NR 546 PMHNP ADVANCED
PHARMACOLOGY FINAL EXAM PREP
QUESTIONS AND ANSWERS (LATEST),
(A+ GUARANTEE). JUST RELEASED
1. A patient diagnosed with schizophrenia is initiated on a Second-Generation Antipsychotic
(SGA). Which pharmacological property primarily distinguishes SGAs from First-Generation
Antipsychotics (FGAs) regarding their effect on the extrapyramidal system?
A. D2 receptor antagonism only
B. Potent Alpha-1 adrenergic blockade
C. 5-HT2A receptor antagonism coupled with D2 receptor antagonism
D. Muscarinic-1 receptor agonism
Answer: C
Conceptual Explanation: SGAs (atypical antipsychotics) are defined by their dual
antagonism of 5-HT2A serotonin receptors and D2 dopamine receptors. The 5-HT2A
antagonism increases dopamine release in the nigrostriatal pathway, which mitigates the
risk of Extrapyramidal Symptoms (EPS) compared to the pure D2 blockade of FGAs.
,2. A 28-year-old female patient with Bipolar I Disorder is being considered for Lithium
therapy. Which of the following laboratory panels is most critical to obtain at baseline and
monitor periodically?
A. Serum Creatinine, Blood Urea Nitrogen (BUN), and Thyroid Stimulating Hormone (TSH)
B. Liver Function Tests (LFTs) and Prothrombin Time
C. Amylase, Lipase, and Complete Blood Count (CBC)
D. Cardiac Troponins and Creatine Kinase
Answer: A
Conceptual Explanation: Lithium is excreted unchanged by the kidneys and can cause
nephrogenic diabetes insipidus or chronic kidney disease; it also frequently causes
hypothyroidism. Therefore, renal function and thyroid function monitoring are mandatory.
3. A patient taking Fluoxetine (Prozac) for Major Depressive Disorder is prescribed Tamoxifen
for breast cancer. The PMHNP understands that Fluoxetine may reduce the efficacy of
Tamoxifen through which mechanism?
A. Inhibition of CYP2D6
B. Induction of CYP3A4
C. Inhibition of P-glycoprotein
D. Induction of CYP1A2
Answer: A
, Conceptual Explanation: Tamoxifen is a prodrug that must be converted to its active
metabolite, endoxifen, by the CYP2D6 enzyme. Fluoxetine is a potent inhibitor of CYP2D6,
thereby preventing the conversion and reducing the clinical efficacy of Tamoxifen.
4. During the administration of a Monoamine Oxidase Inhibitor (MAOI), the patient must
strictly avoid tyramine-rich foods to prevent which life-threatening complication?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome
C. Agranulocytosis
D. Hypertensive Crisis
Answer: D
Conceptual Explanation: Tyramine acts as a catecholamine releasing agent. When MAO is
inhibited, tyramine is not broken down and leads to a massive release of norepinephrine,
causing vasoconstriction and a potentially fatal hypertensive crisis.
5. Atomoxetine (Strattera) is utilized in the treatment of ADHD. What is its primary
mechanism of action?
A. Selective inhibition of the Norepinephrine Transporter (NET)
B. Blockade of Dopamine Transporter (DAT) in the Nucleus Accumbens
C. Agonism at Alpha-2A adrenergic receptors
D. Release of vesicular Monoamines into the synapse
PHARMACOLOGY FINAL EXAM PREP
QUESTIONS AND ANSWERS (LATEST),
(A+ GUARANTEE). JUST RELEASED
1. A patient diagnosed with schizophrenia is initiated on a Second-Generation Antipsychotic
(SGA). Which pharmacological property primarily distinguishes SGAs from First-Generation
Antipsychotics (FGAs) regarding their effect on the extrapyramidal system?
A. D2 receptor antagonism only
B. Potent Alpha-1 adrenergic blockade
C. 5-HT2A receptor antagonism coupled with D2 receptor antagonism
D. Muscarinic-1 receptor agonism
Answer: C
Conceptual Explanation: SGAs (atypical antipsychotics) are defined by their dual
antagonism of 5-HT2A serotonin receptors and D2 dopamine receptors. The 5-HT2A
antagonism increases dopamine release in the nigrostriatal pathway, which mitigates the
risk of Extrapyramidal Symptoms (EPS) compared to the pure D2 blockade of FGAs.
,2. A 28-year-old female patient with Bipolar I Disorder is being considered for Lithium
therapy. Which of the following laboratory panels is most critical to obtain at baseline and
monitor periodically?
A. Serum Creatinine, Blood Urea Nitrogen (BUN), and Thyroid Stimulating Hormone (TSH)
B. Liver Function Tests (LFTs) and Prothrombin Time
C. Amylase, Lipase, and Complete Blood Count (CBC)
D. Cardiac Troponins and Creatine Kinase
Answer: A
Conceptual Explanation: Lithium is excreted unchanged by the kidneys and can cause
nephrogenic diabetes insipidus or chronic kidney disease; it also frequently causes
hypothyroidism. Therefore, renal function and thyroid function monitoring are mandatory.
3. A patient taking Fluoxetine (Prozac) for Major Depressive Disorder is prescribed Tamoxifen
for breast cancer. The PMHNP understands that Fluoxetine may reduce the efficacy of
Tamoxifen through which mechanism?
A. Inhibition of CYP2D6
B. Induction of CYP3A4
C. Inhibition of P-glycoprotein
D. Induction of CYP1A2
Answer: A
, Conceptual Explanation: Tamoxifen is a prodrug that must be converted to its active
metabolite, endoxifen, by the CYP2D6 enzyme. Fluoxetine is a potent inhibitor of CYP2D6,
thereby preventing the conversion and reducing the clinical efficacy of Tamoxifen.
4. During the administration of a Monoamine Oxidase Inhibitor (MAOI), the patient must
strictly avoid tyramine-rich foods to prevent which life-threatening complication?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome
C. Agranulocytosis
D. Hypertensive Crisis
Answer: D
Conceptual Explanation: Tyramine acts as a catecholamine releasing agent. When MAO is
inhibited, tyramine is not broken down and leads to a massive release of norepinephrine,
causing vasoconstriction and a potentially fatal hypertensive crisis.
5. Atomoxetine (Strattera) is utilized in the treatment of ADHD. What is its primary
mechanism of action?
A. Selective inhibition of the Norepinephrine Transporter (NET)
B. Blockade of Dopamine Transporter (DAT) in the Nucleus Accumbens
C. Agonism at Alpha-2A adrenergic receptors
D. Release of vesicular Monoamines into the synapse
