NR 546 Week 3 Exam V2 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
3 Exam) | Chamberlain University
1. A patient is prescribed Fluoxetine for Major Depressive Disorder. Which cytochrome P450
enzyme is significantly inhibited by this medication, potentially leading to drug-drug
interactions with beta-blockers or TCAs?
A. CYP1A2
B. CYP3A4
C. CYP2D6
D. CYP2C19
Correct Answer: C
Explanation: Fluoxetine is a potent inhibitor of the CYP2D6 isoenzyme. This inhibition can
lead to increased serum levels of other drugs metabolized by this pathway, such as tricyclic
antidepressants and certain antiarrhythmics. The PMHNP must carefully monitor for
toxicity when fluoxetine is combined with these agents.
2. When educating a patient on a newly prescribed Monoamine Oxidase Inhibitor (MAOI),
which dietary item must be strictly avoided to prevent a hypertensive crisis?
A. Fresh poultry
B. Leafy green vegetables
,C. Pasteurized milk
D. Aged cheddar cheese
Correct Answer: D
Explanation: MAOIs block the breakdown of tyramine, an amino acid found in aged or
fermented foods. Consuming high-tyramine foods like aged cheese can cause a massive
release of norepinephrine, leading to dangerous increases in blood pressure. Patients must
receive comprehensive education on low-tyramine diets prior to starting treatment.
3. A 24-year-old male with a history of epilepsy is seeking treatment for depression. Which
antidepressant is strictly contraindicated due to its potential to lower the seizure threshold?
A. Bupropion
B. Escitalopram
C. Sertraline
D. Venlafaxine
Correct Answer: A
Explanation: Bupropion is known to lower the seizure threshold, particularly at higher
doses or in immediate-release formulations. It is contraindicated in patients with seizure
disorders or conditions that predispose to seizures, such as bulimia or anorexia nervosa.
For this patient, an SSRI would be a safer first-line option.
, 4. Which side effect of Tricyclic Antidepressants (TCAs) is primarily attributed to their
blockade of the Muscarinic-1 (M1) receptors?
A. Orthostatic hypotension
B. Dry mouth and constipation
C. Weight gain
D. Sedation
Correct Answer: B
Explanation: The blockade of M1 muscarinic receptors by TCAs results in classic
anticholinergic side effects. Common symptoms include xerostomia (dry mouth),
constipation, urinary retention, and blurred vision. These side effects are often dose-
limiting and can lead to poor patient adherence.
5. A patient exhibits hyperreflexia, agitation, diaphoresis, and tremors shortly after adding a
second serotonergic agent to their regimen. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome
C. Anticholinergic Toxicity
D. Panic Disorder
Correct Answer: A
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
3 Exam) | Chamberlain University
1. A patient is prescribed Fluoxetine for Major Depressive Disorder. Which cytochrome P450
enzyme is significantly inhibited by this medication, potentially leading to drug-drug
interactions with beta-blockers or TCAs?
A. CYP1A2
B. CYP3A4
C. CYP2D6
D. CYP2C19
Correct Answer: C
Explanation: Fluoxetine is a potent inhibitor of the CYP2D6 isoenzyme. This inhibition can
lead to increased serum levels of other drugs metabolized by this pathway, such as tricyclic
antidepressants and certain antiarrhythmics. The PMHNP must carefully monitor for
toxicity when fluoxetine is combined with these agents.
2. When educating a patient on a newly prescribed Monoamine Oxidase Inhibitor (MAOI),
which dietary item must be strictly avoided to prevent a hypertensive crisis?
A. Fresh poultry
B. Leafy green vegetables
,C. Pasteurized milk
D. Aged cheddar cheese
Correct Answer: D
Explanation: MAOIs block the breakdown of tyramine, an amino acid found in aged or
fermented foods. Consuming high-tyramine foods like aged cheese can cause a massive
release of norepinephrine, leading to dangerous increases in blood pressure. Patients must
receive comprehensive education on low-tyramine diets prior to starting treatment.
3. A 24-year-old male with a history of epilepsy is seeking treatment for depression. Which
antidepressant is strictly contraindicated due to its potential to lower the seizure threshold?
A. Bupropion
B. Escitalopram
C. Sertraline
D. Venlafaxine
Correct Answer: A
Explanation: Bupropion is known to lower the seizure threshold, particularly at higher
doses or in immediate-release formulations. It is contraindicated in patients with seizure
disorders or conditions that predispose to seizures, such as bulimia or anorexia nervosa.
For this patient, an SSRI would be a safer first-line option.
, 4. Which side effect of Tricyclic Antidepressants (TCAs) is primarily attributed to their
blockade of the Muscarinic-1 (M1) receptors?
A. Orthostatic hypotension
B. Dry mouth and constipation
C. Weight gain
D. Sedation
Correct Answer: B
Explanation: The blockade of M1 muscarinic receptors by TCAs results in classic
anticholinergic side effects. Common symptoms include xerostomia (dry mouth),
constipation, urinary retention, and blurred vision. These side effects are often dose-
limiting and can lead to poor patient adherence.
5. A patient exhibits hyperreflexia, agitation, diaphoresis, and tremors shortly after adding a
second serotonergic agent to their regimen. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome
C. Anticholinergic Toxicity
D. Panic Disorder
Correct Answer: A
