MSN 671 : Psychopathopharmacology I -Module 4 quiz 4
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Free MSN 671 : Psychopathopharmacology I -Module 4 quiz 4 Questions
Which dopamine pathway is most associated with the development of extrapyramidal side effects (EPS) when D2 receptors are blocked by antipsychotics?
-
Mesolimbic pathway
-
Mesocortical pathway
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Nigrostriatal pathway
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Tuberoinfundibular pathway
Explanation
Correct Answer:
C. Nigrostriatal pathway
Explanation:
The nigrostriatal pathway runs from the substantia nigra to the striatum and regulates motor control. When D2 receptors in this pathway are blocked by antipsychotics, it disrupts dopamine’s normal role in coordinating movement. This results in extrapyramidal side effects (EPS) such as dystonia, akathisia, parkinsonism, and tardive dyskinesia.
Why Other Options Are Wrong:
A. Mesolimbic pathway
This is incorrect because blockade here reduces positive symptoms of schizophrenia (hallucinations, delusions), not EPS.
B. Mesocortical pathway
This is incorrect because blockade here may worsen negative and cognitive symptoms, not produce movement disorders.
D. Tuberoinfundibular pathway
This is incorrect because blockade here leads to hyperprolactinemia (galactorrhea, amenorrhea, gynecomastia), not EPS.
Which antidepressant carries the highest risk of seizures at high doses?
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Fluoxetine
-
Sertraline
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Bupropion
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Duloxetine
Explanation
Correct Answer:
C. Bupropion
Explanation:
Bupropion is associated with a dose-dependent risk of seizures, especially at higher doses or in patients with predisposing conditions (e.g., eating disorders, alcohol withdrawal, head trauma). This risk is due to its stimulant-like effects as a norepinephrine-dopamine reuptake inhibitor (NDRI). Despite this, it is widely used because it is weight-neutral, activating, and does not cause sexual side effects.
Why Other Options Are Wrong:
A. Fluoxetine
This is incorrect because fluoxetine (an SSRI) is not linked to a high seizure risk; its side effects are more related to GI upset, insomnia, and sexual dysfunction.
B. Sertraline
This is incorrect because sertraline (an SSRI) carries a very low seizure risk and is generally safe in this regard.
D. Duloxetine
This is incorrect because duloxetine (an SNRI) is not associated with significant seizure risk but may cause nausea, dry mouth, or hypertension at higher doses.
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.
Which antidepressant is contraindicated in patients with narrow-angle glaucoma due to its anticholinergic effects?
-
Amitriptyline
-
Escitalopram
-
Sertraline
-
Venlafaxine
Explanation
Correct Answer:
A. Amitriptyline
Explanation:
Amitriptyline, a tricyclic antidepressant (TCA), has strong anticholinergic effects, which can precipitate acute angle-closure glaucoma in patients with narrow-angle glaucoma by causing pupillary dilation and increased intraocular pressure. For this reason, TCAs are contraindicated in such patients.
Why Other Options Are Wrong:
B. Escitalopram
This is incorrect because escitalopram, an SSRI, does not have significant anticholinergic activity and is safer for patients with glaucoma.
C. Sertraline
This is incorrect because sertraline, another SSRI, also lacks strong anticholinergic properties and does not pose the same risk.
D. Venlafaxine
This is incorrect because venlafaxine, an SNRI, may cause mild adrenergic effects but is not contraindicated in narrow-angle glaucoma due to anticholinergic effects.
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.
N-methyl-D-aspartate (NMDA) receptor activation necessitates the following:
-
Glutamate only
-
Glutamate and glycine
-
Glutamate, glycine and magnesium
Explanation
Correct Answer:
B. Glutamate and glycine
Explanation:
NMDA receptors are ionotropic glutamate receptors that require co-activation by two ligands: glutamate, the primary excitatory neurotransmitter, and glycine (or D-serine), which acts as a co-agonist at a separate binding site. Both must be present for the channel to open. Additionally, at resting membrane potential, the channel pore is blocked by magnesium ions. Depolarization is required to expel magnesium, allowing calcium and sodium influx, but magnesium is not a ligand needed for activation.
Why Other Options Are Wrong:
A. Glutamate only
This is incorrect because glutamate binding alone is insufficient to open NMDA receptors—glycine (or D-serine) must also bind.
C. Glutamate, glycine and magnesium
This is incorrect because magnesium does not activate the receptor. In fact, magnesium blocks the channel until the membrane depolarizes; its role is inhibitory, not activating.
Which enzyme primarily metabolizes caffeine in the liver?
-
CYP1A2
-
CYP2D6
-
CYP3A4
-
CYP2C19
Explanation
Correct Answer:
A. CYP1A2
Explanation:
Caffeine is metabolized in the liver mainly by the cytochrome P450 enzyme CYP1A2, which accounts for approximately 95% of its metabolism. This enzyme converts caffeine into metabolites such as paraxanthine, theobromine, and theophylline. Variations in CYP1A2 activity, as well as inhibitors like fluvoxamine, can significantly alter caffeine clearance and sensitivity.
Why Other Options Are Wrong:
B. CYP2D6
This is incorrect because CYP2D6 metabolizes many antidepressants, antipsychotics, and opioids, but not caffeine.
C. CYP3A4
This is incorrect because CYP3A4 is responsible for metabolizing a wide range of drugs (e.g., benzodiazepines, statins), but it is not the primary pathway for caffeine metabolism.
D. CYP2C19
This is incorrect because CYP2C19 metabolizes drugs such as proton pump inhibitors and some antidepressants, not caffeine.
Which SSRI is most associated with QT interval prolongation?
-
Paroxetine
-
Fluoxetine
-
Citalopram
-
Fluvoxamine
Explanation
Correct Answer:
C. Citalopram
Explanation:
Among SSRIs, citalopram is most strongly associated with QT interval prolongation, especially at higher doses (>40 mg/day). This increases the risk of torsades de pointes and sudden cardiac death. Because of this risk, the FDA has issued dosing limits and recommends EKG monitoring in patients with cardiac risk factors.
Why Other Options Are Wrong:
A. Paroxetine
This is incorrect because paroxetine is not associated with significant QT prolongation; its main concerns are weight gain and withdrawal symptoms.
B. Fluoxetine
This is incorrect because fluoxetine has a long half-life and drug–drug interactions but is not strongly linked to QT prolongation.
D. Fluvoxamine
This is incorrect because fluvoxamine is more associated with drug interactions due to CYP inhibition, not QT interval prolongation.
Which benzodiazepine has the shortest half-life and is often used for acute anxiety or panic attacks?
-
Diazepam
-
Alprazolam
-
Lorazepam
-
Midazolam
Explanation
Correct Answer:
D. Midazolam
Explanation:
Midazolam is a short-acting benzodiazepine with the shortest half-life among the listed options. It is primarily used in medical settings for acute sedation, procedural anesthesia, and rapid anxiolysis. Because of its rapid onset and short duration, it is less commonly prescribed for outpatient panic attacks but is considered the shortest-acting option here.
Why Other Options Are Wrong:
A. Diazepam
This is incorrect because diazepam has a long half-life and active metabolites, making it less suitable for rapid, short-term relief.
B. Alprazolam
This is incorrect because alprazolam has an intermediate half-life and is commonly prescribed for panic attacks, but it is not the shortest-acting benzodiazepine.
C. Lorazepam
This is incorrect because lorazepam also has an intermediate duration of action and is useful for acute anxiety, but it lasts longer than midazolam.
NMDA receptor activation requires which of the following?
-
Glutamate only
-
Glycine only
-
Glutamate and glycine
-
Glutamate, glycine, and magnesium binding
Explanation
Correct Answer:
C. Glutamate and glycine
Explanation:
NMDA receptors are a subtype of glutamate receptors that require both glutamate and glycine (or D-serine) to bind for activation. These two act as co-agonists at distinct receptor sites. At resting potential, the channel pore is blocked by magnesium, which prevents ion flow. Depolarization removes this magnesium block, but magnesium is not an activating ligand—it is an inhibitory block. Therefore, true activation depends on glutamate and glycine.
Why Other Options Are Wrong:
A. Glutamate only
This is incorrect because glutamate alone cannot open the NMDA receptor; glycine is also required.
B. Glycine only
This is incorrect because glycine alone cannot activate the receptor without glutamate binding.
D. Glutamate, glycine, and magnesium binding
This is incorrect because magnesium does not activate NMDA receptors; it blocks the ion channel until depolarization removes it.
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