. They are primarily involved in drug metabolism and elimina on in the liver.
• C. They transport drugs across the blood-brain barrier.
• D. They are inac ve in most psychiatric pa ents.
• Answer: B. The CYP450 enzyme system (primarily in the liver) is responsible for phase I
metabolism of many psychotropic medica ons, conver ng lipophilic drugs into
hydrophilic metabolites for renal excre on.
4. A pa ent is a poor metabolizer of CYP2D6. Which of the following medica ons would
require a significantly lower star ng dose to avoid toxicity?
• A. Fluoxe ne
• B. Sertraline
• C. Paroxe ne
• D. Escitalopram
, • Answer: C. Paroxe ne is a substrate of CYP2D6 and also a potent inhibitor of CYP2D6.
Poor metabolizers have reduced clearance, leading to higher serum levels and increased
risk of side effects. Fluoxe ne also inhibits CYP2D6 but is metabolized by CYP2D6 and
CYP3A4.
5. A pa ent on warfarin is started on fluvoxamine for OCD. The PMHNP should monitor for:
• A. Decreased warfarin effect (subtherapeu c INR)
• B. Increased warfarin effect (elevated INR and bleeding risk)
• C. No interac on
• D. Increased fluvoxamine levels
• Answer: B. Fluvoxamine is a potent inhibitor of CYP1A2 and CYP2C19, and a moderate
inhibitor of CYP2C9. Warfarin is metabolized by CYP2C9. Inhibi on leads to increased
warfarin levels, elevated INR, and bleeding risk.
6. A medica on with a half-life of 24 hours is administered at a fixed dose. Approximately
how many days will it take to reach steady-state plasma concentra on?
• A. 1 day
• B. 3 days
• C. 5 days
• D. 10 days
• Answer: C. Steady-state is reached a er approximately 4–5 half-lives. For a 24-hour half-
life, 4–5 × 24 hours = 4–5 days.
7. A pa ent is switched from fluoxe ne to phenelzine (MAOI). What is the recommended
washout period?
• A. 2 days
• B. 7 days
• C. 14 days
• D. 5 weeks
• Answer: D. Fluoxe ne has a long half-life (1–3 days) and an ac ve metabolite
(norfluoxe ne) with a half-life of 7–15 days. A 5-week washout is required when
switching from fluoxe ne to an MAOI to prevent serotonin syndrome.
TREATMENT
,TABLE OF CONTEXT
• Sec on 1 (Ques ons 1–80):
• Sec on 2 (Ques ons 81–150):
• Sec on 3 (Ques ons 151–230
• Sec on 4 (Ques ons 231–300
.
NR 668 Midterm Examina on – Psychopharmacology & Evidence-Based Psychiatric Treatment
SECTION 1: FUNDAMENTAL NEUROPHARMACOLOGY &
PHARMACOKINETICS (QUESTIONS 1–80)
1. A pa ent is prescribed a medica on that acts as a full agonist at the dopamine D2 receptor.
Which of the following effects would you expect?
• A. Decreased dopaminergic transmission
• B. Maximum intrinsic ac vity at the receptor
• C. Antagonism of dopamine effects
• D. Par al s mula on of the receptor
, • Answer: B. A full agonist binds to the receptor and produces a maximal response (100%
intrinsic ac vity) . Full D2 agonists (like some dopamine precursors) ac vate the
receptor completely, unlike par al agonists or antagonists.
2. A pa ent is started on a medica on with a high affinity for the serotonin transporter (SERT)
and low affinity for histaminergic, cholinergic, and alpha-adrenergic receptors. This
medica on is most likely from which class?
• A. Tricyclic An depressant (TCA)
• B. Selec ve Serotonin Reuptake Inhibitor (SSRI)
• C. Atypical An psycho c
• D. Monoamine Oxidase Inhibitor (MAOI)
• Answer: B. SSRIs are highly selec ve for SERT and generally lack significant affinity for
histamine (H1), muscarinic, and alpha-1 receptors, which is why they have fewer
seda ng, an cholinergic, and orthosta c side effects compared to TCAs.
3. A PMHNP is explaining the cytochrome P450 (CYP450) system to a pa ent. Which
statement accurately describes the role of CYP450 enzymes?
• A. They are responsible for binding to drug receptors in the brain.
• B. They are primarily involved in drug metabolism and elimina on in the liver.
• C. They transport drugs across the blood-brain barrier.
• D. They are inac ve in most psychiatric pa ents.
• Answer: B. The CYP450 enzyme system (primarily in the liver) is responsible for phase I
metabolism of many psychotropic medica ons, conver ng lipophilic drugs into
hydrophilic metabolites for renal excre on.
4. A pa ent is a poor metabolizer of CYP2D6. Which of the following medica ons would
require a significantly lower star ng dose to avoid toxicity?
• A. Fluoxe ne
• B. Sertraline
• C. Paroxe ne
• D. Escitalopram
, • Answer: C. Paroxe ne is a substrate of CYP2D6 and also a potent inhibitor of CYP2D6.
Poor metabolizers have reduced clearance, leading to higher serum levels and increased
risk of side effects. Fluoxe ne also inhibits CYP2D6 but is metabolized by CYP2D6 and
CYP3A4.
5. A pa ent on warfarin is started on fluvoxamine for OCD. The PMHNP should monitor for:
• A. Decreased warfarin effect (subtherapeu c INR)
• B. Increased warfarin effect (elevated INR and bleeding risk)
• C. No interac on
• D. Increased fluvoxamine levels
• Answer: B. Fluvoxamine is a potent inhibitor of CYP1A2 and CYP2C19, and a moderate
inhibitor of CYP2C9. Warfarin is metabolized by CYP2C9. Inhibi on leads to increased
warfarin levels, elevated INR, and bleeding risk.
6. A medica on with a half-life of 24 hours is administered at a fixed dose. Approximately
how many days will it take to reach steady-state plasma concentra on?
• A. 1 day
• B. 3 days
• C. 5 days
• D. 10 days
• Answer: C. Steady-state is reached a er approximately 4–5 half-lives. For a 24-hour half-
life, 4–5 × 24 hours = 4–5 days.
7. A pa ent is switched from fluoxe ne to phenelzine (MAOI). What is the recommended
washout period?
• A. 2 days
• B. 7 days
• C. 14 days
• D. 5 weeks
• Answer: D. Fluoxe ne has a long half-life (1–3 days) and an ac ve metabolite
(norfluoxe ne) with a half-life of 7–15 days. A 5-week washout is required when
switching from fluoxe ne to an MAOI to prevent serotonin syndrome.
