CMN 548 MODULE 5
PSYCHOPHARMACOLOGY EXAM 2026-2027
WITH ACTUAL CORRECT QUESTIONS AND
VERIFIED DETAILED ANSWERS
|CURRENTLY TESTING QUESTIONS AND
SOLUTIONS|ALREADY GRADED
A+|NEWEST|BRAND NEW VERSION
!!|GUARANTEED PASS
Describe the physiologic cause of bleeding concern with SSRIs.
- Serotonin is released from platelets following vascular injury. It promotes vasoconstriction and
a change in the shape of the platelets that lead to aggregation.
- Platelets cannot themselves synthesize 5-HT, so SSRIs deplete 5-HT in the platelets, which may
decrease coagulation.
Fluoxetine (Prozac, SSRI) has almost complete absorption and first pass metabolism by the cells
in which organ?
- Liver hepatocytes
- Maximum Plasma concentation 6-8 hours
When is maximum systemic concentration reached in the patient taking Sertraline (Zoloft,
SSRI)?
4.5 to 8.4 hours of ingestion after 14 days of dosing
What effect does food have on the administration of sertraline (Zoloft, SSRI)?
1|Page
,When administered with food, the mean peak plasma concentration is increased by 25% with
the tablet preparation, and the peak plasma concentration is achieved in 5.5 hours.
- Clinical significance is questionable, but initial administration should be AFTER A MEAL
When is recommended dosing regimen in the patient taking Paroxetine (Paxil, SSRI) for all
indications except panic disorder?
- 20 mg per day for all approved indications
*Take with meals to reduce nausea
When is recommended dosing regimen in the patient taking Paroxetine (Paxil, SSRI) for panic
disorder or OCD?
Initial dose of 10 mg per day, with gradual titration to a target dose of 40 mg per day
When is maximum systemic concentration reached in the patient taking Escitalopram (Lexapro,
SSRI)?
4 hours
- peak serum levels at 5 hours
MDD often requires more than one step treatment for remission. Which medications/
medication classes should be trialed if an SSRI is not effective?
- SSRI (although switching to another class is often more useful)
- SNRI
- Bupropion (Wellbutrin, atypical antidepressant)
- Citalopram combination therapy (Celexa, SSRI)
- Mirtazipine (remeron, TCA)
Which SSRI is associated with the most severe withdrawal syndrome and carries the strongest
FDA warning about use in
pregnancy?
Paroxetine (Paxil)
2|Page
, Which SNRI has a safety and tolerability profile that approaches that of the more widely
prescribed SSRI class?
Venlafaxine (Effexor)
- Side Effects: Nausea and decreased libido
What is the nausea caused by Venlafaxine (Effexor, SNRI) attributed to and how can it be
treated?
- Stimulation of 5-HT3 receptors
- Can be controlled by prescribing a selective 5-HT3 antagonist or mirtazapine
- Diminishes on its own over the first few weeks due to desensitization of the 5HT3 receptors
What SNRI is commonly associated with discontinuation syndrome and what are the presenting
symptoms?
- Venlafaxine (Effexor)
- Can occur with XR form as well
- Dizziness, dry mouth, insomnia, nausea, nervousness, sweating, anorexia, diarrhea,
somnolence, and sensory disturbances
- Mitigate with a taper (75mg/ day weekly decrease) or substitution of a few doses with
fluoxetine
Where are TCAs absorbed and what is the importance of their peak level timing?
- Small intestine
- Peak levels have implications for side effect presentation during initial dosing
Which TCAs have demonstrated a relationship between blood levels and response in
melancholic patients?
- Imipramine, desipramine, and nortriptyline
*It has proven difficult to demonstrate a relationship between blood levels and response in
depressed outpatients.
At what plasma concentration is the risk of delirium likely in Amitryptyline therapy?
3|Page
PSYCHOPHARMACOLOGY EXAM 2026-2027
WITH ACTUAL CORRECT QUESTIONS AND
VERIFIED DETAILED ANSWERS
|CURRENTLY TESTING QUESTIONS AND
SOLUTIONS|ALREADY GRADED
A+|NEWEST|BRAND NEW VERSION
!!|GUARANTEED PASS
Describe the physiologic cause of bleeding concern with SSRIs.
- Serotonin is released from platelets following vascular injury. It promotes vasoconstriction and
a change in the shape of the platelets that lead to aggregation.
- Platelets cannot themselves synthesize 5-HT, so SSRIs deplete 5-HT in the platelets, which may
decrease coagulation.
Fluoxetine (Prozac, SSRI) has almost complete absorption and first pass metabolism by the cells
in which organ?
- Liver hepatocytes
- Maximum Plasma concentation 6-8 hours
When is maximum systemic concentration reached in the patient taking Sertraline (Zoloft,
SSRI)?
4.5 to 8.4 hours of ingestion after 14 days of dosing
What effect does food have on the administration of sertraline (Zoloft, SSRI)?
1|Page
,When administered with food, the mean peak plasma concentration is increased by 25% with
the tablet preparation, and the peak plasma concentration is achieved in 5.5 hours.
- Clinical significance is questionable, but initial administration should be AFTER A MEAL
When is recommended dosing regimen in the patient taking Paroxetine (Paxil, SSRI) for all
indications except panic disorder?
- 20 mg per day for all approved indications
*Take with meals to reduce nausea
When is recommended dosing regimen in the patient taking Paroxetine (Paxil, SSRI) for panic
disorder or OCD?
Initial dose of 10 mg per day, with gradual titration to a target dose of 40 mg per day
When is maximum systemic concentration reached in the patient taking Escitalopram (Lexapro,
SSRI)?
4 hours
- peak serum levels at 5 hours
MDD often requires more than one step treatment for remission. Which medications/
medication classes should be trialed if an SSRI is not effective?
- SSRI (although switching to another class is often more useful)
- SNRI
- Bupropion (Wellbutrin, atypical antidepressant)
- Citalopram combination therapy (Celexa, SSRI)
- Mirtazipine (remeron, TCA)
Which SSRI is associated with the most severe withdrawal syndrome and carries the strongest
FDA warning about use in
pregnancy?
Paroxetine (Paxil)
2|Page
, Which SNRI has a safety and tolerability profile that approaches that of the more widely
prescribed SSRI class?
Venlafaxine (Effexor)
- Side Effects: Nausea and decreased libido
What is the nausea caused by Venlafaxine (Effexor, SNRI) attributed to and how can it be
treated?
- Stimulation of 5-HT3 receptors
- Can be controlled by prescribing a selective 5-HT3 antagonist or mirtazapine
- Diminishes on its own over the first few weeks due to desensitization of the 5HT3 receptors
What SNRI is commonly associated with discontinuation syndrome and what are the presenting
symptoms?
- Venlafaxine (Effexor)
- Can occur with XR form as well
- Dizziness, dry mouth, insomnia, nausea, nervousness, sweating, anorexia, diarrhea,
somnolence, and sensory disturbances
- Mitigate with a taper (75mg/ day weekly decrease) or substitution of a few doses with
fluoxetine
Where are TCAs absorbed and what is the importance of their peak level timing?
- Small intestine
- Peak levels have implications for side effect presentation during initial dosing
Which TCAs have demonstrated a relationship between blood levels and response in
melancholic patients?
- Imipramine, desipramine, and nortriptyline
*It has proven difficult to demonstrate a relationship between blood levels and response in
depressed outpatients.
At what plasma concentration is the risk of delirium likely in Amitryptyline therapy?
3|Page
