NU 643 Exam 2 V1 | NU 643 Advanced
Psychopharmacology | Actual Q&A with Rationale
(NU643 Exam 2) | Regis University
1. Which neurotransmitter system is primarily targeted by Selective Serotonin Reuptake
Inhibitors (SSRIs) to treat Major Depressive Disorder?
A. Dopamine D2 receptors
B. GABA-A receptors
C. Serotonin Transporter (SERT)
D. Alpha-2 adrenergic receptors
Correct Answer: C
Explanation: SSRIs work by binding to and inhibiting the serotonin transporter (SERT),
which prevents the reuptake of serotonin into the presynaptic neuron. This leads to an
increase in serotonin concentrations within the synaptic cleft, facilitating neuroplasticity
and downstream signaling. Over time, this mechanism is believed to lead to the
downregulation of 5HT1A autoreceptors, which is crucial for the clinical antidepressant
effect.
2. A patient taking a Monoamine Oxidase Inhibitor (MAOI) consumes aged cheese and wine,
subsequently developing a severe headache and hypertension. What is the mechanism of this
‘cheese reaction’?
A. Excessive accumulation of tyramine displacing norepinephrine
,B. Inhibition of the CYP2D6 enzyme
C. Antagonism of the NMDA receptor
D. Sudden depletion of serotonin stores
Correct Answer: A
Explanation: Tyramine is a sympathomimetic amine found in aged foods that is normally
metabolized by MAO-A in the gut. When MAO-A is inhibited by medication, tyramine enters
the systemic circulation and causes the release of massive amounts of stored
norepinephrine from sympathetic nerve terminals. This results in a hypertensive crisis,
which is a medical emergency characterized by rapid rises in blood pressure and potential
organ damage.
3. Which antidepressant is specifically contraindicated in patients with a history of seizure
disorders or bulimia nervosa?
A. Fluoxetine
B. Bupropion
C. Sertraline
D. Venlafaxine
Correct Answer: B
Explanation: Bupropion is known to lower the seizure threshold, particularly at high
doses or in susceptible populations. Patients with eating disorders like bulimia or anorexia
,are at an increased risk for electrolyte imbalances, which further predisposes them to
seizures while taking this medication. Therefore, its use is strictly avoided in these clinical
scenarios to ensure patient safety.
4. A 28-year-old female patient is prescribed Lamotrigine for Bipolar II disorder. What is the
most critical education topic regarding the titration of this medication?
A. Avoidance of grapefruit juice
B. Monitoring for a new-onset rash
C. Weekly blood draws for serum levels
D. Increasing dietary sodium intake
Correct Answer: B
Explanation: Lamotrigine carries a Black Box Warning for serious, potentially life-
threatening rashes, including Stevens-Johnson Syndrome (SJS). A slow titration schedule is
mandatory to minimize the risk of these dermatological reactions. Patients must be
instructed to discontinue the medication and seek immediate medical attention if any rash
or mucosal involvement occurs during the early stages of treatment.
5. Which of the following Second-Generation Antipsychotics (SGAs) is associated with the
highest risk for weight gain and metabolic syndrome?
A. Aripiprazole
B. Ziprasidone
C. Lurasidone
, D. Olanzapine
Correct Answer: D
Explanation: Olanzapine and Clozapine are recognized as having the highest metabolic
risk among antipsychotics, often leading to significant weight gain, dyslipidemia, and
insulin resistance. This effect is largely attributed to their potent antagonism of H1
histamine and 5HT2C serotonin receptors. Frequent monitoring of BMI, fasting glucose,
and lipid profiles is essential for patients prescribed these agents.
6. A patient experiences ‘cogwheeling’ and muscle rigidity shortly after starting Haloperidol.
Which pathway’s D2 blockade is responsible for these Extrapyramidal Symptoms (EPS)?
A. Nigrostriatal pathway
B. Mesocortical pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Correct Answer: A
Explanation: The Nigrostriatal pathway controls motor function and movement. Blockade
of D2 receptors in this pathway by first-generation antipsychotics like Haloperidol leads to
a relative deficiency in dopamine, causing Parkinsonian-like symptoms such as rigidity and
tremors. Balancing this with anticholinergic medications can sometimes alleviate these side
effects, though reducing the antipsychotic dose is often preferred.
Psychopharmacology | Actual Q&A with Rationale
(NU643 Exam 2) | Regis University
1. Which neurotransmitter system is primarily targeted by Selective Serotonin Reuptake
Inhibitors (SSRIs) to treat Major Depressive Disorder?
A. Dopamine D2 receptors
B. GABA-A receptors
C. Serotonin Transporter (SERT)
D. Alpha-2 adrenergic receptors
Correct Answer: C
Explanation: SSRIs work by binding to and inhibiting the serotonin transporter (SERT),
which prevents the reuptake of serotonin into the presynaptic neuron. This leads to an
increase in serotonin concentrations within the synaptic cleft, facilitating neuroplasticity
and downstream signaling. Over time, this mechanism is believed to lead to the
downregulation of 5HT1A autoreceptors, which is crucial for the clinical antidepressant
effect.
2. A patient taking a Monoamine Oxidase Inhibitor (MAOI) consumes aged cheese and wine,
subsequently developing a severe headache and hypertension. What is the mechanism of this
‘cheese reaction’?
A. Excessive accumulation of tyramine displacing norepinephrine
,B. Inhibition of the CYP2D6 enzyme
C. Antagonism of the NMDA receptor
D. Sudden depletion of serotonin stores
Correct Answer: A
Explanation: Tyramine is a sympathomimetic amine found in aged foods that is normally
metabolized by MAO-A in the gut. When MAO-A is inhibited by medication, tyramine enters
the systemic circulation and causes the release of massive amounts of stored
norepinephrine from sympathetic nerve terminals. This results in a hypertensive crisis,
which is a medical emergency characterized by rapid rises in blood pressure and potential
organ damage.
3. Which antidepressant is specifically contraindicated in patients with a history of seizure
disorders or bulimia nervosa?
A. Fluoxetine
B. Bupropion
C. Sertraline
D. Venlafaxine
Correct Answer: B
Explanation: Bupropion is known to lower the seizure threshold, particularly at high
doses or in susceptible populations. Patients with eating disorders like bulimia or anorexia
,are at an increased risk for electrolyte imbalances, which further predisposes them to
seizures while taking this medication. Therefore, its use is strictly avoided in these clinical
scenarios to ensure patient safety.
4. A 28-year-old female patient is prescribed Lamotrigine for Bipolar II disorder. What is the
most critical education topic regarding the titration of this medication?
A. Avoidance of grapefruit juice
B. Monitoring for a new-onset rash
C. Weekly blood draws for serum levels
D. Increasing dietary sodium intake
Correct Answer: B
Explanation: Lamotrigine carries a Black Box Warning for serious, potentially life-
threatening rashes, including Stevens-Johnson Syndrome (SJS). A slow titration schedule is
mandatory to minimize the risk of these dermatological reactions. Patients must be
instructed to discontinue the medication and seek immediate medical attention if any rash
or mucosal involvement occurs during the early stages of treatment.
5. Which of the following Second-Generation Antipsychotics (SGAs) is associated with the
highest risk for weight gain and metabolic syndrome?
A. Aripiprazole
B. Ziprasidone
C. Lurasidone
, D. Olanzapine
Correct Answer: D
Explanation: Olanzapine and Clozapine are recognized as having the highest metabolic
risk among antipsychotics, often leading to significant weight gain, dyslipidemia, and
insulin resistance. This effect is largely attributed to their potent antagonism of H1
histamine and 5HT2C serotonin receptors. Frequent monitoring of BMI, fasting glucose,
and lipid profiles is essential for patients prescribed these agents.
6. A patient experiences ‘cogwheeling’ and muscle rigidity shortly after starting Haloperidol.
Which pathway’s D2 blockade is responsible for these Extrapyramidal Symptoms (EPS)?
A. Nigrostriatal pathway
B. Mesocortical pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Correct Answer: A
Explanation: The Nigrostriatal pathway controls motor function and movement. Blockade
of D2 receptors in this pathway by first-generation antipsychotics like Haloperidol leads to
a relative deficiency in dopamine, causing Parkinsonian-like symptoms such as rigidity and
tremors. Balancing this with anticholinergic medications can sometimes alleviate these side
effects, though reducing the antipsychotic dose is often preferred.
