NR.110.574
Clinical Psychopharmacology
Midterm Exam Review
(Questions & Solutions)
2025
1
,1. A 32-year-old patient on sertraline reports worsening insomnia and
agitation two weeks after dose escalation. Which mechanism most likely
explains these symptoms?
A. Down-regulation of 5-HT₂A receptors
B. Acute increase in synaptic serotonin
C. Inhibition of dopamine reuptake
D. Antagonism at H₁ histamine receptors
ANS: B
Rationale: SSRIs acutely raise synaptic serotonin levels, which can
transiently worsen anxiety, insomnia, and agitation before adaptive
receptor changes occur.
2. A patient stabilized on lithium has a serum level of 1.1 mEq/L;
creatinine clearance has declined. Which adjustment is safest?
A. Increase dose by 20%
B. Maintain dose, repeat level in one month
C. Decrease dose by 25%
D. Switch to valproate
ANS: C
Rationale: Reduced renal clearance raises lithium retention;
decreasing the dose by about 25% prevents toxicity while preserving
efficacy.
3. A 45-year-old on clozapine presents with fever and sore throat. Which
laboratory test is urgent?
A. Absolute neutrophil count
B. Serum prolactin
C. Liver function panel
D. Serum creatine kinase
2
, ANS: A
Rationale: Agranulocytosis is a life-threatening clozapine adverse
effect; an immediate ANC is required to detect neutropenia.
4. A patient on fluoxetine begins taking tamoxifen for breast cancer.
Which interaction is most concerning?
A. Tamoxifen reduces fluoxetine bioavailability
B. Fluoxetine inhibits CYP2D6, reducing tamoxifen activation
C. Combined QT prolongation risk
D. Increased serotonin syndrome risk
ANS: B
Rationale: Fluoxetine is a potent CYP2D6 inhibitor; tamoxifen
requires CYP2D6-mediated conversion to active metabolites, so efficacy
may decrease.
5. A rapid-acting benzodiazepine is chosen for acute panic. Which agent
is ideal?
A. Diazepam
B. Alprazolam
C. Lorazepam
D. Clonazepam
ANS: B
Rationale: Alprazolam has high potency, rapid absorption, and quick
onset, making it effective for acute panic attacks.
6. A patient on imipramine reports tachycardia, dry mouth, and urinary
retention. These effects are due to:
A. Alpha-1 adrenergic blockade
B. Muscarinic receptor antagonism
C. Histamine H₁ blockade
D. Serotonin reuptake inhibition
ANS: B
3
Clinical Psychopharmacology
Midterm Exam Review
(Questions & Solutions)
2025
1
,1. A 32-year-old patient on sertraline reports worsening insomnia and
agitation two weeks after dose escalation. Which mechanism most likely
explains these symptoms?
A. Down-regulation of 5-HT₂A receptors
B. Acute increase in synaptic serotonin
C. Inhibition of dopamine reuptake
D. Antagonism at H₁ histamine receptors
ANS: B
Rationale: SSRIs acutely raise synaptic serotonin levels, which can
transiently worsen anxiety, insomnia, and agitation before adaptive
receptor changes occur.
2. A patient stabilized on lithium has a serum level of 1.1 mEq/L;
creatinine clearance has declined. Which adjustment is safest?
A. Increase dose by 20%
B. Maintain dose, repeat level in one month
C. Decrease dose by 25%
D. Switch to valproate
ANS: C
Rationale: Reduced renal clearance raises lithium retention;
decreasing the dose by about 25% prevents toxicity while preserving
efficacy.
3. A 45-year-old on clozapine presents with fever and sore throat. Which
laboratory test is urgent?
A. Absolute neutrophil count
B. Serum prolactin
C. Liver function panel
D. Serum creatine kinase
2
, ANS: A
Rationale: Agranulocytosis is a life-threatening clozapine adverse
effect; an immediate ANC is required to detect neutropenia.
4. A patient on fluoxetine begins taking tamoxifen for breast cancer.
Which interaction is most concerning?
A. Tamoxifen reduces fluoxetine bioavailability
B. Fluoxetine inhibits CYP2D6, reducing tamoxifen activation
C. Combined QT prolongation risk
D. Increased serotonin syndrome risk
ANS: B
Rationale: Fluoxetine is a potent CYP2D6 inhibitor; tamoxifen
requires CYP2D6-mediated conversion to active metabolites, so efficacy
may decrease.
5. A rapid-acting benzodiazepine is chosen for acute panic. Which agent
is ideal?
A. Diazepam
B. Alprazolam
C. Lorazepam
D. Clonazepam
ANS: B
Rationale: Alprazolam has high potency, rapid absorption, and quick
onset, making it effective for acute panic attacks.
6. A patient on imipramine reports tachycardia, dry mouth, and urinary
retention. These effects are due to:
A. Alpha-1 adrenergic blockade
B. Muscarinic receptor antagonism
C. Histamine H₁ blockade
D. Serotonin reuptake inhibition
ANS: B
3
