NR546 MIDTERM PSYCHOPHARMACOLOGY EXAM 200
QUESTIONS & ANSWERS WITH RATIONALES LATEST
UPDATE ALREADY GRADED A+
TABLE OF CONTENTS
Section 1: Neuroanatomy & Neurotransmitter Systems ................. Q1 - Q40
Section 2: Pharmacokinetics & Pharmacodynamics .................... Q41 - Q70
Section 3: Antidepressants (SSRI, SNRI, MAOI, TCA, Atypical) ..... Q71 - Q100
Section 4: Antipsychotics (First & Second Generation) ............ Q101 - Q130
Section 5: Mood Stabilizers (Lithium, Anticonvulsants) ........... Q131 - Q155
Section 6: Anxiolytics & Hypnotics ............................... Q156 - Q175
Section 7: ADHD Medications & Stimulants ......................... Q176 - Q190
Section 8: Substance Use Disorders & Special Populations ......... Q191 - Q200
SECTION 1: NEUROANATOMY & NEUROTRANSMITTER SYSTEMS (Questions 1-40)
Q1. A drug that acts as an inverse agonist at a receptor will produce which of
the following effects?
a) The same effect as a neutral antagonist
b) Stabilization of the receptor in its inactive state, reducing constitutive
activity
c) Blockade of the receptor without affecting baseline activity
d) Activation of the receptor to a greater degree than a full agonist
Correct Answer: b)
Rationale: An inverse agonist stabilizes a receptor in its inactive
conformation, reducing the baseline (constitutive) activity of the receptor.
A neutral antagonist simply blocks agonist binding without affecting
constitutive activity. A full agonist activates the receptor to produce a
maximal response.
Q2. The therapeutic effect of selective serotonin reuptake inhibitors (SSRIs) is
primarily mediated by which mechanism?
, a) Upregulation of postsynaptic 5-HT2A receptors
b) Downregulation of presynaptic autoreceptors and desensitization
c) Immediate increase in synaptic serotonin
d) Antagonism of norepinephrine transporters
Correct Answer: b)
Rationale: SSRIs block SERT, initially increasing synaptic serotonin.
However, the therapeutic effect (delayed 2-6 weeks) results from downstream
adaptive changes, including desensitization and downregulation of
presynaptic 5-HT1A autoreceptors, which allows sustained increases in
serotonergic neurotransmission.
Q3. A patient with schizophrenia shows significant improvement in positive
symptoms after starting antipsychotic therapy. This improvement is most
likely due to blockade of which receptor?
a) D1 receptors in the prefrontal cortex
b) D2 receptors in the mesolimbic pathway
c) 5-HT2A receptors in the cortex
d) D2 receptors in the nigrostriatal pathway
Correct Answer: b)
Rationale: Positive symptoms (hallucinations, delusions) are attributed to
hyperdopaminergia in the mesolimbic pathway. D2 receptor blockade in this
pathway is the primary mechanism for reducing positive symptoms.
Q4. A patient develops extrapyramidal symptoms (EPS) after starting a typical
antipsychotic. These symptoms are most likely due to D2 receptor blockade in
which brain region?
a) Mesolimbic pathway
b) Mesocortical pathway
c) Nigrostriatal pathway
, d) Tuberoinfundibular pathway
Correct Answer: c)
Rationale: The nigrostriatal pathway modulates motor control. D2 blockade
in this pathway disrupts the dopamine-acetylcholine balance, leading to EPS
(dystonia, parkinsonism, akathisia, tardive dyskinesia).
Q5. Prolactin elevation is a common side effect of antipsychotics due to D2
blockade in which pathway?
a) Mesolimbic
b) Mesocortical
c) Nigrostriatal
d) Tuberoinfundibular
Correct Answer: d)
Rationale: The tuberoinfundibular pathway connects the hypothalamus to the
pituitary gland. Dopamine tonically inhibits prolactin release. D2
blockade removes this inhibition, leading to hyperprolactinemia.
Q6. A patient with depression has low levels of serotonin, norepinephrine, and
dopamine. Which receptor is primarily responsible for regulating the release
of these monoamines via autoreceptor function?
a) 5-HT2A
b) D2
c) Alpha-2
d) 5-HT1A
Correct Answer: d)
Rationale: 5-HT1A autoreceptors on raphe nuclei cell bodies inhibit
serotonin release. Their desensitization is key to SSRI therapeutic effects.
They do not directly regulate NE or DA release.
, Q7. Which of the following neurotransmitters is synthesized from tyrosine and is
the precursor to both dopamine and norepinephrine?
a) Tryptophan
b) Tyrosine
c) Glutamate
d) Acetylcholine
Correct Answer: b)
Rationale: Tyrosine is the amino acid precursor for dopamine,
norepinephrine, and epinephrine. Tryptophan is the precursor for serotonin.
Glutamate and acetylcholine have different synthetic pathways.
Q8. A patient presents with memory impairment and confusion. Which
neurotransmitter system, if dysfunctional, is most commonly associated with
these cognitive symptoms?
a) Dopamine
b) Serotonin
c) Acetylcholine
d) Norepinephrine
Correct Answer: c)
Rationale: Acetylcholine is critically involved in memory, attention, and
learning. Cholinergic dysfunction is strongly associated with Alzheimer's
disease and other dementias.
Q9. A patient with anxiety is started on a medication that enhances GABA-
mediated
chloride influx. This mechanism is characteristic of which drug class?
a) SSRIs
QUESTIONS & ANSWERS WITH RATIONALES LATEST
UPDATE ALREADY GRADED A+
TABLE OF CONTENTS
Section 1: Neuroanatomy & Neurotransmitter Systems ................. Q1 - Q40
Section 2: Pharmacokinetics & Pharmacodynamics .................... Q41 - Q70
Section 3: Antidepressants (SSRI, SNRI, MAOI, TCA, Atypical) ..... Q71 - Q100
Section 4: Antipsychotics (First & Second Generation) ............ Q101 - Q130
Section 5: Mood Stabilizers (Lithium, Anticonvulsants) ........... Q131 - Q155
Section 6: Anxiolytics & Hypnotics ............................... Q156 - Q175
Section 7: ADHD Medications & Stimulants ......................... Q176 - Q190
Section 8: Substance Use Disorders & Special Populations ......... Q191 - Q200
SECTION 1: NEUROANATOMY & NEUROTRANSMITTER SYSTEMS (Questions 1-40)
Q1. A drug that acts as an inverse agonist at a receptor will produce which of
the following effects?
a) The same effect as a neutral antagonist
b) Stabilization of the receptor in its inactive state, reducing constitutive
activity
c) Blockade of the receptor without affecting baseline activity
d) Activation of the receptor to a greater degree than a full agonist
Correct Answer: b)
Rationale: An inverse agonist stabilizes a receptor in its inactive
conformation, reducing the baseline (constitutive) activity of the receptor.
A neutral antagonist simply blocks agonist binding without affecting
constitutive activity. A full agonist activates the receptor to produce a
maximal response.
Q2. The therapeutic effect of selective serotonin reuptake inhibitors (SSRIs) is
primarily mediated by which mechanism?
, a) Upregulation of postsynaptic 5-HT2A receptors
b) Downregulation of presynaptic autoreceptors and desensitization
c) Immediate increase in synaptic serotonin
d) Antagonism of norepinephrine transporters
Correct Answer: b)
Rationale: SSRIs block SERT, initially increasing synaptic serotonin.
However, the therapeutic effect (delayed 2-6 weeks) results from downstream
adaptive changes, including desensitization and downregulation of
presynaptic 5-HT1A autoreceptors, which allows sustained increases in
serotonergic neurotransmission.
Q3. A patient with schizophrenia shows significant improvement in positive
symptoms after starting antipsychotic therapy. This improvement is most
likely due to blockade of which receptor?
a) D1 receptors in the prefrontal cortex
b) D2 receptors in the mesolimbic pathway
c) 5-HT2A receptors in the cortex
d) D2 receptors in the nigrostriatal pathway
Correct Answer: b)
Rationale: Positive symptoms (hallucinations, delusions) are attributed to
hyperdopaminergia in the mesolimbic pathway. D2 receptor blockade in this
pathway is the primary mechanism for reducing positive symptoms.
Q4. A patient develops extrapyramidal symptoms (EPS) after starting a typical
antipsychotic. These symptoms are most likely due to D2 receptor blockade in
which brain region?
a) Mesolimbic pathway
b) Mesocortical pathway
c) Nigrostriatal pathway
, d) Tuberoinfundibular pathway
Correct Answer: c)
Rationale: The nigrostriatal pathway modulates motor control. D2 blockade
in this pathway disrupts the dopamine-acetylcholine balance, leading to EPS
(dystonia, parkinsonism, akathisia, tardive dyskinesia).
Q5. Prolactin elevation is a common side effect of antipsychotics due to D2
blockade in which pathway?
a) Mesolimbic
b) Mesocortical
c) Nigrostriatal
d) Tuberoinfundibular
Correct Answer: d)
Rationale: The tuberoinfundibular pathway connects the hypothalamus to the
pituitary gland. Dopamine tonically inhibits prolactin release. D2
blockade removes this inhibition, leading to hyperprolactinemia.
Q6. A patient with depression has low levels of serotonin, norepinephrine, and
dopamine. Which receptor is primarily responsible for regulating the release
of these monoamines via autoreceptor function?
a) 5-HT2A
b) D2
c) Alpha-2
d) 5-HT1A
Correct Answer: d)
Rationale: 5-HT1A autoreceptors on raphe nuclei cell bodies inhibit
serotonin release. Their desensitization is key to SSRI therapeutic effects.
They do not directly regulate NE or DA release.
, Q7. Which of the following neurotransmitters is synthesized from tyrosine and is
the precursor to both dopamine and norepinephrine?
a) Tryptophan
b) Tyrosine
c) Glutamate
d) Acetylcholine
Correct Answer: b)
Rationale: Tyrosine is the amino acid precursor for dopamine,
norepinephrine, and epinephrine. Tryptophan is the precursor for serotonin.
Glutamate and acetylcholine have different synthetic pathways.
Q8. A patient presents with memory impairment and confusion. Which
neurotransmitter system, if dysfunctional, is most commonly associated with
these cognitive symptoms?
a) Dopamine
b) Serotonin
c) Acetylcholine
d) Norepinephrine
Correct Answer: c)
Rationale: Acetylcholine is critically involved in memory, attention, and
learning. Cholinergic dysfunction is strongly associated with Alzheimer's
disease and other dementias.
Q9. A patient with anxiety is started on a medication that enhances GABA-
mediated
chloride influx. This mechanism is characteristic of which drug class?
a) SSRIs
