NR 546 Comprehensive Exam Study Guide
Midterm Exam
Review the weekly Explore section content and required readings as noted within your
Student Lesson Plan for Learning Success. Review the medication and neurotransmitter
tables you have completed. Each weekly module will 17-18 questions on the exam.
Study tips:
These questions are very similar to what you will see on boards.
Neuroscience matters-. Neuroscience is the foundation for mental health
prescribing, especially as the future moves toward symptom-based prescribing
rather than selecting a drug class based on a diagnosis. Know what area of the
brain is associated with presenting symptoms AND how the medication works
on that area of the brain to treat that symptom (the medication mechanism of
action)
Use this study guide -As you use your study guide and medication sheets to
prepare for the exams, take note of outliers and unique properties. What
medication in that class has the most adverse effects? Who should not take
that medication? Which medication has no CYP450 interactions? Which
medication is the first line? What area of the brain is affected by these
medications?
Read the questions carefully- It is my recommendation that you take the
available time to read the questions and consider what is being asked. This is
often how you can discriminate between the two most likely answers.
Week Functional neuroanatomy- brain anatomy and physiology covered in both the course
1 Explore section and readings.
If a particular area of the brain is affected, what is the expected response?
What symptoms would you expect to see? Link the assessment to the affected brain
area. For example, if a client comes to your office with complaints of (fill in physical
complaint) what area of the brain is affected? Focus on those specific examples within
the Explore section and your readings. A client cannot copy a written word or drawing;
what area of the brain is affected?
Ethical issues- covered in both the course Explore section and readings.
Epigenetics- covered in both the course Explore section and readings. Why is
epigenetics important? How does epigenetics impact a person’s mental health?
Genetics- the CYP 450 impact is discussed in the course Explore section. How does the
CYP450 affect pharmacodynamics and pharmacokinetics? What are some very
common/concerning interactions? Also see Stahl Ch 2.
Incidence of mental illness-what factors are increasing the incidence? This is covered
in the course Explore section
,Week CYP450-how this affects metabolism. Review Stahl Ch 2.
2 Inducers & Inhibitors- review Stahl p.49.
How does an inhibitor or inducer affect medication efficacy? Note the most common
inhibitors and inducers noted in your Stahl readings. You will see these mentioned on
boards. Make sure to review carbamazepine. Is this medication an inhibitor or an
inducer? How does combining carbamazepine with another medication affect your
prescribing? Are dose adjustments necessary? What happens if you prescribe an inducer
or an inhibitor with a substrate?
Agonists/Antagonists (full, partial, reverse)- know definitions, and be able to apply
this to a clinical situation. Think about how this is applied clinically. For example- if a
medication is an agonist, how does that affect transmission? Review Stahl’s agonist
spectrum section. Review the figures regarding agonists.
Neurotransmission- covered in both the course Explore section and readings. What are
the types of neurotransmission? Review retrograde, and signal transduction cascades.
Why do some medications take weeks for the client to notice a response? Which
neurotransmission process causes this?
Week Dopamine pathways-know the four pathways, the functions, and adverse effects. If
3 given a scenario with an adverse effect, you should be able to select the responsible
pathway.
FGA/SGA- know the risks and benefits of each class including affected
neurotransmitters and adverse effects.
Which medication class is the first line?
Which medication is associated with a higher incidence of EPS or metabolic side
effects?
How are these medication classes similar? How are they different?
Medications-know the most common benefits, adverse effects, black box warnings and
specialized testing for these medications.
Pay attention to medications that stand out from the others either for their benefits or
their risks.
Are there medication combinations that are associated with an adverse reaction?
Be prepared to select a medication based on its profile (i.e., lowest weight gain, lowest
cardiometabolic risk, first-line medication for new-onset schizophrenia)
Which medications are noted for decreased risk of death by suicide? (There are 2.)
Review your completed antipsychotic table for the next section.
Medications-know indication, mechanism of action, adverse and starting dosing of the
medications on your table. Look at the clinical pearls you listed; this will reinforce the
unique characteristics of certain medications. What medications are the first-line
treatment for hallucinations?
NMS, tardive dyskinesia, akathisia, acute dystonia- signs, symptoms, and treatment
Week Benzodiazepines- appropriate prescribing practices, review the risks and benefits of
4 prescribing.
Which benzodiazepine is safe in lactation? Which benzodiazepine should not be
prescribed in pregnancy? Know the recommended length of treatment and how to wean.
Review diversion prevention practices.
, Know the fight or flight response.
Pathophysiology of Fear and worry-know what areas of the brain are associated with
the fight or flight response and which neurotransmitters are affected.
GAD treatment- recommended actions for efficacy
PTSD- which medication is FDA approved? What medication is approved for
nightmares?
OCD approved treatments. Which medication is first line?
Lifespan considerations- which medications are appropriate for the elderly? Which
medications should be avoided in the elderly? In lactation?
Medications-know indication, mechanism of action, adverse and starting dosing of the
medications on your anxiolytic table. Pay attention to buspirone.
What medication can be prescribed after an acute trauma to prevent a permanent fear
response?
Which medication is most associated with unwanted activation and/or panic attacks?
In what situation would a client be forcibly medicated?
Final Exam
Week 5 MDD- Monoamine hypothesis of depression, prescribing considerations-
SSRIs what screens should be completed prior to prescribing a SSRI?
Which age group is most at risk when prescribed a SSRI? Why?
Which SSRI has the least CYP interactions, which is best tolerated, longest acting,
and more likely to cause discontinuation syndrome?
Which medications are used as adjuncts?
Which substances/medications can affect lithium levels?
What is serotonin syndrome?
Which SSRI has the potential for activation?
Which SSRI has the potential to increase panic attacks?
Which medication should be avoided when the client has anxiety because it can
exacerbate anxiety?
Which medication is pharmacologically similar to the combination of an SRRI and
buspirone?
These answers should be included on this week’s medication table.
MAOIs-half life, interactions, benefits, and adverse effects
Bipolar medications- half-life, interactions, benefits, and adverse effects
Think about the common side effects of this medication class, which
medication has that side effect?
Medications-
know indication, mechanism of action, adverse reactions and starting dosing of the
medications, and any necessary lab/diagnostic tests on your table.
Know the neurotransmitter actions for each medication. This goes beyond 5HT-
Midterm Exam
Review the weekly Explore section content and required readings as noted within your
Student Lesson Plan for Learning Success. Review the medication and neurotransmitter
tables you have completed. Each weekly module will 17-18 questions on the exam.
Study tips:
These questions are very similar to what you will see on boards.
Neuroscience matters-. Neuroscience is the foundation for mental health
prescribing, especially as the future moves toward symptom-based prescribing
rather than selecting a drug class based on a diagnosis. Know what area of the
brain is associated with presenting symptoms AND how the medication works
on that area of the brain to treat that symptom (the medication mechanism of
action)
Use this study guide -As you use your study guide and medication sheets to
prepare for the exams, take note of outliers and unique properties. What
medication in that class has the most adverse effects? Who should not take
that medication? Which medication has no CYP450 interactions? Which
medication is the first line? What area of the brain is affected by these
medications?
Read the questions carefully- It is my recommendation that you take the
available time to read the questions and consider what is being asked. This is
often how you can discriminate between the two most likely answers.
Week Functional neuroanatomy- brain anatomy and physiology covered in both the course
1 Explore section and readings.
If a particular area of the brain is affected, what is the expected response?
What symptoms would you expect to see? Link the assessment to the affected brain
area. For example, if a client comes to your office with complaints of (fill in physical
complaint) what area of the brain is affected? Focus on those specific examples within
the Explore section and your readings. A client cannot copy a written word or drawing;
what area of the brain is affected?
Ethical issues- covered in both the course Explore section and readings.
Epigenetics- covered in both the course Explore section and readings. Why is
epigenetics important? How does epigenetics impact a person’s mental health?
Genetics- the CYP 450 impact is discussed in the course Explore section. How does the
CYP450 affect pharmacodynamics and pharmacokinetics? What are some very
common/concerning interactions? Also see Stahl Ch 2.
Incidence of mental illness-what factors are increasing the incidence? This is covered
in the course Explore section
,Week CYP450-how this affects metabolism. Review Stahl Ch 2.
2 Inducers & Inhibitors- review Stahl p.49.
How does an inhibitor or inducer affect medication efficacy? Note the most common
inhibitors and inducers noted in your Stahl readings. You will see these mentioned on
boards. Make sure to review carbamazepine. Is this medication an inhibitor or an
inducer? How does combining carbamazepine with another medication affect your
prescribing? Are dose adjustments necessary? What happens if you prescribe an inducer
or an inhibitor with a substrate?
Agonists/Antagonists (full, partial, reverse)- know definitions, and be able to apply
this to a clinical situation. Think about how this is applied clinically. For example- if a
medication is an agonist, how does that affect transmission? Review Stahl’s agonist
spectrum section. Review the figures regarding agonists.
Neurotransmission- covered in both the course Explore section and readings. What are
the types of neurotransmission? Review retrograde, and signal transduction cascades.
Why do some medications take weeks for the client to notice a response? Which
neurotransmission process causes this?
Week Dopamine pathways-know the four pathways, the functions, and adverse effects. If
3 given a scenario with an adverse effect, you should be able to select the responsible
pathway.
FGA/SGA- know the risks and benefits of each class including affected
neurotransmitters and adverse effects.
Which medication class is the first line?
Which medication is associated with a higher incidence of EPS or metabolic side
effects?
How are these medication classes similar? How are they different?
Medications-know the most common benefits, adverse effects, black box warnings and
specialized testing for these medications.
Pay attention to medications that stand out from the others either for their benefits or
their risks.
Are there medication combinations that are associated with an adverse reaction?
Be prepared to select a medication based on its profile (i.e., lowest weight gain, lowest
cardiometabolic risk, first-line medication for new-onset schizophrenia)
Which medications are noted for decreased risk of death by suicide? (There are 2.)
Review your completed antipsychotic table for the next section.
Medications-know indication, mechanism of action, adverse and starting dosing of the
medications on your table. Look at the clinical pearls you listed; this will reinforce the
unique characteristics of certain medications. What medications are the first-line
treatment for hallucinations?
NMS, tardive dyskinesia, akathisia, acute dystonia- signs, symptoms, and treatment
Week Benzodiazepines- appropriate prescribing practices, review the risks and benefits of
4 prescribing.
Which benzodiazepine is safe in lactation? Which benzodiazepine should not be
prescribed in pregnancy? Know the recommended length of treatment and how to wean.
Review diversion prevention practices.
, Know the fight or flight response.
Pathophysiology of Fear and worry-know what areas of the brain are associated with
the fight or flight response and which neurotransmitters are affected.
GAD treatment- recommended actions for efficacy
PTSD- which medication is FDA approved? What medication is approved for
nightmares?
OCD approved treatments. Which medication is first line?
Lifespan considerations- which medications are appropriate for the elderly? Which
medications should be avoided in the elderly? In lactation?
Medications-know indication, mechanism of action, adverse and starting dosing of the
medications on your anxiolytic table. Pay attention to buspirone.
What medication can be prescribed after an acute trauma to prevent a permanent fear
response?
Which medication is most associated with unwanted activation and/or panic attacks?
In what situation would a client be forcibly medicated?
Final Exam
Week 5 MDD- Monoamine hypothesis of depression, prescribing considerations-
SSRIs what screens should be completed prior to prescribing a SSRI?
Which age group is most at risk when prescribed a SSRI? Why?
Which SSRI has the least CYP interactions, which is best tolerated, longest acting,
and more likely to cause discontinuation syndrome?
Which medications are used as adjuncts?
Which substances/medications can affect lithium levels?
What is serotonin syndrome?
Which SSRI has the potential for activation?
Which SSRI has the potential to increase panic attacks?
Which medication should be avoided when the client has anxiety because it can
exacerbate anxiety?
Which medication is pharmacologically similar to the combination of an SRRI and
buspirone?
These answers should be included on this week’s medication table.
MAOIs-half life, interactions, benefits, and adverse effects
Bipolar medications- half-life, interactions, benefits, and adverse effects
Think about the common side effects of this medication class, which
medication has that side effect?
Medications-
know indication, mechanism of action, adverse reactions and starting dosing of the
medications, and any necessary lab/diagnostic tests on your table.
Know the neurotransmitter actions for each medication. This goes beyond 5HT-
