NRNP 6635 ADVANCED
PSYCHOPHARMACOLOGY
COMPREHENSIVE EXAM
1. Which of the following best describes the mechanism of action of Aripiprazole at the
Dopamine D2 receptor?
A. Full agonist
B. Full antagonist
C. Partial agonist
D. Inverse agonist
Answer: C
Conceptual Explanation: Aripiprazole acts as a partial agonist at D2 receptors, meaning it
modulates dopamine activity by acting as an antagonist in high-dopamine environments
and an agonist in low-dopamine environments.
2. A 32-year-old patient on Clozapine presents with a WBC count of 2,800/mm3 and an ANC
of 1,200/mm3. What is the most appropriate clinical action?
A. Interrupt treatment and monitor ANC daily until it rises above 1,500/mm3
,B. Immediately discontinue Clozapine and monitor closely
C. Increase the dose to compensate for metabolic clearance
D. Continue Clozapine and retest in one month
Answer: A
Conceptual Explanation: According to Clozapine REMS guidelines, for mild neutropenia
(ANC 1000-1499/mm3), treatment should be interrupted, and the patient monitored until
the ANC returns to baseline or >1500/mm3.
3. Which cytochrome P450 enzyme is primarily responsible for the metabolism of most TCAs
and is inhibited by Fluoxetine?
A. CYP1A2
B. CYP2C19
C. CYP3A4
D. CYP2D6
Answer: D
Conceptual Explanation: Fluoxetine is a potent inhibitor of CYP2D6, which is the primary
metabolic pathway for many tricyclic antidepressants (TCAs) and several antipsychotics.
4. Lithium toxicity is significantly increased by the concurrent use of which medication class?
A. Thiazide diuretics
B. Calcium channel blockers
, C. H2 blockers
D. Proton pump inhibitors
Answer: A
Conceptual Explanation: Thiazide diuretics reduce renal clearance of lithium by
increasing sodium excretion, leading to a compensatory increase in lithium reabsorption in
the proximal tubule.
5. What is the primary mechanism by which Atomoxetine treats ADHD?
A. Alpha-2 adrenergic agonism
B. Selective Norepinephrine Reuptake Inhibition
C. Dopamine reuptake inhibition
D. VMAT2 inhibition
Answer: B
Conceptual Explanation: Atomoxetine is a non-stimulant medication that works
specifically by inhibiting the presynaptic norepinephrine transporter (NET).
6. Which antidepressant is associated with a dose-dependent risk of seizures and is
contraindicated in patients with eating disorders?
A. Sertraline
B. Bupropion
C. Venlafaxine
PSYCHOPHARMACOLOGY
COMPREHENSIVE EXAM
1. Which of the following best describes the mechanism of action of Aripiprazole at the
Dopamine D2 receptor?
A. Full agonist
B. Full antagonist
C. Partial agonist
D. Inverse agonist
Answer: C
Conceptual Explanation: Aripiprazole acts as a partial agonist at D2 receptors, meaning it
modulates dopamine activity by acting as an antagonist in high-dopamine environments
and an agonist in low-dopamine environments.
2. A 32-year-old patient on Clozapine presents with a WBC count of 2,800/mm3 and an ANC
of 1,200/mm3. What is the most appropriate clinical action?
A. Interrupt treatment and monitor ANC daily until it rises above 1,500/mm3
,B. Immediately discontinue Clozapine and monitor closely
C. Increase the dose to compensate for metabolic clearance
D. Continue Clozapine and retest in one month
Answer: A
Conceptual Explanation: According to Clozapine REMS guidelines, for mild neutropenia
(ANC 1000-1499/mm3), treatment should be interrupted, and the patient monitored until
the ANC returns to baseline or >1500/mm3.
3. Which cytochrome P450 enzyme is primarily responsible for the metabolism of most TCAs
and is inhibited by Fluoxetine?
A. CYP1A2
B. CYP2C19
C. CYP3A4
D. CYP2D6
Answer: D
Conceptual Explanation: Fluoxetine is a potent inhibitor of CYP2D6, which is the primary
metabolic pathway for many tricyclic antidepressants (TCAs) and several antipsychotics.
4. Lithium toxicity is significantly increased by the concurrent use of which medication class?
A. Thiazide diuretics
B. Calcium channel blockers
, C. H2 blockers
D. Proton pump inhibitors
Answer: A
Conceptual Explanation: Thiazide diuretics reduce renal clearance of lithium by
increasing sodium excretion, leading to a compensatory increase in lithium reabsorption in
the proximal tubule.
5. What is the primary mechanism by which Atomoxetine treats ADHD?
A. Alpha-2 adrenergic agonism
B. Selective Norepinephrine Reuptake Inhibition
C. Dopamine reuptake inhibition
D. VMAT2 inhibition
Answer: B
Conceptual Explanation: Atomoxetine is a non-stimulant medication that works
specifically by inhibiting the presynaptic norepinephrine transporter (NET).
6. Which antidepressant is associated with a dose-dependent risk of seizures and is
contraindicated in patients with eating disorders?
A. Sertraline
B. Bupropion
C. Venlafaxine
