NSG 552 Psychopharmacology Exams 1, 2 & 3 Questions and Answers| Wilkes University|2027

NSG 552 Psychopharmacology Exams 1, 2 & 3
Questions and Answers| Wilkes University| Updated



Question 1. A patient is prescribed a medication that undergoes extensive first-
pass metabolism. Which route of administration would bypass this effect?
A. Oral
B. Sublingual
C. Rectal (partial)
D. Enteric-coated oral
Answer: B
Rationale: Sublingual administration allows drug absorption directly into systemic
circulation via the oral mucosa, bypassing hepatic first-pass metabolism entirely,
unlike oral routes that pass through the portal circulation and liver before
reaching systemic circulation.

Question 2. Which pharmacokinetic parameter best describes the percentage of
an administered drug dose that reaches systemic circulation unchanged?
A. Volume of distribution
B. Bioavailability
C. Clearance
D. Half-life
Answer: B
Rationale: Bioavailability is defined as the fraction of an administered dose that
reaches systemic circulation unchanged; IV drugs have 100% bioavailability, while
oral drugs are often lower due to first-pass metabolism and incomplete absorption.

Question 3. A drug with a large volume of distribution (Vd) most likely indicates
that the drug is:
A. Highly protein-bound and stays in the vascular space
B. Extensively distributed into tissues rather than remaining in plasma
C. Rapidly excreted unchanged by the kidneys
D. Poorly absorbed from the GI tract

,Answer: B
Rationale: A large Vd indicates the drug distributes extensively into tissues (e.g.,
fat, muscle) rather than staying in the vascular compartment, which is common
for lipophilic psychotropic drugs like many antidepressants and antipsychotics.

Question 4. Which cytochrome P450 enzyme is most commonly responsible for
the metabolism of many SSRIs and is also frequently subject to genetic
polymorphism affecting drug response?
A. CYP1A2
B. CYP2D6
C. CYP3A4 only
D. CYP2C9
Answer: B
Rationale: CYP2D6 metabolizes many SSRIs (e.g., paroxetine, fluoxetine) and
antipsychotics, and has well-documented genetic polymorphisms creating poor,
intermediate, extensive, and ultrarapid metabolizer phenotypes that significantly
affect drug levels and response.

Question 5. A patient taking fluoxetine (a potent CYP2D6 inhibitor) is started on a
second medication also metabolized by CYP2D6. What is the primary clinical
concern?
A. Decreased efficacy of the second drug due to faster metabolism
B. Increased plasma levels of the second drug due to inhibited metabolism
C. No interaction because fluoxetine does not affect CYP enzymes
D. Increased renal clearance of the second drug
Answer: B
Rationale: Fluoxetine is a potent CYP2D6 inhibitor, so co-administration with
another CYP2D6 substrate can reduce that drug's metabolism, raising plasma
concentrations and increasing risk of toxicity.

Question 6. Which term describes the range between the minimum effective
concentration and the minimum toxic concentration of a drug?
A. Bioavailability
B. Therapeutic index
C. Half-life
D. Steady state

,Answer: B
Rationale: The therapeutic index (or therapeutic window) reflects the margin
between effective and toxic drug concentrations; drugs like lithium have a narrow
therapeutic index requiring close monitoring.

Question 7. How many half-lives are generally required for a drug to reach
steady-state plasma concentration?
A. 1-2 half-lives
B. 2-3 half-lives
C. 4-5 half-lives
D. 7-8 half-lives
Answer: C
Rationale: It generally takes 4-5 half-lives for a drug to reach steady state with
regular dosing, which is why clinicians wait this long before assessing full
therapeutic effect or adjusting doses for many psychotropics.

Question 8. A drug that binds to a receptor and produces a submaximal response
even at full receptor occupancy is best described as a:
A. Full agonist
B. Partial agonist
C. Competitive antagonist
D. Inverse agonist
Answer: B
Rationale: A partial agonist binds to the receptor but produces a submaximal
biological response compared to a full agonist, even when all receptors are
occupied; buprenorphine and aripiprazole are clinical examples.

Question 9. Which neurotransmitter is primarily implicated in the
pathophysiology of both mood and the reward pathway, and is a target of many
antidepressants and stimulants?
A. Acetylcholine
B. Dopamine
C. Histamine
D. Glycine
Answer: B

, Rationale: Dopamine plays a central role in mood, motivation, and the mesolimbic
reward pathway, making it a key target for antidepressants, antipsychotics, and
stimulant medications.

Question 10. GABA is the primary inhibitory neurotransmitter in the CNS. Which
class of drugs enhances GABA activity by increasing the frequency of chloride
channel opening?
A. Barbiturates
B. Benzodiazepines
C. SSRIs
D. MAOIs
Answer: B
Rationale: Benzodiazepines enhance GABA-A receptor activity by increasing the
frequency of chloride channel opening, whereas barbiturates increase the duration
of channel opening; both potentiate GABA's inhibitory effect.

Question 11. Which of the following best describes the mechanism of action of
SSRIs?
A. Block reuptake of serotonin and norepinephrine equally
B. Selectively inhibit presynaptic reuptake of serotonin, increasing synaptic
availability
C. Inhibit monoamine oxidase to prevent neurotransmitter breakdown
D. Block postsynaptic dopamine receptors
Answer: B
Rationale: SSRIs selectively inhibit the serotonin transporter (SERT), blocking
presynaptic reuptake of serotonin and increasing its availability in the synaptic
cleft, with minimal direct effect on norepinephrine or dopamine transporters.

Question 12. A patient starting sertraline should be counseled that the full
therapeutic antidepressant effect typically takes how long to occur?
A. 24-48 hours
B. 3-7 days
C. 4-6 weeks
D. 6 months
Answer: C