NSG552/ PSYCHOPHARMACOLOGY
EXAM 2023/2024 – ACTUAL QUESTIONS
AND 100% VERIFIED ANSWERS | A+
GRADED REVIEW
1. Which neurotransmitter is primarily targeted by selective serotonin reuptake
inhibitors (SSRIs) to alleviate symptoms of depression?
A. Dopamine
B. Serotonin
C. Norepinephrine
D. GABA
Correct Answer: B
Rationale: SSRIs work by inhibiting the reuptake of serotonin (5-HT) into the
presynaptic neuron, increasing serotonin availability in the synaptic cleft. This enhances
serotonergic neurotransmission, which is implicated in mood regulation and is a primary
mechanism for treating depression. Dopamine, norepinephrine, and GABA are not the
primary targets of SSRIs.
2. What is the primary mechanism of action of first-generation antipsychotics (FGAs)?
A. Serotonin receptor agonism
B. Dopamine D2 receptor antagonism
C. GABA receptor modulation
D. Norepinephrine reuptake inhibition
Correct Answer: B
Rationale: First-generation antipsychotics, also known as typical antipsychotics,
primarily exert their effects by blocking dopamine D2 receptors in the mesolimbic
pathway, reducing positive symptoms of schizophrenia. Their strong D2 antagonism is
associated with a higher risk of extrapyramidal symptoms (EPS).
3. Which side effect is most commonly associated with high-potency first-generation
antipsychotics?
A. Weight gain
B. Extrapyramidal symptoms (EPS)
C. Anticholinergic effects
D. Sedation
Correct Answer: B
Rationale: High-potency FGAs, such as haloperidol, have a strong affinity for D2
receptors, leading to a higher incidence of EPS (e.g., dystonia, akathisia, parkinsonism)
compared to low-potency FGAs, which are more likely to cause anticholinergic effects or
sedation.
4. A patient on clozapine develops a fever and sore throat. What is the most urgent
clinical concern?
A. Neuroleptic malignant syndrome
B. Agranulocytosis
, C. Tardive dyskinesia
D. Serotonin syndrome
Correct Answer: B
Rationale: Clozapine is associated with a risk of agranulocytosis, a potentially life-
threatening drop in white blood cell count. Fever and sore throat are hallmark symptoms
of infection due to neutropenia, requiring immediate cessation of clozapine and
hematologic evaluation. Regular monitoring of absolute neutrophil count (ANC) is
mandatory.
5. Which medication is considered the safest and best-tolerated anticonvulsant for
patients taking clozapine who experience dose-related seizures?
A. Phenytoin
B. Carbamazepine
C. Valproate
D. Topiramate
Correct Answer: C
Rationale: Valproate is preferred for managing clozapine-induced seizures due to its
favorable safety profile and minimal drug-drug interactions with clozapine. Phenytoin
and carbamazepine can induce clozapine metabolism, reducing its efficacy, while
topiramate is less studied in this context.
6. What is the primary clinical use of bupropion in psychopharmacology?
A. Anxiety disorders
B. Major depressive disorder
C. Schizophrenia
D. Bipolar mania
Correct Answer: B
Rationale: Bupropion, a norepinephrine-dopamine reuptake inhibitor (NDRI), is FDA-
approved for major depressive disorder and smoking cessation. It is not indicated for
anxiety disorders (may worsen anxiety), schizophrenia, or bipolar mania (may precipitate
mania).
7. Which extrapyramidal symptom is characterized by involuntary teeth grinding
associated with antipsychotics?
A. Akathisia
B. Dystonia
C. Bruxism
D. Tardive dyskinesia
Correct Answer: C
Rationale: Bruxism, or involuntary teeth grinding, is a recognized extrapyramidal side
effect of antipsychotics, particularly those with strong D2 receptor antagonism. Akathisia
involves restlessness, dystonia involves muscle contractions, and tardive dyskinesia
involves repetitive movements, typically of the face.
8. What is the onset timeline for acute dystonia as an extrapyramidal side effect?
A. Hours to days
B. Days to weeks
C. Weeks to months
D. Months to years
Correct Answer: A
, Rationale: Acute dystonia, characterized by involuntary muscle contractions (e.g.,
torticollis, oculogyric crisis), typically occurs within hours to days of initiating or
increasing the dose of an antipsychotic, particularly high-potency FGAs.
9. Which medication class is most likely to cause metabolic syndrome as a side effect?
A. First-generation antipsychotics
B. Second-generation antipsychotics
C. Tricyclic antidepressants
D. SSRIs
Correct Answer: B
Rationale: Second-generation antipsychotics (SGAs), such as olanzapine and clozapine,
are associated with a higher risk of metabolic syndrome (weight gain, diabetes,
dyslipidemia) due to their effects on histamine, serotonin, and other receptors. FGAs,
TCAs, and SSRIs have lower risks.
10. A patient on an SSRI reports sexual dysfunction. Which medication is least likely to
cause this side effect?
A. Sertraline
B. Paroxetine
C. Bupropion
D. Fluoxetine
Correct Answer: C
Rationale: Bupropion, an NDRI, has a lower incidence of sexual dysfunction compared
to SSRIs like sertraline, paroxetine, and fluoxetine, which commonly cause sexual side
effects due to serotonin reuptake inhibition.
11. What is the primary mechanism of action of benzodiazepines in treating anxiety?
A. Serotonin reuptake inhibition
B. GABA receptor agonism
C. Dopamine receptor antagonism
D. Norepinephrine reuptake inhibition
Correct Answer: B
Rationale: Benzodiazepines enhance the effect of GABA, the primary inhibitory
neurotransmitter, by binding to the GABA-A receptor, increasing chloride ion influx, and
hyperpolarizing neurons, thus reducing anxiety.
12. Which antipsychotic is most likely to cause significant QTc prolongation?
A. Aripiprazole
B. Olanzapine
C. Ziprasidone
D. Risperidone
Correct Answer: C
Rationale: Ziprasidone has a higher risk of QTc prolongation compared to other SGAs
due to its effects on cardiac potassium channels. Aripiprazole, olanzapine, and
risperidone have lower risks. ECG monitoring is recommended with ziprasidone.
13. A patient with bipolar disorder is prescribed lithium. What is a critical monitoring
parameter?
A. Liver function tests
B. Serum lithium levels
C. Complete blood count
EXAM 2023/2024 – ACTUAL QUESTIONS
AND 100% VERIFIED ANSWERS | A+
GRADED REVIEW
1. Which neurotransmitter is primarily targeted by selective serotonin reuptake
inhibitors (SSRIs) to alleviate symptoms of depression?
A. Dopamine
B. Serotonin
C. Norepinephrine
D. GABA
Correct Answer: B
Rationale: SSRIs work by inhibiting the reuptake of serotonin (5-HT) into the
presynaptic neuron, increasing serotonin availability in the synaptic cleft. This enhances
serotonergic neurotransmission, which is implicated in mood regulation and is a primary
mechanism for treating depression. Dopamine, norepinephrine, and GABA are not the
primary targets of SSRIs.
2. What is the primary mechanism of action of first-generation antipsychotics (FGAs)?
A. Serotonin receptor agonism
B. Dopamine D2 receptor antagonism
C. GABA receptor modulation
D. Norepinephrine reuptake inhibition
Correct Answer: B
Rationale: First-generation antipsychotics, also known as typical antipsychotics,
primarily exert their effects by blocking dopamine D2 receptors in the mesolimbic
pathway, reducing positive symptoms of schizophrenia. Their strong D2 antagonism is
associated with a higher risk of extrapyramidal symptoms (EPS).
3. Which side effect is most commonly associated with high-potency first-generation
antipsychotics?
A. Weight gain
B. Extrapyramidal symptoms (EPS)
C. Anticholinergic effects
D. Sedation
Correct Answer: B
Rationale: High-potency FGAs, such as haloperidol, have a strong affinity for D2
receptors, leading to a higher incidence of EPS (e.g., dystonia, akathisia, parkinsonism)
compared to low-potency FGAs, which are more likely to cause anticholinergic effects or
sedation.
4. A patient on clozapine develops a fever and sore throat. What is the most urgent
clinical concern?
A. Neuroleptic malignant syndrome
B. Agranulocytosis
, C. Tardive dyskinesia
D. Serotonin syndrome
Correct Answer: B
Rationale: Clozapine is associated with a risk of agranulocytosis, a potentially life-
threatening drop in white blood cell count. Fever and sore throat are hallmark symptoms
of infection due to neutropenia, requiring immediate cessation of clozapine and
hematologic evaluation. Regular monitoring of absolute neutrophil count (ANC) is
mandatory.
5. Which medication is considered the safest and best-tolerated anticonvulsant for
patients taking clozapine who experience dose-related seizures?
A. Phenytoin
B. Carbamazepine
C. Valproate
D. Topiramate
Correct Answer: C
Rationale: Valproate is preferred for managing clozapine-induced seizures due to its
favorable safety profile and minimal drug-drug interactions with clozapine. Phenytoin
and carbamazepine can induce clozapine metabolism, reducing its efficacy, while
topiramate is less studied in this context.
6. What is the primary clinical use of bupropion in psychopharmacology?
A. Anxiety disorders
B. Major depressive disorder
C. Schizophrenia
D. Bipolar mania
Correct Answer: B
Rationale: Bupropion, a norepinephrine-dopamine reuptake inhibitor (NDRI), is FDA-
approved for major depressive disorder and smoking cessation. It is not indicated for
anxiety disorders (may worsen anxiety), schizophrenia, or bipolar mania (may precipitate
mania).
7. Which extrapyramidal symptom is characterized by involuntary teeth grinding
associated with antipsychotics?
A. Akathisia
B. Dystonia
C. Bruxism
D. Tardive dyskinesia
Correct Answer: C
Rationale: Bruxism, or involuntary teeth grinding, is a recognized extrapyramidal side
effect of antipsychotics, particularly those with strong D2 receptor antagonism. Akathisia
involves restlessness, dystonia involves muscle contractions, and tardive dyskinesia
involves repetitive movements, typically of the face.
8. What is the onset timeline for acute dystonia as an extrapyramidal side effect?
A. Hours to days
B. Days to weeks
C. Weeks to months
D. Months to years
Correct Answer: A
, Rationale: Acute dystonia, characterized by involuntary muscle contractions (e.g.,
torticollis, oculogyric crisis), typically occurs within hours to days of initiating or
increasing the dose of an antipsychotic, particularly high-potency FGAs.
9. Which medication class is most likely to cause metabolic syndrome as a side effect?
A. First-generation antipsychotics
B. Second-generation antipsychotics
C. Tricyclic antidepressants
D. SSRIs
Correct Answer: B
Rationale: Second-generation antipsychotics (SGAs), such as olanzapine and clozapine,
are associated with a higher risk of metabolic syndrome (weight gain, diabetes,
dyslipidemia) due to their effects on histamine, serotonin, and other receptors. FGAs,
TCAs, and SSRIs have lower risks.
10. A patient on an SSRI reports sexual dysfunction. Which medication is least likely to
cause this side effect?
A. Sertraline
B. Paroxetine
C. Bupropion
D. Fluoxetine
Correct Answer: C
Rationale: Bupropion, an NDRI, has a lower incidence of sexual dysfunction compared
to SSRIs like sertraline, paroxetine, and fluoxetine, which commonly cause sexual side
effects due to serotonin reuptake inhibition.
11. What is the primary mechanism of action of benzodiazepines in treating anxiety?
A. Serotonin reuptake inhibition
B. GABA receptor agonism
C. Dopamine receptor antagonism
D. Norepinephrine reuptake inhibition
Correct Answer: B
Rationale: Benzodiazepines enhance the effect of GABA, the primary inhibitory
neurotransmitter, by binding to the GABA-A receptor, increasing chloride ion influx, and
hyperpolarizing neurons, thus reducing anxiety.
12. Which antipsychotic is most likely to cause significant QTc prolongation?
A. Aripiprazole
B. Olanzapine
C. Ziprasidone
D. Risperidone
Correct Answer: C
Rationale: Ziprasidone has a higher risk of QTc prolongation compared to other SGAs
due to its effects on cardiac potassium channels. Aripiprazole, olanzapine, and
risperidone have lower risks. ECG monitoring is recommended with ziprasidone.
13. A patient with bipolar disorder is prescribed lithium. What is a critical monitoring
parameter?
A. Liver function tests
B. Serum lithium levels
C. Complete blood count
