A strong foundation in the principles of neurobiology and psychopathology is essential for any pharmacist managing medications that act on the central nervous system. Understanding how neurotransmitters function, how disease states alter these pathways, and how drugs modulate them is key to providing safe and effective patient care. This quiz for PharmD students will test your knowledge of the core scientific principles that underpin the practice of neurologic and psychiatric pharmacy.
1. The “monoamine hypothesis” of depression suggests a functional deficiency in which group of neurotransmitters?
- GABA and glutamate
- Acetylcholine and histamine
- Serotonin, norepinephrine, and dopamine
- Endorphins and enkephalins
Answer: Serotonin, norepinephrine, and dopamine
2. The primary inhibitory neurotransmitter in the adult brain, which is the main target for benzodiazepines, is:
- Glutamate
- GABA (gamma-aminobutyric acid)
- Dopamine
- Acetylcholine
Answer: GABA (gamma-aminobutyric acid)
3. The primary excitatory neurotransmitter in the brain, implicated in processes like learning and memory, is:
- GABA
- Glycine
- Serotonin
- Glutamate
Answer: Glutamate
4. The “dopamine hypothesis” of schizophrenia suggests that positive symptoms (like hallucinations) are caused by:
- A deficit of dopamine in the mesolimbic pathway.
- An excess of dopamine activity in the mesolimbic pathway.
- An excess of serotonin in the prefrontal cortex.
- A deficit of acetylcholine in the nigrostriatal pathway.
Answer: An excess of dopamine activity in the mesolimbic pathway.
5. Selective Serotonin Reuptake Inhibitors (SSRIs) exert their primary therapeutic effect by:
- Blocking the breakdown of serotonin by the MAO enzyme.
- Blocking the presynaptic reuptake transporter for serotonin (SERT).
- Acting as a direct agonist at postsynaptic serotonin receptors.
- Increasing the synthesis of serotonin in the neuron.
Answer: Blocking the presynaptic reuptake transporter for serotonin (SERT).
6. A key principle of neurotransmission is that a neurotransmitter is released from the ________ neuron and binds to a receptor on the ________ neuron.
- Postsynaptic; Presynaptic
- Presynaptic; Postsynaptic
- Axonal; Dendritic
- Both B and C are correct
Answer: Both B and C are correct
7. First-generation (“typical”) antipsychotics primarily exert their therapeutic effect by blocking which receptor?
- Serotonin 5-HT2A
- Dopamine D2
- Histamine H1
- Alpha-1 adrenergic
Answer: Dopamine D2
8. Blockade of dopamine D2 receptors in the nigrostriatal pathway is responsible for which common side effect of first-generation antipsychotics?
- Weight gain
- Sedation
- Extrapyramidal symptoms (EPS)
- Dry mouth
Answer: Extrapyramidal symptoms (EPS)
9. Benzodiazepines work by binding to the GABA-A receptor complex, which leads to an increased:
- Duration of chloride channel opening.
- Frequency of chloride channel opening.
- Influx of sodium ions.
- Efflux of potassium ions.
Answer: Frequency of chloride channel opening.
10. “Pain” that is described as burning, tingling, or shooting is most characteristic of which type?
- Nociceptive
- Somatic
- Visceral
- Neuropathic
Answer: Neuropathic
11. The principle of “neuroplasticity” refers to the brain’s ability to:
- Remain static and unchanging throughout life.
- Reorganize itself by forming new neural connections.
- Be completely resistant to the effects of medication.
- Use only one type of neurotransmitter.
Answer: Reorganize itself by forming new neural connections.
12. The pathophysiology of anxiety disorders is strongly linked to hyperactivity in which brain region?
- The cerebellum
- The visual cortex
- The amygdala
- The brainstem
Answer: The amygdala
13. Opioid analgesics like morphine produce their primary effect by acting as agonists at which receptor?
- NMDA
- GABA
- Mu (µ) opioid
- Dopamine D2
Answer: Mu (µ) opioid
14. The principle of “tolerance” to a CNS drug means that:
- The patient experiences fewer side effects over time.
- A higher dose is needed over time to achieve the same effect.
- The drug’s half-life becomes shorter.
- The patient develops an allergic reaction.
Answer: A higher dose is needed over time to achieve the same effect.
15. “Physical dependence” on a substance is demonstrated when:
- The person compulsively seeks the drug for its euphoric effects.
- A withdrawal syndrome occurs upon abrupt discontinuation.
- The person requires a higher dose to get the same effect.
- The person loses interest in other activities.
Answer: A withdrawal syndrome occurs upon abrupt discontinuation.
16. The pathophysiology of alcohol withdrawal is a state of CNS hyperexcitability caused by the brain adapting to the chronic presence of a ________ and the sudden removal of its effects.
- CNS stimulant
- CNS depressant
- Hallucinogen
- Pain reliever
Answer: CNS depressant
17. The mechanism of action of stimulant medications for ADHD involves increasing the synaptic levels of:
- Serotonin and GABA.
- Dopamine and norepinephrine.
- Acetylcholine and histamine.
- Only serotonin.
Answer: Dopamine and norepinephrine.
18. Serotonin syndrome is a potentially life-threatening condition caused by:
- Excessive serotonergic activity in the central nervous system.
- A deficiency of serotonin.
- A blockade of dopamine receptors.
- An overdose of a benzodiazepine.
Answer: Excessive serotonergic activity in the central nervous system.
19. A key neurologic principle is that the “blood-brain barrier”:
- Is a highly permeable barrier that allows all substances to enter the brain.
- Is a protective, semi-permeable barrier that regulates the passage of substances from the blood into the brain.
- Is only present in the spinal cord.
- Is easily penetrated by all medications.
Answer: Is a protective, semi-permeable barrier that regulates the passage of substances from the blood into the brain.
20. The “diathesis-stress” model is a psychiatric principle suggesting that disorders develop from:
- A purely genetic cause.
- A purely environmental cause.
- An interaction between a pre-existing vulnerability and a life stressor.
- A random event.
Answer: An interaction between a pre-existing vulnerability and a life stressor.
21. A “synapse” is the:
- Body of the neuron.
- Long projection of a neuron that carries a signal.
- Junction between two nerve cells where signals are transmitted.
- Protective covering of a nerve cell.
Answer: The junction between two nerve cells where signals are transmitted.
22. An “action potential” is a fundamental neurologic principle describing:
- The resting state of a neuron.
- The rapid, all-or-nothing electrical signal that travels down an axon.
- The process of neurotransmitter reuptake.
- The binding of a drug to a receptor.
Answer: The rapid, all-or-nothing electrical signal that travels down an axon.
23. The therapeutic effects of antidepressants are thought to be related not just to an increase in neurotransmitters, but also to downstream effects on:
- Neurogenesis and synaptic plasticity.
- The patient’s blood pressure.
- The liver’s ability to metabolize drugs.
- The number of receptors in the heart.
Answer: Neurogenesis and synaptic plasticity.
24. The principle behind using a “taper” to discontinue a psychiatric medication is to:
- Allow the brain to gradually adapt to the absence of the drug and minimize withdrawal symptoms.
- Save the patient money.
- Make the process of stopping the medication as fast as possible.
- Increase the risk of side effects.
Answer: Allow the brain to gradually adapt to the absence of the drug and minimize withdrawal symptoms.
25. A key principle of pharmacogenomics in psychiatry is that:
- All patients respond to psychiatric medications in the same way.
- Genetic variations in CYP450 enzymes can affect a patient’s metabolism of a drug, influencing their risk of side effects or therapeutic failure.
- A patient’s genetics can predict with 100% certainty which medication will work best.
- It is not a relevant field for psychiatric medications.
Answer: Genetic variations in CYP450 enzymes can affect a patient’s metabolism of a drug, influencing their risk of side effects or therapeutic failure.
26. The primary role of the neurotransmitter acetylcholine in the CNS is related to:
- Mood and emotion.
- Memory, learning, and attention.
- Sleep and appetite.
- Reward and motivation.
Answer: Memory, learning, and attention.
27. Drugs with strong anticholinergic properties can cause what psychiatric side effect, especially in the elderly?
- Depression
- Anxiety
- Psychosis
- Confusion and delirium
Answer: Confusion and delirium
28. The brain’s “reward pathway,” which is implicated in substance use disorders, is a circuit that is rich in which neurotransmitter?
- Acetylcholine
- Histamine
- Dopamine
- Serotonin
Answer: Dopamine
29. A key neurologic principle of pain is “central sensitization,” where:
- The peripheral nerves become less sensitive to pain.
- The central nervous system becomes amplified and hypersensitive to pain signals.
- The brain completely blocks out all pain signals.
- Pain is only felt at the site of injury.
Answer: The central nervous system becomes amplified and hypersensitive to pain signals.
30. The ultimate principle guiding all neurologic and psychiatric pharmacotherapy is to:
- Target specific neurobiological pathways to correct a pathophysiological state and improve a patient’s symptoms and functioning.
- Use the newest drug available, regardless of its mechanism.
- Find a single drug that cures all disorders.
- Eliminate all side effects, even if it means sacrificing efficacy.
Answer: Target specific neurobiological pathways to correct a pathophysiological state and improve a patient’s symptoms and functioning.
31. An “agonist” is a drug that _________, while an “antagonist” is a drug that _________.
- Blocks a receptor; activates a receptor.
- Activates a receptor; blocks a receptor.
- Is metabolized quickly; is metabolized slowly.
- Has a short half-life; has a long half-life.
Answer: Activates a receptor; blocks a receptor.
32. The “half-life” of a psychiatric drug is a key pharmacokinetic principle that determines:
- The drug’s mechanism of action.
- How long it takes for the drug to be eliminated from the body and its optimal dosing interval.
- The drug’s potential for side effects.
- The cost of the drug.
Answer: How long it takes for the drug to be eliminated from the body and its optimal dosing interval.
33. The pathophysiology of a seizure involves:
- A deficiency of excitatory neurotransmission.
- A sudden, excessive, and synchronized firing of neurons in the brain.
- A slowing of all brain wave activity.
- A normal pattern of neuronal communication.
Answer: A sudden, excessive, and synchronized firing of neurons in the brain.
34. The primary principle of many anti-epileptic drugs is to:
- Increase excitatory neurotransmission.
- Enhance inhibitory (GABAergic) neurotransmission or block excitatory (glutamatergic) neurotransmission.
- Increase the permeability of the blood-brain barrier.
- Stimulate the central nervous system.
Answer: Enhance inhibitory (GABAergic) neurotransmission or block excitatory (glutamatergic) neurotransmission.
35. A key psychiatric principle is that most mental health conditions are best treated with:
- Medication alone.
- Psychotherapy alone.
- A combination of medication and psychotherapy.
- No treatment at all.
Answer: A combination of medication and psychotherapy.
36. A drug’s “lipophilicity” is a principle that determines its ability to:
- Dissolve in water.
- Cross the blood-brain barrier.
- Bind to proteins in the blood.
- Be eliminated by the kidneys.
Answer: Cross the blood-brain barrier.
37. The principle of “downregulation” of receptors occurs when:
- A receptor is chronically exposed to an antagonist.
- A receptor is chronically exposed to an agonist, leading to a decrease in the number of receptors.
- A new receptor is created.
- A receptor is not exposed to any neurotransmitter.
Answer: A receptor is chronically exposed to an agonist, leading to a decrease in the number of receptors.
38. The “first-pass effect” is a pharmacokinetic principle where a drug’s concentration is significantly reduced before it reaches the systemic circulation due to metabolism in the:
- Kidneys
- Lungs
- Brain
- Liver
Answer: The liver
39. A key principle in managing Parkinson’s disease is to increase the levels of which neurotransmitter in the brain?
- Serotonin
- Dopamine
- GABA
- Norepinephrine
Answer: Dopamine
40. The neurobiology of trauma and PTSD involves a hyperactive ________ and an underactive ________.
- Amygdala (fear center); Prefrontal cortex (control center)
- Prefrontal cortex; Amygdala
- Cerebellum; Brainstem
- Hippocampus; Visual cortex
Answer: Amygdala (fear center); Prefrontal cortex (control center)
41. The principle behind a “drug-drug interaction” at the metabolic level is:
- One drug altering the absorption, distribution, metabolism, or excretion of another drug.
- Two drugs having the same therapeutic effect.
- A patient taking two drugs for different conditions.
- The patient being allergic to two different medications.
Answer: One drug altering the absorption, distribution, metabolism, or excretion of another drug.
42. The “therapeutic window” is a principle that describes the range of a drug’s concentration that is:
- Above the toxic level.
- Below the effective level.
- High enough to be effective but low enough to avoid toxicity.
- The same for all patients.
Answer: High enough to be effective but low enough to avoid toxicity.
43. A core principle of the brain’s “fight or flight” response is the activation of the sympathetic nervous system and the release of:
- Serotonin.
- Endorphins.
- Norepinephrine and epinephrine.
- Acetylcholine.
Answer: Norepinephrine and epinephrine.
44. A key principle of a “placebo effect” in a clinical trial is that:
- It is a sign that the active drug is not working.
- A patient’s symptoms can improve due to their expectation of benefit, even with an inert substance.
- It only occurs in psychiatric drug trials.
- It is a form of malingering.
Answer: A patient’s symptoms can improve due to their expectation of benefit, even with an inert substance.
45. A fundamental neurologic principle is that different areas of the brain are specialized for different functions. The area primarily responsible for vision is the:
- Frontal lobe
- Temporal lobe
- Parietal lobe
- Occipital lobe
Answer: The Occipital lobe
46. The principle of using a mood stabilizer in bipolar disorder is to:
- Treat only the depressive episodes.
- Treat only the manic episodes.
- Prevent the cycling between manic and depressive episodes.
- Eliminate the need for sleep.
Answer: Prevent the cycling between manic and depressive episodes.
47. A key principle of “neuroinflammation” is that:
- The brain is immune to all inflammatory processes.
- Inflammation in the central nervous system may play a role in the pathophysiology of disorders like depression and Alzheimer’s disease.
- It is always a beneficial and protective process.
- It can only be caused by a direct infection of the brain.
Answer: Inflammation in the central nervous system may play a role in the pathophysiology of disorders like depression and Alzheimer’s disease.
48. The “Leadership” principle of empathy is critical in psychiatric care because:
- It allows the pharmacist to build a trusting, therapeutic relationship with the patient.
- It is a required documentation element.
- It helps the pharmacist make a diagnosis.
- It is not a relevant principle.
Answer: It allows the pharmacist to build a trusting, therapeutic relationship with the patient.
49. The “Advocacy” principle applies to psychiatric care when a pharmacist:
- Helps a patient navigate insurance barriers to access a needed mental health medication.
- Fights the stigma associated with mental illness.
- Ensures a patient’s voice is heard in their own care plan.
- All of the above.
Answer: All of the above.
50. The ultimate principle guiding a pharmacist’s role in neurologic and psychiatric care is to:
- Apply their deep knowledge of these foundational principles to ensure the safe and effective use of medications for every patient.
- Dispense medications as quickly as possible without asking questions.
- Defer all clinical judgment to the physician.
- Focus only on the cost of the medications.
Answer: Apply their deep knowledge of these foundational principles to ensure the safe and effective use of medications for every patient.
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com