NU 643 Exam 2 V3 | NU 643 Advanced
Psychopharmacology | Actual Q&A with Rationale
(NU643 Exam 2) | Regis University
1. A 28-year-old female patient diagnosed with Bipolar I Disorder is being started on Lithium.
Which of the following laboratory panels is most critical to obtain at baseline and periodically
during treatment?
A. Serum creatinine, BUN, and Thyroid Stimulating Hormone (TSH)
B. Liver function tests and Vitamin B12 levels
C. Complete blood count with differential and C-reactive protein
D. Electromyography and serum potassium levels
Correct Answer: A
Explanation: Lithium is primarily excreted by the kidneys, making renal function
monitoring via BUN and creatinine essential to prevent toxicity. Additionally, lithium can
cause hypothyroidism and nephrogenic diabetes insipidus, requiring regular TSH
monitoring. Failure to monitor these parameters can lead to irreversible organ damage or
life-threatening serum levels.
2. When initiating Lamotrigine for a patient with Bipolar Depression, what is the primary
reason for the strict 8-week titration schedule?
A. To ensure the patient does not develop acute dystonia
B. To avoid the sudden onset of hypertensive crisis
,C. To minimize the risk of weight gain and metabolic syndrome
D. To prevent the development of Stevens-Johnson Syndrome (SJS)
Correct Answer: D
Explanation: Lamotrigine carries a black box warning for serious rashes, including
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. The risk of these life-
threatening conditions is significantly increased by rapid dose escalation or high starting
doses. A slow titration allows the clinician to monitor for early signs of hypersensitivity and
ensures better dermatological safety.
3. A patient taking Haloperidol presents with severe muscle rigidity, a temperature of 103°F,
and altered mental status. Which condition should the clinician suspect immediately?
A. Serotonin Syndrome
B. Tardive Dyskinesia
C. Anticholinergic Toxicity
D. Neuroleptic Malignant Syndrome (NMS)
Correct Answer: D
Explanation: Neuroleptic Malignant Syndrome (NMS) is a rare but life-threatening
reaction to dopamine antagonists characterized by ‘lead-pipe’ rigidity, hyperpyrexia, and
autonomic instability. It differs from Serotonin Syndrome by the presence of muscle
rigidity rather than hyperreflexia and clonus. Immediate discontinuation of the
antipsychotic and supportive care are mandatory to prevent mortality.
,4. Which Second-Generation Antipsychotic (SGA) is associated with the highest risk of weight
gain and metabolic dysregulation?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Lurasidone
Correct Answer: C
Explanation: Olanzapine and Clozapine carry the highest risk for weight gain,
hyperglycemia, and dyslipidemia among the SGAs. These metabolic effects require baseline
and ongoing monitoring of BMI, waist circumference, and fasting glucose/lipids. In
contrast, agents like Ziprasidone and Aripiprazole are generally considered metabolic-
neutral.
5. A patient is prescribed Clozapine for treatment-resistant schizophrenia. Which Absolute
Neutrophil Count (ANC) value requires immediate discontinuation of the drug and
consultation with a hematologist?
A. ANC < 2000/mm³
B. ANC < 1500/mm³
C. ANC < 1000/mm³
D. ANC < 500/mm³
, Correct Answer: C
Explanation: Clozapine usage is strictly regulated through the REMS program due to the
risk of severe neutropenia (agranulocytosis). According to current guidelines, an ANC
below 1000/mm³ (for the general population) or 500/mm³ (for patients with benign
ethnic neutropenia) warrants immediate cessation of the medication. This protocol is vital
to protect the patient from life-threatening infections.
6. What is the mechanism of action of Aripiprazole that distinguishes it from other Second-
Generation Antipsychotics?
A. Potent D2 receptor antagonism
B. GABA-A receptor modulation
C. Pure 5-HT2A receptor antagonism
D. Partial D2 receptor agonism
Correct Answer: D
Explanation: Aripiprazole functions as a D2 receptor partial agonist, which allows it to
stabilize dopamine activity—reducing it in the mesolimbic pathway while maintaining it in
the mesocortical pathway. This ‘dopamine tuning’ helps mitigate both positive and negative
symptoms with a lower risk of extrapyramidal symptoms. Other SGAs typically act as full
D2 antagonists, leading to different side effect profiles.
Psychopharmacology | Actual Q&A with Rationale
(NU643 Exam 2) | Regis University
1. A 28-year-old female patient diagnosed with Bipolar I Disorder is being started on Lithium.
Which of the following laboratory panels is most critical to obtain at baseline and periodically
during treatment?
A. Serum creatinine, BUN, and Thyroid Stimulating Hormone (TSH)
B. Liver function tests and Vitamin B12 levels
C. Complete blood count with differential and C-reactive protein
D. Electromyography and serum potassium levels
Correct Answer: A
Explanation: Lithium is primarily excreted by the kidneys, making renal function
monitoring via BUN and creatinine essential to prevent toxicity. Additionally, lithium can
cause hypothyroidism and nephrogenic diabetes insipidus, requiring regular TSH
monitoring. Failure to monitor these parameters can lead to irreversible organ damage or
life-threatening serum levels.
2. When initiating Lamotrigine for a patient with Bipolar Depression, what is the primary
reason for the strict 8-week titration schedule?
A. To ensure the patient does not develop acute dystonia
B. To avoid the sudden onset of hypertensive crisis
,C. To minimize the risk of weight gain and metabolic syndrome
D. To prevent the development of Stevens-Johnson Syndrome (SJS)
Correct Answer: D
Explanation: Lamotrigine carries a black box warning for serious rashes, including
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. The risk of these life-
threatening conditions is significantly increased by rapid dose escalation or high starting
doses. A slow titration allows the clinician to monitor for early signs of hypersensitivity and
ensures better dermatological safety.
3. A patient taking Haloperidol presents with severe muscle rigidity, a temperature of 103°F,
and altered mental status. Which condition should the clinician suspect immediately?
A. Serotonin Syndrome
B. Tardive Dyskinesia
C. Anticholinergic Toxicity
D. Neuroleptic Malignant Syndrome (NMS)
Correct Answer: D
Explanation: Neuroleptic Malignant Syndrome (NMS) is a rare but life-threatening
reaction to dopamine antagonists characterized by ‘lead-pipe’ rigidity, hyperpyrexia, and
autonomic instability. It differs from Serotonin Syndrome by the presence of muscle
rigidity rather than hyperreflexia and clonus. Immediate discontinuation of the
antipsychotic and supportive care are mandatory to prevent mortality.
,4. Which Second-Generation Antipsychotic (SGA) is associated with the highest risk of weight
gain and metabolic dysregulation?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Lurasidone
Correct Answer: C
Explanation: Olanzapine and Clozapine carry the highest risk for weight gain,
hyperglycemia, and dyslipidemia among the SGAs. These metabolic effects require baseline
and ongoing monitoring of BMI, waist circumference, and fasting glucose/lipids. In
contrast, agents like Ziprasidone and Aripiprazole are generally considered metabolic-
neutral.
5. A patient is prescribed Clozapine for treatment-resistant schizophrenia. Which Absolute
Neutrophil Count (ANC) value requires immediate discontinuation of the drug and
consultation with a hematologist?
A. ANC < 2000/mm³
B. ANC < 1500/mm³
C. ANC < 1000/mm³
D. ANC < 500/mm³
, Correct Answer: C
Explanation: Clozapine usage is strictly regulated through the REMS program due to the
risk of severe neutropenia (agranulocytosis). According to current guidelines, an ANC
below 1000/mm³ (for the general population) or 500/mm³ (for patients with benign
ethnic neutropenia) warrants immediate cessation of the medication. This protocol is vital
to protect the patient from life-threatening infections.
6. What is the mechanism of action of Aripiprazole that distinguishes it from other Second-
Generation Antipsychotics?
A. Potent D2 receptor antagonism
B. GABA-A receptor modulation
C. Pure 5-HT2A receptor antagonism
D. Partial D2 receptor agonism
Correct Answer: D
Explanation: Aripiprazole functions as a D2 receptor partial agonist, which allows it to
stabilize dopamine activity—reducing it in the mesolimbic pathway while maintaining it in
the mesocortical pathway. This ‘dopamine tuning’ helps mitigate both positive and negative
symptoms with a lower risk of extrapyramidal symptoms. Other SGAs typically act as full
D2 antagonists, leading to different side effect profiles.
