NR 546 Week 1 Exam V2 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
1 Exam) | Chamberlain University
1. When a patient begins smoking cigarettes, which effect on the metabolism of certain
psychotropic medications like Clozapine should the PMHNP expect?
A. Decreased metabolism via CYP1A2 inhibition.
B. No significant change in serum levels.
C. Increased metabolism via CYP1A2 induction.
D. Decreased metabolism via CYP3A4 induction.
Correct Answer: C
Explanation: Tobacco smoke contains polycyclic aromatic hydrocarbons that act as potent
inducers of the CYP1A2 enzyme. Since Clozapine is a primary substrate for CYP1A2, its
metabolism is significantly accelerated, leading to lower plasma concentrations. The
PMHNP must closely monitor clinical symptoms and may need to increase the dosage to
maintain therapeutic efficacy.
2. Which of the following describes the function of an ‘inverse agonist’ at a receptor site?
A. It mimics the natural ligand to produce a maximal biological response.
B. It binds to the receptor and blocks the action of the agonist without affecting baseline
activity.
,C. It binds to an allosteric site to enhance the binding of the primary neurotransmitter.
D. It binds to the receptor and reduces the constitutive activity of the receptor below
baseline levels.
Correct Answer: D
Explanation: An inverse agonist does more than just block a receptor; it induces a
response that is opposite to that of an agonist. This occurs by stabilizing the receptor in an
inactive state, thereby reducing the constitutive activity present even in the absence of a
ligand. This mechanism is distinct from a competitive antagonist, which merely maintains
the status quo by blocking agonists.
3. The process by which a neurotransmitter is transported back into the presynaptic neuron
for reuse is known as:
A. Enzymatic degradation
B. Signal transduction
C. Reuptake
D. Diffusion
Correct Answer: C
Explanation: Reuptake is a primary mechanism for terminating the signal between
neurons by removing the neurotransmitter from the synaptic cleft. Specialized transport
proteins, such as SERT for serotonin or DAT for dopamine, facilitate this movement back
, into the presynaptic terminal. Inhibiting this process is a common pharmacological
strategy used in antidepressant and stimulant medications.
4. A patient is identified as a ‘Poor Metabolizer’ for CYP2D6 via pharmacogenetic testing.
How should the PMHNP adjust the dosing of a substrate drug like Fluoxetine?
A. Increase the dose significantly to achieve therapeutic levels.
B. Standard dosing is appropriate regardless of genotype.
C. Administer a lower dose to prevent toxicity.
D. Avoid all medications metabolized by the liver.
Correct Answer: C
Explanation: Poor metabolizers lack functional CYP2D6 enzymes, meaning they process
substrates much more slowly than the general population. This leads to higher-than-
expected drug concentrations and an increased risk of side effects or toxicity at standard
doses. Therefore, the PMHNP should prescribe a lower initial dose and titrate cautiously
based on clinical response.
5. Which neurotransmitter is primarily associated with the ‘reward circuit’ and the
pathophysiology of addiction?
A. GABA
B. Acetylcholine
C. Glutamate
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
1 Exam) | Chamberlain University
1. When a patient begins smoking cigarettes, which effect on the metabolism of certain
psychotropic medications like Clozapine should the PMHNP expect?
A. Decreased metabolism via CYP1A2 inhibition.
B. No significant change in serum levels.
C. Increased metabolism via CYP1A2 induction.
D. Decreased metabolism via CYP3A4 induction.
Correct Answer: C
Explanation: Tobacco smoke contains polycyclic aromatic hydrocarbons that act as potent
inducers of the CYP1A2 enzyme. Since Clozapine is a primary substrate for CYP1A2, its
metabolism is significantly accelerated, leading to lower plasma concentrations. The
PMHNP must closely monitor clinical symptoms and may need to increase the dosage to
maintain therapeutic efficacy.
2. Which of the following describes the function of an ‘inverse agonist’ at a receptor site?
A. It mimics the natural ligand to produce a maximal biological response.
B. It binds to the receptor and blocks the action of the agonist without affecting baseline
activity.
,C. It binds to an allosteric site to enhance the binding of the primary neurotransmitter.
D. It binds to the receptor and reduces the constitutive activity of the receptor below
baseline levels.
Correct Answer: D
Explanation: An inverse agonist does more than just block a receptor; it induces a
response that is opposite to that of an agonist. This occurs by stabilizing the receptor in an
inactive state, thereby reducing the constitutive activity present even in the absence of a
ligand. This mechanism is distinct from a competitive antagonist, which merely maintains
the status quo by blocking agonists.
3. The process by which a neurotransmitter is transported back into the presynaptic neuron
for reuse is known as:
A. Enzymatic degradation
B. Signal transduction
C. Reuptake
D. Diffusion
Correct Answer: C
Explanation: Reuptake is a primary mechanism for terminating the signal between
neurons by removing the neurotransmitter from the synaptic cleft. Specialized transport
proteins, such as SERT for serotonin or DAT for dopamine, facilitate this movement back
, into the presynaptic terminal. Inhibiting this process is a common pharmacological
strategy used in antidepressant and stimulant medications.
4. A patient is identified as a ‘Poor Metabolizer’ for CYP2D6 via pharmacogenetic testing.
How should the PMHNP adjust the dosing of a substrate drug like Fluoxetine?
A. Increase the dose significantly to achieve therapeutic levels.
B. Standard dosing is appropriate regardless of genotype.
C. Administer a lower dose to prevent toxicity.
D. Avoid all medications metabolized by the liver.
Correct Answer: C
Explanation: Poor metabolizers lack functional CYP2D6 enzymes, meaning they process
substrates much more slowly than the general population. This leads to higher-than-
expected drug concentrations and an increased risk of side effects or toxicity at standard
doses. Therefore, the PMHNP should prescribe a lower initial dose and titrate cautiously
based on clinical response.
5. Which neurotransmitter is primarily associated with the ‘reward circuit’ and the
pathophysiology of addiction?
A. GABA
B. Acetylcholine
C. Glutamate
