MSN 672 Psychopathopharmacology II at Northern Kentucky University
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Free MSN 672 Psychopathopharmacology II at Northern Kentucky University Questions
Empathogens produce an altered state of consciousness described as experiences of emotional communion, oneness, relatedness, and emotional openness. Using the options below, please select the prototype empathogen.
- A. 3,4-methylenedioxymethamphetamine (MDMA)
- B. Phencyclidine (PCP)
- C. Tropane Alkaloid (TK)
- D. Gamma-hydroxybutyrate (GHB)
Explanation
MDMA is the prototype empathogen, known for enhancing empathy, emotional closeness, and feelings of connection with others. It increases serotonin, dopamine, and oxytocin release, creating the emotional openness and interpersonal bonding characteristic of empathogens. PCP, tropane alkaloids, and GHB belong to different substance classes and do not produce the unique empathogenic effects seen with MDMA.
Correct Answer Is:
A. 3,4-methylenedioxymethamphetamine (MDMA)
A 42-year-old police officer presents to the clinic with complaints of "sleep disturbances." After sufficient consultation, you prescribe the patient eszopiclone. Which receptors are primarily being targeted by this treatment, producing the desired effect of sedation?
- A. GABAA receptors that contain the α1 subunit/subtype
- B. Serotonin receptor that contains the β1 subtype/subunit
- C. Histamine1 receptor that contains an α2 subunit/subtype
- D. Histamine2 receptor that contains β2 subunits/subtypes
Explanation
Eszopiclone, a non-benzodiazepine hypnotic (commonly known as a “Z-drug”), selectively
binds to the GABAA receptor complex containing the α1 subunit. This subunit is primarily
responsible for the sedative and hypnotic effects of GABAergic medications. When eszopiclone
enhances GABA’s action at these receptors, it increases chloride ion flow, hyperpolarizing
neurons and inducing sleep without significant muscle relaxation or anticonvulsant properties.
This selective binding explains its efficacy in treating insomnia with minimal next-day sedation.
A 25-year-old patient comes into the clinic for treatment of alcoholism. The PMHNP decides to prescribe disulfiram for treatment of alcoholism. Which of the following statements best describes the action of disulfiram?
- A. When alcohol is ingested in the presence of disulfiram, alcohol metabolism is inhibited and the result is the build-up of toxic levels of acetaldehyde. This creates an aversive experience with flushing, nausea, vomiting, and hypotension
- B. When alcohol is ingested in the presence of disulfiram, alcohol metabolism is inhibited and the result is the build-up of toxic levels of acetanilide. This creates an aversive experience with flushing, nausea, vomiting, and hypertension
- C. When alcohol is ingested in the presence of disulfiram, alcohol metabolism is promoted and the result is the build-up of toxic levels of glutathione. This creates an aversive experience with flushing, nausea, vomiting, and hypertension
- D. When alcohol is ingested in the presence of disulfiram, alcohol metabolism is promoted and the result is the build-up of toxic levels of acetonitrile. This creates an aversive experience with flushing, nausea, vomiting, and hypotension
Explanation
Disulfiram works by inhibiting the enzyme aldehyde dehydrogenase, which is necessary for the breakdown of acetaldehyde, the toxic intermediate of alcohol metabolism. When alcohol is consumed while on disulfiram, acetaldehyde accumulates rapidly and produces an unpleasant reaction—flushing, severe nausea, vomiting, headache, chest pain, palpitations, and hypotension. This aversive reaction is intended to condition patients to avoid alcohol use.
Correct Answer Is:
A. When alcohol is ingested in the presence of disulfiram, alcohol metabolism is inhibited and the result is the build-up of toxic levels of acetaldehyde. This creates an aversive experience with flushing, nausea, vomiting, and hypotension
A 25-year-old female patient diagnosed with bipolar depression comes into the mental health clinic for treatment. The PMHNP decides to prescribe a combination medication to assist with control of symptoms. Which combination medication has been FDA-approved for bipolar depression?
- A. Risperdal and Benztropine
- B. Olanzapine and Fluoxetine
- C. Quetiapine and Cariprazine
- D. Clozapine and Trazodone
Explanation
B. Olanzapine and Fluoxetine
The olanzapine–fluoxetine combination (brand name Symbyax) is FDA-approved specifically
for bipolar depression. Olanzapine provides antimanic and mood-stabilizing effects, while
fluoxetine treats the depressive phase. This combination has proven efficacy when depressive
symptoms dominate and when monotherapy is insufficient.
A 44-year-old unemployed male with a 20-year debilitating history of alcoholism "heavy drinker" presents to the clinic. The patient has a history of Bipolar Disorder and is currently taking lithium. The patient has not experienced withdrawal; his longest period of sobriety recently has been one week. The patient fears that he may start drinking again due to “stress.” Which of the following medications below would be most appropriate for the PMHNP to prescribe for the treatment of alcoholism for this patient?
- A. Disulfiram
- B. Naloxone
- C. Acamprosate
- D. Naltrexone
Explanation
Acamprosate is the safest option for this patient because it does not interact with lithium, does not affect mood stability in bipolar disorder, and is indicated to help maintain abstinence in patients who have recently stopped drinking. It works by modulating glutamate and GABA balance disrupted by chronic alcohol use. Disulfiram is risky in patients with poor adherence and can worsen mood instability. Naltrexone is contraindicated in bipolar patients on lithium due to increased risk of mood destabilization and possible hepatotoxicity. Naloxone is not a treatment for alcohol use disorder.
Correct Answer Is:
C. Acamprosate
Opioid withdrawal syndrome is characterized by which of the following symptoms (select all that apply)
- A. Bradycardia
- B. Dysphoria
- C. Irritability
- D. Pilo-erection
Explanation
B. Dysphoria
Dysphoria is a common symptom of opioid withdrawal because the abrupt loss of opioid stimulation leads to reduced dopamine activity in the reward pathways. This produces emotional distress, sadness, anxiety, and a strong sense of unease as the body adjusts to the absence of opioids.
C. Irritability
Irritability occurs due to noradrenergic overactivity in the locus coeruleus when opioids are removed. This sudden increase in sympathetic activity makes patients feel tense, restless, and easily angered during withdrawal.
D. Pilo-erection
Pilo-erection, or “goosebumps,” results from autonomic hyperactivity during opioid withdrawal. Increased sympathetic output triggers involuntary contraction of the tiny muscles attached to hair follicles, making pilo-erection a classic physical sign of withdrawal.
Correct Answer Is:
B. Dysphoria
C. Irritability
D. Pilo-erection
Which of the statements are true regarding Valproic Acid? Select all that apply.
- A. Monitor hepatic levels: LFTs
- B. Valproate is metabolized primarily in the kidneys
- C. Valproate can induce high levels of lamotrigine and risk for Stevens-Johnson Syndrome
- D. Valproate is effective for acute manic phase
Explanation
A. Monitor hepatic levels: LFTs
Valproic acid carries a significant risk of hepatotoxicity. Liver function tests (LFTs) must be
checked before initiating therapy and monitored periodically. Hepatic failure can occur,
especially in the first 6 months of treatment, making this an essential precaution.
C. Valproate can induce high levels of lamotrigine and risk for Stevens-Johnson Syndrome
Valproate inhibits the metabolism of lamotrigine, causing lamotrigine serum levels to rise.
Elevated lamotrigine greatly increases the risk of Stevens–Johnson Syndrome (SJS), a
life-threatening dermatologic reaction. Dose adjustments and slow titration of lamotrigine are
required.
D. Valproate is effective for acute manic phase
Valproic acid is one of the most effective mood stabilizers for acute mania, mixed episodes, and
rapid-cycling bipolar disorder. It acts quickly and is often preferred when lithium is ineffective or
contraindicated.
Which symptoms should be reported immediately due to severity in a 15-year-old patient prescribed valproate? Select all that apply.
- A. Vomiting
- B. Severe abdominal pain
- C. Oily, smelly stools
- D. Weight gain
Explanation
A. Vomiting
Vomiting can be an early sign of valproate-induced hepatotoxicity or pancreatitis, both of
which are medical emergencies. Any sudden or severe vomiting in a patient taking valproate
requires immediate evaluation.
B. Severe abdominal pain
Severe or persistent abdominal pain is a classic warning sign of acute pancreatitis, a life-threatening adverse reaction to valproate. This symptom must be reported immediately for
emergency assessment.
C. Oily, smelly stools
Oily, foul-smelling stools (steatorrhea) may indicate pancreatic dysfunction, which can occur
in valproate-induced pancreatitis. This is a red-flag symptom requiring urgent medical attention.
Which of the following neurotransmitters are considered part of the ascending reticular activating system in the brain that works together to regulate arousal? (Select all that apply.)
- A. Histamine
- B. Dopamine
- C. Orexin
- D. Methylation
Explanation
The ascending reticular activating system (ARAS) is responsible for regulating arousal,
wakefulness, and attention. Several neurotransmitters play a central role in this process:
A. Histamine
Histamine is produced in the tuberomammillary nucleus of the hypothalamus and promotes
alertness and wakefulness. Antihistamine medications that cross the blood-brain barrier often
cause drowsiness due to histamine inhibition.
B. Dopamine
Dopamine, released from the ventral tegmental area (VTA) and other midbrain regions, is
essential for maintaining arousal, motivation, and cognitive alertness. It supports the brain’s
reward and activation pathways that sustain wakefulness.
C. Orexin
Orexin (also known as hypocretin), produced in the lateral hypothalamus, stabilizes
wakefulness by stimulating other arousal-promoting systems. Deficiency in orexin is associated
with narcolepsy.
This particular mood stabilizer has a profound immediate suppressant effect upon the bone marrow, requiring initial monitoring of blood counts and notable induction of the cytochrome P450 enzyme. Which mood stabilizer is this?
- A. Lithium
- B. Carbamazepine
- C. Valproate
- D. Topiramate
Explanation
B. Carbamazepine
Carbamazepine can cause bone marrow suppression, including leukopenia, anemia, and, in
severe cases, aplastic anemia or agranulocytosis. Therefore, baseline and ongoing CBC
monitoring is required. Additionally, carbamazepine is a strong inducer of cytochrome P450
(CYP3A4), which can significantly lower serum levels of many medications by speeding their
metabolism. This combination—bone marrow suppression plus CYP450 induction—uniquely
fits carbamazepine.
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