NU 643 Exam 1 V2 | NU 643 Advanced
Psychopharmacology | Actual Q&A with Rationale
(NU643 Exam 1) | Regis University
1. A patient being treated with Fluoxetine for Major Depressive Disorder reports high levels
of anxiety. Which pharmacokinetic property of Fluoxetine explains its initial activating effect?
A. High affinity for the 5-HT2C receptor leading to downstream dopamine release
B. Potent inhibition of the CYP2D6 enzyme system
C. The long half-life of its active metabolite norfluoxetine
D. Its short half-life requires frequent dosing leading to fluctuations
Correct Answer: A
Explanation: Fluoxetine is unique among SSRIs because it possesses 5-HT2C antagonist
properties. This antagonism leads to an increase in norepinephrine and dopamine levels in
the prefrontal cortex, which can be perceived as stimulating or activating. Patients may
experience increased energy or agitation early in treatment due to this specific mechanism.
Close monitoring is required for patients with comorbid anxiety disorders.
2. When prescribing Lithium Carbonate, which electrolyte imbalance is most likely to increase
the risk of lithium toxicity?
A. Hyperkalemia
B. Hypermagnesemia
,C. Hypocalcemia
D. Hyponatremia
Correct Answer: D
Explanation: Lithium is handled by the kidneys in a manner very similar to sodium. When
a patient experiences hyponatremia, the proximal tubules increase the reabsorption of
lithium in an attempt to conserve cations. This leads to decreased lithium clearance and
potentially toxic serum levels, necessitating education on consistent salt and fluid intake.
3. Which of the following brain regions is primarily associated with the ‘reward’ pathway and
is the target of many addictive substances?
A. Dorsolateral prefrontal cortex
B. Substantia nigra
C. Locus coeruleus
D. Nucleus accumbens
Correct Answer: D
Explanation: The nucleus accumbens is a key component of the mesolimbic dopamine
pathway. It plays a central role in the rewarding effects of natural reinforcers and drugs of
abuse. Dysregulation in this area is often linked to the pathology of addiction and impulsive
behaviors.
, 4. A 32-year-old patient on Lamotrigine for Bipolar II Disorder presents with a mild
maculopapular rash. What is the most appropriate clinical action?
A. Reassure the patient and continue the medication at the same dose
B. Reduce the dose by 50% and monitor daily
C. Add an antihistamine and continue titration
D. Immediately discontinue the medication and evaluate for Stevens-Johnson Syndrome
Correct Answer: D
Explanation: Lamotrigine carries a black box warning for serious and potentially life-
threatening rashes, including Stevens-Johnson Syndrome. Because benign rashes cannot be
reliably distinguished from the early stages of a serious reaction, the drug should be
stopped at the first sign of a rash. This clinical guideline is strictly enforced to ensure
patient safety given the high mortality rate of SJS.
5. Which antidepressant is contraindicated in patients with a history of seizure disorders or
eating disorders?
A. Sertraline
B. Mirtazapine
C. Duloxetine
D. Bupropion
Correct Answer: D
Psychopharmacology | Actual Q&A with Rationale
(NU643 Exam 1) | Regis University
1. A patient being treated with Fluoxetine for Major Depressive Disorder reports high levels
of anxiety. Which pharmacokinetic property of Fluoxetine explains its initial activating effect?
A. High affinity for the 5-HT2C receptor leading to downstream dopamine release
B. Potent inhibition of the CYP2D6 enzyme system
C. The long half-life of its active metabolite norfluoxetine
D. Its short half-life requires frequent dosing leading to fluctuations
Correct Answer: A
Explanation: Fluoxetine is unique among SSRIs because it possesses 5-HT2C antagonist
properties. This antagonism leads to an increase in norepinephrine and dopamine levels in
the prefrontal cortex, which can be perceived as stimulating or activating. Patients may
experience increased energy or agitation early in treatment due to this specific mechanism.
Close monitoring is required for patients with comorbid anxiety disorders.
2. When prescribing Lithium Carbonate, which electrolyte imbalance is most likely to increase
the risk of lithium toxicity?
A. Hyperkalemia
B. Hypermagnesemia
,C. Hypocalcemia
D. Hyponatremia
Correct Answer: D
Explanation: Lithium is handled by the kidneys in a manner very similar to sodium. When
a patient experiences hyponatremia, the proximal tubules increase the reabsorption of
lithium in an attempt to conserve cations. This leads to decreased lithium clearance and
potentially toxic serum levels, necessitating education on consistent salt and fluid intake.
3. Which of the following brain regions is primarily associated with the ‘reward’ pathway and
is the target of many addictive substances?
A. Dorsolateral prefrontal cortex
B. Substantia nigra
C. Locus coeruleus
D. Nucleus accumbens
Correct Answer: D
Explanation: The nucleus accumbens is a key component of the mesolimbic dopamine
pathway. It plays a central role in the rewarding effects of natural reinforcers and drugs of
abuse. Dysregulation in this area is often linked to the pathology of addiction and impulsive
behaviors.
, 4. A 32-year-old patient on Lamotrigine for Bipolar II Disorder presents with a mild
maculopapular rash. What is the most appropriate clinical action?
A. Reassure the patient and continue the medication at the same dose
B. Reduce the dose by 50% and monitor daily
C. Add an antihistamine and continue titration
D. Immediately discontinue the medication and evaluate for Stevens-Johnson Syndrome
Correct Answer: D
Explanation: Lamotrigine carries a black box warning for serious and potentially life-
threatening rashes, including Stevens-Johnson Syndrome. Because benign rashes cannot be
reliably distinguished from the early stages of a serious reaction, the drug should be
stopped at the first sign of a rash. This clinical guideline is strictly enforced to ensure
patient safety given the high mortality rate of SJS.
5. Which antidepressant is contraindicated in patients with a history of seizure disorders or
eating disorders?
A. Sertraline
B. Mirtazapine
C. Duloxetine
D. Bupropion
Correct Answer: D
