Schizophrenia: antipsychotic therapy and monitoring MCQs With Answer

Introduction

This quiz collection on Schizophrenia: antipsychotic therapy and monitoring is designed for M.Pharm students preparing for Pharmacotherapeutics II (MPP 202T). It focuses on pharmacology, mechanisms, adverse effects, therapeutic drug monitoring, safety issues and clinical monitoring strategies for both typical and atypical antipsychotics. Questions probe receptor pharmacodynamics, pharmacokinetics, important drug interactions, management of extrapyramidal and metabolic complications, clozapine-specific requirements and practical aspects of switching and long-acting injectable formulations. Use these MCQs to deepen understanding of evidence-based antipsychotic use, safety surveillance protocols and laboratory monitoring essential for optimizing therapy in schizophrenia.

Q1. Which antipsychotic is most strongly associated with metabolic adverse effects such as significant weight gain, hyperglycaemia and dyslipidaemia?

• Haloperidol
• Olanzapine
• Ziprasidone
• Risperidone

Correct Answer: Olanzapine

Q2. Which mechanism best explains the antipsychotic efficacy common to both typical and many atypical antipsychotics?

• Serotonin 5-HT1A agonism
• Dopamine D2 receptor antagonism or partial agonism
• Alpha-2 adrenergic blockade
• NMDA receptor antagonism

Correct Answer: Dopamine D2 receptor antagonism or partial agonism

Q3. Which antipsychotic has the highest risk for causing acute extrapyramidal symptoms (EPS) such as parkinsonism and acute dystonia?

• Chlorpromazine
• Clozapine
• Haloperidol
• Quetiapine

Correct Answer: Haloperidol

Q4. For a patient who develops acute dystonia after antipsychotic initiation, which immediate treatment is recommended?

• Start metformin and lifestyle intervention
• Administer an anticholinergic agent such as intramuscular benztropine
• Switch to clozapine immediately
• Give a long-acting injectable antipsychotic

Correct Answer: Administer an anticholinergic agent such as intramuscular benztropine

Q5. Which monitoring schedule is the standard recommended for absolute neutrophil count (ANC) when initiating clozapine therapy?

• Weekly for 6 months, then every 2 weeks for 6 months, then monthly
• No ANC monitoring required
• Monthly for the first year only
• One baseline ANC and then annually

Correct Answer: Weekly for 6 months, then every 2 weeks for 6 months, then monthly

Q6. Which antipsychotic is most strongly associated with clinically significant QT interval prolongation?

• Ziprasidone
• Aripiprazole
• Olanzapine
• Risperidone

Correct Answer: Ziprasidone

Q7. Smoking tobacco can reduce plasma concentrations of which antipsychotics primarily via CYP1A2 induction?

• Haloperidol and risperidone
• Clozapine and olanzapine
• Aripiprazole and quetiapine
• Paliperidone and amisulpride

Correct Answer: Clozapine and olanzapine

Q8. Which strategy is most appropriate for a patient with tardive dyskinesia refractory to anticholinergics?

• Increase the dose of the current typical antipsychotic
• Initiate a VMAT2 inhibitor such as valbenazine or deutetrabenazine
• Begin high-dose benzodiazepines indefinitely
• Switch to ziprasidone to reverse symptoms

Correct Answer: Initiate a VMAT2 inhibitor such as valbenazine or deutetrabenazine

Q9. Which laboratory tests are recommended at baseline and periodically to monitor metabolic risks in patients on atypical antipsychotics?

• Electrolytes and liver enzymes only
• Fasting glucose, fasting lipid profile, weight/BMI and waist circumference
• Only prolactin and thyroid function tests
• Complete blood count only

Correct Answer: Fasting glucose, fasting lipid profile, weight/BMI and waist circumference

Q10. Which antipsychotic is considered the treatment of choice for treatment-resistant schizophrenia after failure of two adequate trials?

• Haloperidol
• Clozapine
• Risperidone
• Quetiapine

Correct Answer: Clozapine

Q11. Which adverse effect is most characteristically associated with elevated prolactin from D2 blockade in the tuberoinfundibular pathway?

• Orthostatic hypotension
• Galactorrhea and amenorrhoea
• Prolonged QT interval
• Severe neutropenia

Correct Answer: Galactorrhea and amenorrhoea

Q12. Which pharmacokinetic interaction is most likely when fluoxetine is co-prescribed with risperidone?

• Fluoxetine induces CYP3A4, lowering risperidone levels
• Fluoxetine inhibits CYP2D6, increasing risperidone plasma concentrations
• Fluoxetine chelates risperidone and reduces absorption
• No interaction is expected

Correct Answer: Fluoxetine inhibits CYP2D6, increasing risperidone plasma concentrations

Q13. Which antipsychotic has the lowest propensity to cause hyperprolactinaemia?

• Risperidone
• Paliperidone
• Aripiprazole
• Amisulpride

Correct Answer: Aripiprazole

Q14. What is the preferred initial management for antipsychotic-induced akathisia?

• Increase antipsychotic dose
• Use a beta-blocker such as propranolol or a benzodiazepine
• Start metformin for metabolic side effects
• Immediate initiation of clozapine

Correct Answer: Use a beta-blocker such as propranolol or a benzodiazepine

Q15. Which statement about long-acting injectable (LAI) antipsychotics is correct?

• LAIs completely eliminate the need to monitor side effects or labs
• LAIs guarantee no relapse regardless of adherence
• LAIs improve adherence and provide steady plasma concentrations that can reduce relapse risk
• LAIs are contraindicated in all patients with EPS history

Correct Answer: LAIs improve adherence and provide steady plasma concentrations that can reduce relapse risk

Q16. Which cardiac or systemic adverse reaction is particularly associated with clozapine and warrants early monitoring?

• Renal failure with electrolyte loss
• Myocarditis and cardiomyopathy
• Severe hypoglycaemia
• Pulmonary embolism exclusively

Correct Answer: Myocarditis and cardiomyopathy

Q17. In therapeutic drug monitoring for clozapine, which plasma concentration is often cited as the minimum target associated with clinical response in treatment-resistant patients?

• Less than 50 ng/mL
• Approximately 350 ng/mL
• Above 2000 ng/mL
• There is no correlation between clozapine levels and response

Correct Answer: Approximately 350 ng/mL

Q18. Which antipsychotic is particularly notable for causing sedation and strong anticholinergic effects due to its low potency and histaminergic/adrenergic blockade?

• Chlorpromazine
• Haloperidol
• Paliperidone
• Aripiprazole

Correct Answer: Chlorpromazine

Q19. When switching from oral antipsychotic therapy to a depot injectable formulation, which principle is most important?

• Stop oral medication immediately in all cases to avoid interactions
• Consider pharmacokinetic half-life, depot initiation protocols and need for oral overlap to maintain therapeutic levels
• Depot injections require no patient education or monitoring
• Depot formulations have identical dosing conversions irrespective of prior oral dose

Correct Answer: Consider pharmacokinetic half-life, depot initiation protocols and need for oral overlap to maintain therapeutic levels

Q20. Which monitoring parameter is essential at baseline and regularly during antipsychotic treatment due to risk of medication-induced hyperprolactinaemia?

• ECG only
• Prolactin level and assessment of menstrual or sexual dysfunction symptoms
• Serum creatinine exclusively
• Daily liver enzyme tests

Correct Answer: Prolactin level and assessment of menstrual or sexual dysfunction symptoms

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