NURS 660 PSYCHOPHARM EXAM 1 ,2,3 AND 4 LATEST
MARYVILLE UNIVERSITY COMPLETE REAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
Positive Symptoms of Schizophrenia - ANSWER: Delusions, hallucinations,
distortions, agitation, disorganized speech, disorganized behavior
Where do positive symptoms originate? - ANSWER: Mesolimbic dopamine pathway
Medications to treat positive symptoms - ANSWER: Antipsychotics
Negative symptoms of schizophrenia - ANSWER: Flat affect, alogia, affective blunting,
asociality, anhedonia, avolition.
Where do negative symptoms originate? - ANSWER: Mesocortical dopamine
pathway. May also involve mesolimbic regions such as nucleus accumbens
Medications to treat negative symptoms - ANSWER: Vraylar, amisulpride
Hypotheses of Schizophrenia - ANSWER: -Mesolimbic pathway is hypothesized to be
hyperactive resulting in excess dopamine at the synapse.
-The gluatamate activity at NMDA receptors is hypofunctional
Mesolimbic Pathway Theory of Schizophrenia - ANSWER: Mesolimbic pathway is
hyperactive, resulting in excess dopamine at the synapse which leads to positive
symptoms. Hyperactivity of mesolimbic dopamine neurons may also play a role in
aggression and hostile symptoms.
Five Different Dopamine Pathways in the brain - ANSWER: -Nigrostriatal Dopamine
Pathway
-Mesolimbic dopamine pathway
-Mesocorticol dopamine pathway
-Tuberoinfundibular dopamine pathway
-Thalamic dopamine pathway
Nigrostriatal pathway - ANSWER: Projects from the substantia nigra to the basal
ganglia or striatum.
-Part of the extrapyramidal nervous system
-Controls motor function and movement
-When dopamine is deficient, can cause parkinsonism with tremor, rigidity, and
akinesia/bradykinesia
-Excess dopamine- can cause hyperkinetic movements, such as tics and dyskinesias
, Mesolimbic dopamine pathway - ANSWER: Projects from the midbrain ventral
tegmental area to the nucleus accumbens (part of limbic system) where many
behaviors such as pleasurable sensations, the powerful euphoria of drug abuse as
well as delusions and hallucinations.
Mesocortical pathway - ANSWER: Projects from the ventral tegmental area to the
prefrontal cortex and is important for cognition
Tuberofundibular pathway - ANSWER: Projects from the hypothalamus to the
anterior pituitary gland and controls prolaction secretion
Thalamic pathway - ANSWER: Arises from multiple sites.
-Function not well known, may be involved in sleep and arousal mechanisms
Major neurotransmitters involved in schizophrenia - ANSWER: -Dopamine
-Glutamate
Dopamine and Schizophrenia - ANSWER: Major neurotransmitter in schizophrenia
Some atypical psychotics block dopamine receptors
Increased in schizophrenia
Glutamate and schizophrenia - ANSWER: Considered the "master switch" of the
brain. Glutamate is the major excitatory neurotransmitter of the CNS as it can turn
on nearly all of the CNS neurons
Decreased in schizophrenia
Neuroleptic Malignant Syndrome - ANSWER: -Adverse reaction to antipsychotics
with severe "lead pipe" rigidity, FEVER, and mental status changes
-Lab findings- increased CK, leukocytosis, low serum iron
-Caused by dopamine antagonists
-Slower in onset, 1-2 weeks after starting/changing therapy.
-Manage by stopping causative agent, supportive care, ECT, Dantrolene,
bromocriptine, and amantadine.
Serotonin Syndrome - ANSWER: -Caused by serotonergic agents
-Hyperreflexia, myoclonus, ocular clonus
-Manage by stopping all serotonergic agents, supportive care aimed at normalization
of vitals, sedation with benzos, administration of serotonergic antagonists, and
antidote therapy with cyproheptadine
-Assess need to resume use of causative serotonergic meds after resolution of
symptoms
-Symptoms seen within 24 hours of starting/changing therapy.
The "-pine" family - ANSWER: Have 5-HT2A and D2 antagonism.
Strong potency for H1 and muscarinic receptors
Clozapine, Olanzapine, Quetiapine,
MARYVILLE UNIVERSITY COMPLETE REAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
Positive Symptoms of Schizophrenia - ANSWER: Delusions, hallucinations,
distortions, agitation, disorganized speech, disorganized behavior
Where do positive symptoms originate? - ANSWER: Mesolimbic dopamine pathway
Medications to treat positive symptoms - ANSWER: Antipsychotics
Negative symptoms of schizophrenia - ANSWER: Flat affect, alogia, affective blunting,
asociality, anhedonia, avolition.
Where do negative symptoms originate? - ANSWER: Mesocortical dopamine
pathway. May also involve mesolimbic regions such as nucleus accumbens
Medications to treat negative symptoms - ANSWER: Vraylar, amisulpride
Hypotheses of Schizophrenia - ANSWER: -Mesolimbic pathway is hypothesized to be
hyperactive resulting in excess dopamine at the synapse.
-The gluatamate activity at NMDA receptors is hypofunctional
Mesolimbic Pathway Theory of Schizophrenia - ANSWER: Mesolimbic pathway is
hyperactive, resulting in excess dopamine at the synapse which leads to positive
symptoms. Hyperactivity of mesolimbic dopamine neurons may also play a role in
aggression and hostile symptoms.
Five Different Dopamine Pathways in the brain - ANSWER: -Nigrostriatal Dopamine
Pathway
-Mesolimbic dopamine pathway
-Mesocorticol dopamine pathway
-Tuberoinfundibular dopamine pathway
-Thalamic dopamine pathway
Nigrostriatal pathway - ANSWER: Projects from the substantia nigra to the basal
ganglia or striatum.
-Part of the extrapyramidal nervous system
-Controls motor function and movement
-When dopamine is deficient, can cause parkinsonism with tremor, rigidity, and
akinesia/bradykinesia
-Excess dopamine- can cause hyperkinetic movements, such as tics and dyskinesias
, Mesolimbic dopamine pathway - ANSWER: Projects from the midbrain ventral
tegmental area to the nucleus accumbens (part of limbic system) where many
behaviors such as pleasurable sensations, the powerful euphoria of drug abuse as
well as delusions and hallucinations.
Mesocortical pathway - ANSWER: Projects from the ventral tegmental area to the
prefrontal cortex and is important for cognition
Tuberofundibular pathway - ANSWER: Projects from the hypothalamus to the
anterior pituitary gland and controls prolaction secretion
Thalamic pathway - ANSWER: Arises from multiple sites.
-Function not well known, may be involved in sleep and arousal mechanisms
Major neurotransmitters involved in schizophrenia - ANSWER: -Dopamine
-Glutamate
Dopamine and Schizophrenia - ANSWER: Major neurotransmitter in schizophrenia
Some atypical psychotics block dopamine receptors
Increased in schizophrenia
Glutamate and schizophrenia - ANSWER: Considered the "master switch" of the
brain. Glutamate is the major excitatory neurotransmitter of the CNS as it can turn
on nearly all of the CNS neurons
Decreased in schizophrenia
Neuroleptic Malignant Syndrome - ANSWER: -Adverse reaction to antipsychotics
with severe "lead pipe" rigidity, FEVER, and mental status changes
-Lab findings- increased CK, leukocytosis, low serum iron
-Caused by dopamine antagonists
-Slower in onset, 1-2 weeks after starting/changing therapy.
-Manage by stopping causative agent, supportive care, ECT, Dantrolene,
bromocriptine, and amantadine.
Serotonin Syndrome - ANSWER: -Caused by serotonergic agents
-Hyperreflexia, myoclonus, ocular clonus
-Manage by stopping all serotonergic agents, supportive care aimed at normalization
of vitals, sedation with benzos, administration of serotonergic antagonists, and
antidote therapy with cyproheptadine
-Assess need to resume use of causative serotonergic meds after resolution of
symptoms
-Symptoms seen within 24 hours of starting/changing therapy.
The "-pine" family - ANSWER: Have 5-HT2A and D2 antagonism.
Strong potency for H1 and muscarinic receptors
Clozapine, Olanzapine, Quetiapine,
