NURS 5359 (Advanced Psychopharmacology) Exam 2
| Questions and Correct Answers plus Rationale | New
Update 2026-2027 | Graded A+
1. Which of the following best describes the primary mechanism of action of
selective serotonin reuptake inhibitors (SSRIs)?
A) Blocking the reuptake of serotonin at the presynaptic membrane
B) Inhibiting monoamine oxidase enzymes
C) Blocking dopamine D2 receptors
D) Enhancing GABA activity at GABA-A receptors
Correct Answer: Blocking the reuptake of serotonin at the presynaptic membrane
Rationale: SSRIs work by blocking the serotonin transporter, preventing the
reuptake of serotonin into the presynaptic neuron and increasing its availability in
the synaptic cleft. This mechanism is distinct from MAOIs, which inhibit
monoamine oxidase enzymes, and antipsychotics, which block dopamine
receptors. Understanding this primary action is essential for predicting therapeutic
effects and side effect profiles.
2. What is the minimum recommended washout period when switching from
an MAOI to an SSRI to prevent serotonin syndrome?
A) 3 days
B) 7 days
C) 14 days
D) 21 days
Correct Answer: 14 days
Rationale: A washout period of at least 14 days is required after discontinuing an
MAOI before starting an SSRI. This allows for the regeneration of the monoamine
,oxidase enzyme, preventing a dangerous accumulation of serotonin. Shorter
washout periods can precipitate serotonin syndrome, a life-threatening condition.
3. Which SSRI requires a 5-week washout period before starting an MAOI due
to its long half-life?
A) Sertraline
B) Fluoxetine
C) Paroxetine
D) Escitalopram
Correct Answer: Fluoxetine
Rationale: Fluoxetine has a long half-life and an active metabolite, norfluoxetine,
which can remain in the body for weeks. Therefore, a 5-week washout period is
required before starting an MAOI. Other SSRIs typically require a 2-week washout
period.
4. Which condition is a life-threatening consequence of combining an MAOI
with an SSRI?
A) Neuroleptic malignant syndrome
B) Hypertensive crisis
C) Serotonin syndrome
D) Stevens-Johnson syndrome
Correct Answer: Serotonin syndrome
Rationale: Combining an MAOI with an SSRI can lead to excessive serotonin levels,
causing serotonin syndrome. This is a life-threatening condition characterized by
neuromuscular hyperactivity, autonomic instability, and altered mental status.
Hypertensive crisis is more associated with tyramine ingestion while on an MAOI.
5. Which atypical antidepressant is least likely to cause sexual dysfunction?
A) Sertraline
B) Fluoxetine
,C) Bupropion
D) Paroxetine
Correct Answer: Bupropion
Rationale: Bupropion, a norepinephrine-dopamine reuptake inhibitor (NDRI), is
unique among antidepressants as it does not typically cause sexual dysfunction.
SSRIs like sertraline, fluoxetine, and paroxetine are commonly associated with
sexual side effects.
6. Which food should a patient taking phenelzine, an MAOI, be instructed to
avoid to prevent a hypertensive crisis?
A) Fresh cottage cheese
B) Aged cheddar cheese
C) Yogurt
D) Cream cheese
Correct Answer: Aged cheddar cheese
Rationale: Aged cheeses, such as cheddar, contain high levels of tyramine. In
patients taking MAOIs, tyramine is not broken down, leading to a massive release
of norepinephrine and a potentially fatal hypertensive crisis. Fresh cheeses,
yogurt, and cream cheese have lower tyramine levels.
7. Which SSRI is most notable for potent CYP1A2 inhibition and approval for
OCD?
A) Fluoxetine
B) Sertraline
C) Fluvoxamine
D) Escitalopram
Correct Answer: Fluvoxamine
, Rationale: Fluvoxamine is most notable for its potent CYP1A2 inhibition and its
approval for OCD. It increases levels of clozapine, theophylline, and caffeine. This
inhibition can lead to significant drug interactions that require careful monitoring.
8. What is the maximum recommended dose of citalopram?
A) 120 mg/day
B) 80 mg/day for all patients
C) 40 mg/day, and 20 mg/day in those over 60 or with hepatic impairment
D) 10 mg/day for all patients
Correct Answer: 40 mg/day, and 20 mg/day in those over 60 or with hepatic
impairment
Rationale: The maximum recommended citalopram dose is 40 mg/day, and 20
mg/day in those over 60 or with hepatic impairment, due to dose-dependent QTc
prolongation that led to the FDA limit. Exceeding these doses increases the risk of
cardiac arrhythmias.
9. Escitalopram is best described as:
A) An MAOI
B) A tricyclic antidepressant
C) The S-enantiomer of citalopram
D) A benzodiazepine
Correct Answer: The S-enantiomer of citalopram
Rationale: Escitalopram is the S-enantiomer of citalopram, which means it is the
purified active isomer. The maximum dose is 20 mg/day. This allows for a more
targeted therapeutic effect with potentially fewer side effects.
10.Duloxetine (Cymbalta) is one of the few antidepressants approved for:
A) OCD
B) Pain associated with diabetic neuropathy
C) Bipolar depression
| Questions and Correct Answers plus Rationale | New
Update 2026-2027 | Graded A+
1. Which of the following best describes the primary mechanism of action of
selective serotonin reuptake inhibitors (SSRIs)?
A) Blocking the reuptake of serotonin at the presynaptic membrane
B) Inhibiting monoamine oxidase enzymes
C) Blocking dopamine D2 receptors
D) Enhancing GABA activity at GABA-A receptors
Correct Answer: Blocking the reuptake of serotonin at the presynaptic membrane
Rationale: SSRIs work by blocking the serotonin transporter, preventing the
reuptake of serotonin into the presynaptic neuron and increasing its availability in
the synaptic cleft. This mechanism is distinct from MAOIs, which inhibit
monoamine oxidase enzymes, and antipsychotics, which block dopamine
receptors. Understanding this primary action is essential for predicting therapeutic
effects and side effect profiles.
2. What is the minimum recommended washout period when switching from
an MAOI to an SSRI to prevent serotonin syndrome?
A) 3 days
B) 7 days
C) 14 days
D) 21 days
Correct Answer: 14 days
Rationale: A washout period of at least 14 days is required after discontinuing an
MAOI before starting an SSRI. This allows for the regeneration of the monoamine
,oxidase enzyme, preventing a dangerous accumulation of serotonin. Shorter
washout periods can precipitate serotonin syndrome, a life-threatening condition.
3. Which SSRI requires a 5-week washout period before starting an MAOI due
to its long half-life?
A) Sertraline
B) Fluoxetine
C) Paroxetine
D) Escitalopram
Correct Answer: Fluoxetine
Rationale: Fluoxetine has a long half-life and an active metabolite, norfluoxetine,
which can remain in the body for weeks. Therefore, a 5-week washout period is
required before starting an MAOI. Other SSRIs typically require a 2-week washout
period.
4. Which condition is a life-threatening consequence of combining an MAOI
with an SSRI?
A) Neuroleptic malignant syndrome
B) Hypertensive crisis
C) Serotonin syndrome
D) Stevens-Johnson syndrome
Correct Answer: Serotonin syndrome
Rationale: Combining an MAOI with an SSRI can lead to excessive serotonin levels,
causing serotonin syndrome. This is a life-threatening condition characterized by
neuromuscular hyperactivity, autonomic instability, and altered mental status.
Hypertensive crisis is more associated with tyramine ingestion while on an MAOI.
5. Which atypical antidepressant is least likely to cause sexual dysfunction?
A) Sertraline
B) Fluoxetine
,C) Bupropion
D) Paroxetine
Correct Answer: Bupropion
Rationale: Bupropion, a norepinephrine-dopamine reuptake inhibitor (NDRI), is
unique among antidepressants as it does not typically cause sexual dysfunction.
SSRIs like sertraline, fluoxetine, and paroxetine are commonly associated with
sexual side effects.
6. Which food should a patient taking phenelzine, an MAOI, be instructed to
avoid to prevent a hypertensive crisis?
A) Fresh cottage cheese
B) Aged cheddar cheese
C) Yogurt
D) Cream cheese
Correct Answer: Aged cheddar cheese
Rationale: Aged cheeses, such as cheddar, contain high levels of tyramine. In
patients taking MAOIs, tyramine is not broken down, leading to a massive release
of norepinephrine and a potentially fatal hypertensive crisis. Fresh cheeses,
yogurt, and cream cheese have lower tyramine levels.
7. Which SSRI is most notable for potent CYP1A2 inhibition and approval for
OCD?
A) Fluoxetine
B) Sertraline
C) Fluvoxamine
D) Escitalopram
Correct Answer: Fluvoxamine
, Rationale: Fluvoxamine is most notable for its potent CYP1A2 inhibition and its
approval for OCD. It increases levels of clozapine, theophylline, and caffeine. This
inhibition can lead to significant drug interactions that require careful monitoring.
8. What is the maximum recommended dose of citalopram?
A) 120 mg/day
B) 80 mg/day for all patients
C) 40 mg/day, and 20 mg/day in those over 60 or with hepatic impairment
D) 10 mg/day for all patients
Correct Answer: 40 mg/day, and 20 mg/day in those over 60 or with hepatic
impairment
Rationale: The maximum recommended citalopram dose is 40 mg/day, and 20
mg/day in those over 60 or with hepatic impairment, due to dose-dependent QTc
prolongation that led to the FDA limit. Exceeding these doses increases the risk of
cardiac arrhythmias.
9. Escitalopram is best described as:
A) An MAOI
B) A tricyclic antidepressant
C) The S-enantiomer of citalopram
D) A benzodiazepine
Correct Answer: The S-enantiomer of citalopram
Rationale: Escitalopram is the S-enantiomer of citalopram, which means it is the
purified active isomer. The maximum dose is 20 mg/day. This allows for a more
targeted therapeutic effect with potentially fewer side effects.
10.Duloxetine (Cymbalta) is one of the few antidepressants approved for:
A) OCD
B) Pain associated with diabetic neuropathy
C) Bipolar depression
