MSN 671 Final Study Guide Exam With
Complete Solutions
Classic Synaptic Neurotransmission - ANSWER Synthesis of neurotransmitter
(NT). Storage in presynaptic vesicles. Release into synaptic cleft via calcium
influx. Binding to postsynaptic receptors (ionotropic or metabotropic).
Reuptake - ANSWER Transporters: SERT, DAT, NET — targets of SSRIs
(fluoxetine Prozac, sertraline Zoloft, escitalopram Lexapro, paroxetine Paxil,
citalopram Celexa), SNRIs (venlafaxine Effexor, duloxetine Cymbalta), TCAs
(amitriptyline Elavil, nortriptyline Pamelor), stimulants (methylphenidate Ritalin,
amphetamine salts Adderall, lisdexamfetamine Vyvanse).
Enzymatic breakdown - ANSWER MAO — phenelzine Nardil, tranylcypromine
Parnate; COMT — entacapone Comtan; acetylcholinesterase — donepezil
Aricept, rivastigmine Exelon, galantamine Razadyne.
Diffusion away - ANSWER E.g., histamine, dopamine in PFC.
Ligand-gated ion channels - ANSWER Ionotropic: NT binds → ion flow directly
(e.g., GABAa, NMDA).
Voltage-sensitive ion channels - ANSWER Open/close in response to voltage
(Na⁺, Ca²⁺, K⁺).
Sodium channels - ANSWER Critical for action potential propagation. Drugs that
block include carbamazepine (Tegretol), tricyclic antidepressants (Elavil,
Pamelor, Tofranil), lidocaine (Xylocaine).
Presynaptic transporters - ANSWER SERT, DAT, NET recycle NT; targets of
SSRIs, SNRIs, TCAs, stimulants.
Norepinephrine - ANSWER Locus coeruleus origin; regulates attention, arousal,
BP.
Acetylcholine - ANSWER Basal forebrain; memory/cognition. Loss in Alzheimer's
disease → acetylcholinesterase inhibitors: donepezil (Aricept), rivastigmine
(Exelon), galantamine (Razadyne).
Melatonin - ANSWER Secreted from pineal gland during darkness. Regulated by
SCN. MT1 = sleep onset, MT2 = circadian regulation.
, Serotonin (5HT) - ANSWER Raphe nuclei; mood, sleep, anxiety.
Dopamine - ANSWER Reward, motivation, movement. Pathways: mesolimbic,
mesocortical, nigrostriatal, tuberoinfundibular.
GABA - ANSWER Major inhibitory NT.
GABAa - ANSWER Ionotropic = benzodiazepines — lorazepam (Ativan),
clonazepam (Klonopin), diazepam (Valium); Z-drugs — zolpidem (Ambien),
eszopiclone (Lunesta).
GABAb - ANSWER Metabotropic = baclofen (Lioresal).
Histamine - ANSWER TMN of hypothalamus; wakefulness.
Tardive Dyskinesia - ANSWER Chronic D2 blockade → receptor
upregulation/supersensitivity in nigrostriatal pathway → involuntary movements.
Breast discharge (galactorrhea) - ANSWER D2 blockade in tuberoinfundibular
pathway → ↑ prolactin release.
Metabolic Monitoring in Antipsychotics - ANSWER Monitor: weight, BMI, waist
circumference, BP, fasting glucose, HbA1c, lipids. Clozapine (Clozaril) &
olanzapine (Zyprexa) highest risk.
Bipolar Depression Treatments - ANSWER Approved agents: quetiapine
(Seroquel), lurasidone (Latuda), olanzapine/fluoxetine combo (Symbyax),
cariprazine (Vraylar). Mood stabilizers: lithium carbonate (Lithobid), lamotrigine
(Lamictal). Antidepressant monotherapy is contraindicated.
Augmenting SSRIs/SNRIs in Unipolar Depression - ANSWER Atypical
antipsychotics: aripiprazole (Abilify), brexpiprazole (Rexulti), quetiapine XR
(Seroquel XR). Lithium carbonate (Lithobid). Thyroid hormone (T3) — Cytomel.
Buspirone (Buspar).
Weight gain/metabolic risk - ANSWER clozapine (Clozaril) > olanzapine
(Zyprexa) > quetiapine (Seroquel) > risperidone (Risperdal) > ziprasidone
(Geodon), lurasidone (Latuda), aripiprazole (Abilify), cariprazine (Vraylar).
Breast discharge (hyperprolactinemia) - ANSWER risperidone (Risperdal),
paliperidone (Invega) > others.
Motor effects - ANSWER high-potency typicals (haloperidol Haldol) > atypicals.
Complete Solutions
Classic Synaptic Neurotransmission - ANSWER Synthesis of neurotransmitter
(NT). Storage in presynaptic vesicles. Release into synaptic cleft via calcium
influx. Binding to postsynaptic receptors (ionotropic or metabotropic).
Reuptake - ANSWER Transporters: SERT, DAT, NET — targets of SSRIs
(fluoxetine Prozac, sertraline Zoloft, escitalopram Lexapro, paroxetine Paxil,
citalopram Celexa), SNRIs (venlafaxine Effexor, duloxetine Cymbalta), TCAs
(amitriptyline Elavil, nortriptyline Pamelor), stimulants (methylphenidate Ritalin,
amphetamine salts Adderall, lisdexamfetamine Vyvanse).
Enzymatic breakdown - ANSWER MAO — phenelzine Nardil, tranylcypromine
Parnate; COMT — entacapone Comtan; acetylcholinesterase — donepezil
Aricept, rivastigmine Exelon, galantamine Razadyne.
Diffusion away - ANSWER E.g., histamine, dopamine in PFC.
Ligand-gated ion channels - ANSWER Ionotropic: NT binds → ion flow directly
(e.g., GABAa, NMDA).
Voltage-sensitive ion channels - ANSWER Open/close in response to voltage
(Na⁺, Ca²⁺, K⁺).
Sodium channels - ANSWER Critical for action potential propagation. Drugs that
block include carbamazepine (Tegretol), tricyclic antidepressants (Elavil,
Pamelor, Tofranil), lidocaine (Xylocaine).
Presynaptic transporters - ANSWER SERT, DAT, NET recycle NT; targets of
SSRIs, SNRIs, TCAs, stimulants.
Norepinephrine - ANSWER Locus coeruleus origin; regulates attention, arousal,
BP.
Acetylcholine - ANSWER Basal forebrain; memory/cognition. Loss in Alzheimer's
disease → acetylcholinesterase inhibitors: donepezil (Aricept), rivastigmine
(Exelon), galantamine (Razadyne).
Melatonin - ANSWER Secreted from pineal gland during darkness. Regulated by
SCN. MT1 = sleep onset, MT2 = circadian regulation.
, Serotonin (5HT) - ANSWER Raphe nuclei; mood, sleep, anxiety.
Dopamine - ANSWER Reward, motivation, movement. Pathways: mesolimbic,
mesocortical, nigrostriatal, tuberoinfundibular.
GABA - ANSWER Major inhibitory NT.
GABAa - ANSWER Ionotropic = benzodiazepines — lorazepam (Ativan),
clonazepam (Klonopin), diazepam (Valium); Z-drugs — zolpidem (Ambien),
eszopiclone (Lunesta).
GABAb - ANSWER Metabotropic = baclofen (Lioresal).
Histamine - ANSWER TMN of hypothalamus; wakefulness.
Tardive Dyskinesia - ANSWER Chronic D2 blockade → receptor
upregulation/supersensitivity in nigrostriatal pathway → involuntary movements.
Breast discharge (galactorrhea) - ANSWER D2 blockade in tuberoinfundibular
pathway → ↑ prolactin release.
Metabolic Monitoring in Antipsychotics - ANSWER Monitor: weight, BMI, waist
circumference, BP, fasting glucose, HbA1c, lipids. Clozapine (Clozaril) &
olanzapine (Zyprexa) highest risk.
Bipolar Depression Treatments - ANSWER Approved agents: quetiapine
(Seroquel), lurasidone (Latuda), olanzapine/fluoxetine combo (Symbyax),
cariprazine (Vraylar). Mood stabilizers: lithium carbonate (Lithobid), lamotrigine
(Lamictal). Antidepressant monotherapy is contraindicated.
Augmenting SSRIs/SNRIs in Unipolar Depression - ANSWER Atypical
antipsychotics: aripiprazole (Abilify), brexpiprazole (Rexulti), quetiapine XR
(Seroquel XR). Lithium carbonate (Lithobid). Thyroid hormone (T3) — Cytomel.
Buspirone (Buspar).
Weight gain/metabolic risk - ANSWER clozapine (Clozaril) > olanzapine
(Zyprexa) > quetiapine (Seroquel) > risperidone (Risperdal) > ziprasidone
(Geodon), lurasidone (Latuda), aripiprazole (Abilify), cariprazine (Vraylar).
Breast discharge (hyperprolactinemia) - ANSWER risperidone (Risperdal),
paliperidone (Invega) > others.
Motor effects - ANSWER high-potency typicals (haloperidol Haldol) > atypicals.
