NR 546 PSYCHOPHARMACOLOGY
MIDTERM EXAM QUESTIONS WITH
CORRECT ANSWERS (LATEST 2026 /
2027), (A+ GUARANTEE).
1. Which dopamine pathway is primarily responsible for the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: Excessive dopamine activity in the mesolimbic pathway is
associated with positive symptoms of schizophrenia. The mesocortical pathway is
associated with negative symptoms, nigrostriatal with motor symptoms, and
tuberoinfundibular with prolactin regulation.
2. A patient taking a first-generation antipsychotic develops muscle rigidity, fever, and
autonomic instability. What is the most likely diagnosis?
A. Serotonin Syndrome
,B. Acute Dystonia
C. Neuroleptic Malignant Syndrome (NMS)
D. Akathisia
Answer: C
Conceptual Explanation: Neuroleptic Malignant Syndrome is a life-threatening reaction to
antipsychotics characterized by lead-pipe rigidity, high fever, and autonomic dysfunction.
3. Which mechanism of action distinguishes atypical (second-generation) antipsychotics from
typical (first-generation) antipsychotics?
A. D2 receptor antagonism only
B. GABA-A receptor modulation
C. Selective serotonin reuptake inhibition
D. 5HT2A receptor antagonism combined with D2 antagonism
Answer: D
Conceptual Explanation: Atypical antipsychotics are characterized by their ability to
block both D2 and 5HT2A receptors, which helps reduce EPS and treat negative symptoms.
4. Which cytochrome P450 enzyme is responsible for the metabolism of approximately 25-
30% of clinically used drugs, including many antidepressants and antipsychotics?
A. CYP1A2
B. CYP2C19
, C. CYP3A4
D. CYP2D6
Answer: D
Conceptual Explanation: CYP2D6 is a major metabolic pathway for many psychotropic
medications. Genetic polymorphisms in this enzyme can lead to poor or ultra-rapid
metabolism.
5. A patient is started on Lamotrigine for bipolar depression. What is the most critical
education point regarding side effects?
A. Risk of weight gain
B. Need for weekly blood draws for levels
C. Importance of reporting any new skin rash
D. Potential for hypertensive crisis
Answer: C
Conceptual Explanation: Lamotrigine carries a boxed warning for Stevens-Johnson
Syndrome (SJS), a life-threatening rash. Patients must be taught to report any skin changes
immediately.
6. What is the primary mechanism of action of Benzodiazepines?
A. Inhibition of GABA transaminase
B. Direct agonism of the GABA-B receptor
MIDTERM EXAM QUESTIONS WITH
CORRECT ANSWERS (LATEST 2026 /
2027), (A+ GUARANTEE).
1. Which dopamine pathway is primarily responsible for the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: Excessive dopamine activity in the mesolimbic pathway is
associated with positive symptoms of schizophrenia. The mesocortical pathway is
associated with negative symptoms, nigrostriatal with motor symptoms, and
tuberoinfundibular with prolactin regulation.
2. A patient taking a first-generation antipsychotic develops muscle rigidity, fever, and
autonomic instability. What is the most likely diagnosis?
A. Serotonin Syndrome
,B. Acute Dystonia
C. Neuroleptic Malignant Syndrome (NMS)
D. Akathisia
Answer: C
Conceptual Explanation: Neuroleptic Malignant Syndrome is a life-threatening reaction to
antipsychotics characterized by lead-pipe rigidity, high fever, and autonomic dysfunction.
3. Which mechanism of action distinguishes atypical (second-generation) antipsychotics from
typical (first-generation) antipsychotics?
A. D2 receptor antagonism only
B. GABA-A receptor modulation
C. Selective serotonin reuptake inhibition
D. 5HT2A receptor antagonism combined with D2 antagonism
Answer: D
Conceptual Explanation: Atypical antipsychotics are characterized by their ability to
block both D2 and 5HT2A receptors, which helps reduce EPS and treat negative symptoms.
4. Which cytochrome P450 enzyme is responsible for the metabolism of approximately 25-
30% of clinically used drugs, including many antidepressants and antipsychotics?
A. CYP1A2
B. CYP2C19
, C. CYP3A4
D. CYP2D6
Answer: D
Conceptual Explanation: CYP2D6 is a major metabolic pathway for many psychotropic
medications. Genetic polymorphisms in this enzyme can lead to poor or ultra-rapid
metabolism.
5. A patient is started on Lamotrigine for bipolar depression. What is the most critical
education point regarding side effects?
A. Risk of weight gain
B. Need for weekly blood draws for levels
C. Importance of reporting any new skin rash
D. Potential for hypertensive crisis
Answer: C
Conceptual Explanation: Lamotrigine carries a boxed warning for Stevens-Johnson
Syndrome (SJS), a life-threatening rash. Patients must be taught to report any skin changes
immediately.
6. What is the primary mechanism of action of Benzodiazepines?
A. Inhibition of GABA transaminase
B. Direct agonism of the GABA-B receptor
