MSN 671 : Psychopathopharmacology I -Module 4 quiz 4

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Free MSN 671 : Psychopathopharmacology I -Module 4 quiz 4 Questions

1.

_____ is the major excitatory neurotransmitter in the central nervous system and is sometimes considered the "master switch" of the brain, since it can excite and turn on virtually all central nervous system neurons.

  • Norepinephrine

  • Epinephrine

  • Glutamate

  • Dopamine

Explanation

Correct Answer:

C. Glutamate

Explanation:

Glutamate is the brain’s major excitatory neurotransmitter and is often referred to as the “master switch” because nearly all neurons in the central nervous system can be activated by glutamatergic signaling. It plays a critical role in synaptic plasticity, learning, and memory. Through receptors like NMDA, AMPA, and kainate, glutamate enables fast excitatory neurotransmission and is central to both normal cognition and pathological processes such as excitotoxicity.

Why Other Options Are Wrong:

A. Norepinephrine

This is incorrect because norepinephrine acts as a neuromodulator involved in alertness, arousal, and the fight-or-flight response, but it is not the primary excitatory neurotransmitter.

B. Epinephrine


This is incorrect because epinephrine functions mainly as a hormone in the periphery and has limited neurotransmitter roles in the CNS.

D. Dopamine


This is incorrect because dopamine is a modulatory neurotransmitter involved in reward, motivation, and motor control, but it is not the brain’s major excitatory neurotransmitter.


2.

What electrolyte imbalance increases the risk of lithium toxicity?

  • Hypercalcemia

  • Hyponatremia

  • Hypokalemia

  • Hypermagnesemia

Explanation

Correct Answer:

B. Hyponatremia

Explanation:

Lithium is handled by the kidneys in a manner similar to sodium. When sodium levels are low (hyponatremia), the kidneys reabsorb more lithium in place of sodium, which leads to elevated lithium concentrations and an increased risk of toxicity. Symptoms include tremor, ataxia, confusion, and in severe cases, seizures or coma.

Why Other Options Are Wrong:

A. Hypercalcemia

This is incorrect because lithium can actually cause hypercalcemia by increasing parathyroid hormone levels, but hypercalcemia itself does not increase lithium toxicity risk.

C. Hypokalemia

This is incorrect because potassium levels do not directly affect lithium clearance or toxicity.

D. Hypermagnesemia

This is incorrect because magnesium levels are not a major factor in lithium metabolism or toxicity risk.


3.

Which neurobiological mechanism best explains negative symptoms of schizophrenia?

  • Hyperdopaminergic activity in the mesolimbic pathway

  • Hypodopaminergic activity in the mesocortical pathway

  • Hypodopaminergic activity in the nigrostriatal pathway

  • Hyperdopaminergic activity in the tuberoinfundibular pathway

Explanation

Correct Answer:

B. Hypodopaminergic activity in the mesocortical pathway

Explanation:

Negative symptoms of schizophrenia—such as apathy, flat affect, social withdrawal, and impaired executive function—are linked to reduced dopamine activity in the mesocortical pathway. This pathway projects from the ventral tegmental area (VTA) to the prefrontal cortex. Insufficient dopamine signaling here leads to deficits in motivation, cognition, and emotional regulation.

Why Other Options Are Wrong:

A. Hyperdopaminergic activity in the mesolimbic pathway

This is incorrect because mesolimbic hyperactivity explains positive symptoms like hallucinations and delusions, not negative symptoms.

C. Hypodopaminergic activity in the nigrostriatal pathway

This is incorrect because dopamine deficiency here causes motor symptoms and extrapyramidal side effects, not schizophrenia’s negative symptoms.

D. Hyperdopaminergic activity in the tuberoinfundibular pathway

This is incorrect because this pathway regulates prolactin release. Hyperactivity here is not associated with schizophrenia but with endocrine imbalance.


4.

The positive symptoms of schizophrenia are most strongly linked to which pathway dysfunction?

  • Nigrostriatal pathway

  • Mesolimbic pathway

  • Mesocortical pathway

  • Tuberoinfundibular pathway

Explanation

Correct Answer:

B. Mesolimbic pathway

Explanation:

Positive symptoms of schizophrenia, including delusions and hallucinations, are strongly associated with dopamine hyperactivity in the mesolimbic pathway. This pathway projects from the ventral tegmental area (VTA) to the nucleus accumbens and other limbic structures, and its overactivation produces the abnormal salience attribution that drives psychosis.

Why Other Options Are Wrong:

A. Nigrostriatal pathway

This is incorrect because the nigrostriatal pathway is primarily involved in motor control. D2 blockade here causes extrapyramidal side effects, not psychotic symptoms.

C. Mesocortical pathway


This is incorrect because mesocortical dopamine hypofunction is associated with negative symptoms (apathy, flat affect) and cognitive impairment, not positive symptoms.

D. Tuberoinfundibular pathway


This is incorrect because this pathway regulates prolactin secretion. D2 blockade here leads to hyperprolactinemia, not hallucinations or delusions.


5.

Which mood stabilizer is associated with neural tube defects if used during pregnancy?

  • Lithium

  • Valproic acid

  • Carbamazepine

  • Lamotrigine

Explanation

Correct Answer:

B. Valproic acid

Explanation:

Valproic acid is strongly associated with teratogenic effects, particularly neural tube defects (e.g., spina bifida), when used during pregnancy. It interferes with folate metabolism, increasing the risk of fetal malformations. For this reason, valproic acid is generally avoided in women of childbearing potential unless no suitable alternatives are available.

Why Other Options Are Wrong:

A. Lithium

This is incorrect because lithium is linked to Ebstein’s anomaly (a congenital heart defect), not neural tube defects.

C. Carbamazepine

This is incorrect because carbamazepine also carries teratogenic risks, including neural tube defects, but the risk is lower than with valproic acid.

D. Lamotrigine

This is incorrect because lamotrigine is considered one of the safer mood stabilizers in pregnancy, though it may increase the risk of oral clefts, not neural tube defects.


6.

There are several known dopamine pathways in the brain. Which of the following pathways contributes to an increase in prolactin levels, resulting in galactorrhea or amenorrhea, when a patient is treated with an antipsychotic drug that blocks D2 receptors?

  • Thalamic Dopamine Pathway

  • Nigrostriatal Dopamine Pathway

  • Tuberoinfundibular Dopamine Pathway

  • Mesolimbic Dopamine Pathway

  • Mesocortical Dopamine Pathway

Explanation

Correct Answer:

C. Tuberoinfundibular Dopamine Pathway

Explanation:

The tuberoinfundibular pathway projects from the hypothalamus to the pituitary gland and regulates the secretion of prolactin. Normally, dopamine inhibits prolactin release via D2 receptor stimulation. When antipsychotic drugs block D2 receptors in this pathway, dopamine’s inhibitory control is lost, leading to elevated prolactin levels (hyperprolactinemia). Clinically, this can result in galactorrhea, amenorrhea, gynecomastia, and sexual dysfunction in patients receiving antipsychotic therapy.

Why Other Options Are Wrong:

A. Thalamic Dopamine Pathway

This is incorrect because there is no well-defined thalamic dopamine pathway associated with prolactin regulation.

B. Nigrostriatal Dopamine Pathway


This is incorrect because the nigrostriatal pathway is involved in motor control, and its D2 blockade causes extrapyramidal side effects, not hyperprolactinemia.

D. Mesolimbic Dopamine Pathway


This is incorrect because the mesolimbic pathway regulates reward and emotion. D2 blockade here reduces positive symptoms of schizophrenia but does not affect prolactin.

E. Mesocortical Dopamine Pathway


This is incorrect because the mesocortical pathway influences cognition and negative symptoms. Its dysfunction is linked to apathy and impaired executive function, not prolactin regulation.


7.

Which antipsychotic is most associated with significant metabolic side effects, including weight gain, diabetes, and hyperlipidemia?

  • Haloperidol

  • Risperidone

  • Olanzapine

  • Ziprasidone

Explanation

Correct Answer:

C. Olanzapine

Explanation:

Olanzapine is strongly associated with metabolic side effects, including significant weight gain, insulin resistance, diabetes mellitus, and hyperlipidemia. It has one of the highest risks for metabolic syndrome among atypical antipsychotics. This is why patients on olanzapine require careful monitoring of weight, blood glucose, and lipid panels during treatment.

Why Other Options Are Wrong:

A. Haloperidol

This is incorrect because haloperidol is a typical antipsychotic more associated with extrapyramidal symptoms (EPS) and tardive dyskinesia, not metabolic issues.

B. Risperidone

This is incorrect because risperidone carries a moderate risk of weight gain and prolactin elevation, but its metabolic side effects are less severe than those of olanzapine.

D. Ziprasidone

This is incorrect because ziprasidone is considered weight-neutral and has a low risk of metabolic complications, though it can prolong the QT interval.


8.

Which antipsychotic would be most appropriate in a patient with schizophrenia and comorbid hyperprolactinemia?

  • Risperidone

  • Haloperidol

  • Aripiprazole

  • Paliperidone

Explanation

Correct Answer:

C. Aripiprazole

Explanation:

Aripiprazole is a partial D2 agonist that acts as a dopamine system stabilizer. Unlike full D2 antagonists, it can reduce antipsychotic-induced hyperprolactinemia by providing partial stimulation of D2 receptors in the tuberoinfundibular pathway, thereby restoring dopamine’s inhibitory control on prolactin release. This makes it especially useful in patients with schizophrenia who also suffer from hyperprolactinemia.

Why Other Options Are Wrong:

A. Risperidone

This is incorrect because risperidone strongly blocks D2 receptors and is well known to cause hyperprolactinemia.

B. Haloperidol

This is incorrect because haloperidol, a high-potency typical antipsychotic, is strongly associated with hyperprolactinemia due to potent D2 antagonism.

D. Paliperidone

This is incorrect because paliperidone, the active metabolite of risperidone, also carries a high risk of hyperprolactinemia.


9.

Delusions and hallucinations are the hallmarks of psychosis and are often referred to as?

  • Negative Symptoms

  • Positive Symptoms

  • Asocial Symptoms

  • Prodromal Symptoms

Explanation

Correct Answer:

B. Positive Symptoms

Explanation:

Delusions and hallucinations are considered positive symptoms of schizophrenia and psychotic disorders. They are called "positive" because they represent an excess or distortion of normal functions, such as adding abnormal perceptions (hallucinations) or false beliefs (delusions). These symptoms are linked to dopamine hyperactivity in the mesolimbic pathway, and they typically improve with antipsychotic treatment targeting D2 receptors.

Why Other Options Are Wrong:

A. Negative Symptoms

This is incorrect because negative symptoms involve the loss or reduction of normal functions, such as flat affect, avolition, and social withdrawal, not delusions or hallucinations.

C. Asocial Symptoms


This is incorrect because "asocial" refers to social withdrawal or lack of interest in relationships, which falls under negative symptoms, not positive ones.

D. Prodromal Symptoms


This is incorrect because prodromal symptoms describe the early warning signs before full-blown psychosis (such as subtle cognitive changes or social withdrawal), not the hallmark features of active psychosis.


10.

Which of the following antipsychotics carries the highest risk of agranulocytosis, requiring regular blood monitoring?

  • Olanzapine

  • Risperidone

  • Clozapine

  • Aripiprazole

Explanation

Correct Answer:

C. Clozapine

Explanation:

Clozapine is the antipsychotic most strongly associated with agranulocytosis, a potentially life-threatening drop in white blood cells (neutropenia). Because of this risk, patients must undergo regular CBC (complete blood count) monitoring. Despite this, clozapine is highly effective for treatment-resistant schizophrenia and reduces the risk of suicide in psychotic patients.

Why Other Options Are Wrong:

A. Olanzapine

This is incorrect because olanzapine can cause weight gain, sedation, and metabolic syndrome, but it is not linked to agranulocytosis.

B. Risperidone

This is incorrect because risperidone commonly causes hyperprolactinemia and EPS at higher doses but not agranulocytosis.

D. Aripiprazole

This is incorrect because aripiprazole is a partial D2 agonist with fewer metabolic and EPS risks, and it is not associated with agranulocytosis.


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