NURS 660 Psychopharmacology & Advanced Mental Health Exam 2 2026/2027 | Maryville Actual Questions with Verified Answers & Detailed Rationales | Grade A Study Practice.

INSTANT PDF DOWNLOAD—This comprehensive study guide is specifically designed for Maryville University graduate nursing students (PMHNP, FNP) preparing for NURS 660 Psychopharmacology and Advanced Mental Health Exam 2 for the 2026/2027 academic year. Based on verified exam materials from top-selling student resources, this resource contains expertly verified practice questions and 100% correct answers with detailed rationales to help you master core psychopharmacology concepts and achieve a top score (Grade A+) . This comprehensive guide covers all major topics tested on NURS 660 Exam 2 : Depression Pathophysiology & Neurotransmitters: Monoamine hypothesis (deficiency of serotonin, norepinephrine, dopamine) ; serotonin role (mood, sleep, appetite, libido) ; norepinephrine role (alertness, attention, executive function) ; dopamine role (reward, motivation) ; GABA (inhibitory) ; glutamate (excitatory) . HPA axis dysregulation (cortisol elevation) ; BDNF (neuroplasticity) . SSRIs (Selective Serotonin Reuptake Inhibitors) : Fluoxetine (Prozac) , sertraline (Zoloft) , paroxetine (Paxil) , citalopram (Celexa) , escitalopram (Lexapro) . MOA: inhibit serotonin reuptake, increasing synaptic serotonin. Onset: 2-6 weeks. Side effects: GI upset, insomnia/sedation, sexual dysfunction, weight gain. Discontinuation syndrome: taper over 2-4 weeks. Serotonin syndrome: agitation, confusion, tachycardia, hyperthermia, rigidity. Avoid with MAOIs (2-week washout) . Citalopram: max dose 40 mg/day (QT prolongation risk) . SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) : Venlafaxine (Effexor) , duloxetine (Cymbalta) , desvenlafaxine (Pristiq) , levomilnacipran (Fetzima) . MOA: inhibit serotonin and norepinephrine reuptake. Uses: MDD, GAD, chronic pain, fibromyalgia. Venlafaxine: dose-dependent (low: SSRI; high: SNRI) . Duloxetine: first-line for diabetic neuropathy. Side effects: nausea, headache, increased BP, diaphoresis, insomnia. NDRIs (Norepinephrine-Dopamine Reuptake Inhibitors) : Bupropion (Wellbutrin, Zyban) . MOA: inhibit norepinephrine and dopamine reuptake. Advantages: no sexual side effects, no weight gain. Indications: MDD, SAD, smoking cessation. Contraindications: seizure disorder, eating disorders, abrupt alcohol/benzodiazepine withdrawal. Side effects: agitation, insomnia, tremor, seizure risk. TCAs (Tricyclic Antidepressants) : Amitriptyline, nortriptyline, imipramine, desipramine. MOA: inhibit norepinephrine and serotonin reuptake; also block histamine, acetylcholine, alpha-1 receptors. Side effects: anticholinergic (dry mouth, constipation, urinary retention, blurred vision) , orthostatic hypotension, sedation, weight gain. Cardiac toxicity: prolonged QRS, QT, risk of fatal overdose (2-week supply). Require baseline EKG. Monitoring: therapeutic drug levels. MAOIs (Monoamine Oxidase Inhibitors) : Phenelzine (Nardil) , tranylcypromine (Parnate) , selegiline (EMSAM patch) . MOA: inhibit MAO-A and MAO-B, preventing breakdown of serotonin, norepinephrine, dopamine. Dietary restrictions: tyramine-rich foods (aged cheese, cured meats, fermented foods, red wine, soy sauce) → hypertensive crisis (severe headache, hypertension, tachycardia). Avoid serotonergic drugs (SSRIs, SNRIs, TCAs, opioids) → serotonin syndrome. Washout: 2 weeks before/after MAOIs. Atypical Antidepressants: Mirtazapine (Remeron) —alpha-2 antagonist, increases norepinephrine/serotonin; benefits: sleep, appetite, low sexual side effects; side effects: sedation, weight gain. Trazodone —5HT2A antagonist, weak SRI; primarily used for insomnia. Vortioxetine (Trintellix) —5HT1A agonist, 5HT3 antagonist; cognitive benefits. Treatment-Resistant Depression: STAR*D trial algorithm (Sequenced Treatment Alternatives to Relieve Depression) : Step 1: SSRI (citalopram) ; Step 2: switch to other SSRI, SNRI, bupropion, or augment with buspirone; Step 3: switch to TCA, MAOI, or augment with lithium; Step 4: MAOI or combination. Augmentation strategies: lithium (gold standard) , T3, atypical antipsychotics (aripiprazole, quetiapine, brexpiprazole) . Bipolar Disorder: Bipolar I: mania ≥7 days or severe symptoms with hospitalization; Bipolar II: hypomania (≥4 days) + major depression. Mania symptoms: elevated/irritable mood, grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased goal-directed activity, excessive pleasure-seeking with high-risk potential. Lithium: MOA: alters sodium transport in nerve/muscle cells; affects neurotransmitter release. Indications: acute mania, maintenance, augmentation in depression. Therapeutic range: 0.6-1.2 mEq/L (acute mania: 0.8-1.2; maintenance: 0.6-0.8) . Toxicity: 1.5 (nausea, vomiting, diarrhea, ataxia, coarse tremor) ; 2.0 (slurred speech, confusion, seizures) ; 2.5 (coma, death). Monitoring: renal function, thyroid (TSH) , CBC, EKG, lithium levels q3-6 months. Contraindications: severe renal impairment, dehydration, sodium depletion, pregnancy (Ebstein's anomaly risk) . Adverse effects: polyuria, polydipsia (nephrogenic diabetes insipidus) , hypothyroidism, weight gain, fine tremor. Valproate (Depakote, Depakene) : MOA: increases GABA, blocks sodium channels. Indications: acute mania, mixed episodes, maintenance. Therapeutic range: 50-100 mcg/mL. Monitoring: LFTs (hepatotoxicity risk), CBC (thrombocytopenia), ammonia levels. Teratogenicity: neural tube defects (spina bifida) —contraindicated in pregnancy (pregnancy category D) . Carbamazepine (Tegretol) : MOA: sodium channel blockade. Indications: acute mania (second-line) , bipolar maintenance. Autoinduction: induces its own metabolism; requires dose adjustment. Monitoring: CBC (agranulocytosis, aplastic anemia) , LFTs, serum levels. Drug interactions: CYP450 inducer (reduces efficacy of oral contraceptives, warfarin) . Lamotrigine (Lamictal) : MOA: sodium channel blockade, glutamate inhibition. Indications: bipolar depression (maintenance) , not effective for acute mania. Slow titration: risk of Stevens-Johnson syndrome (rash, require immediate discontinuation) . Starting dose: 25 mg, titrate up over 6-8 weeks. First-Generation Antipsychotics (FGAs) : Haloperidol (Haldol) , chlorpromazine, fluphenazine. MOA: dopamine D2 receptor antagonism. Indications: acute mania, psychosis, schizophrenia. EPS: acute dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia (irreversible) . NMS: fever, rigidity, autonomic instability, elevated CK. Anticholinergic side effects. Second-Generation Antipsychotics (SGAs) : Aripiprazole (Abilify) —partial D2 agonist, 5HT2A antagonist; lower metabolic risk. Olanzapine (Zyprexa) —high metabolic risk (weight gain, diabetes) . Quetiapine (Seroquel) —sedating, effective for bipolar depression. Risperidone (Risperdal) —EPS dose-dependent, prolactin elevation. Ziprasidone (Geodon) —QT prolongation, take with food. Lurasidone (Latuda) —bipolar depression, take with food (350 kcal) . Monitoring: weight, BMI, blood glucose, lipids, prolactin, EKG (QTc) , AIMS scale for tardive dyskinesia. Sample Questions Include : "Which neurotransmitter deficiency is primarily associated with the monoamine hypothesis of depression?" → Serotonin, norepinephrine, and dopamine "A patient taking fluoxetine reports sexual dysfunction. Which antidepressant class could be considered as an alternative?" → Bupropion (NDRI) "What is the therapeutic range for lithium in acute mania?" → 0.8-1.2 mEq/L "What serious adverse effect is associated with rapid titration of lamotrigine?" → Stevens-Johnson syndrome "A patient on phenelzine (MAOI) reports severe headache and hypertension after eating aged cheese. What is the most likely diagnosis?" → Hypertensive crisis "Which antipsychotic is associated with the highest risk of metabolic syndrome?" → Olanzapine (Zyprexa) "What monitoring is essential for a patient starting valproate?" → Liver function tests (LFTs) "What is the first-line augmentation strategy for treatment-resistant depression?" → Lithium All questions include complete rationales based on current evidence-based practice, psychopharmacology standards, and Maryville University curriculum requirements . DOCUMENT ACCESS: This study guide is available as an instant digital download (PDF) immediately upon purchase. 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