MCQ Quiz: Pharmacology of Antipsychotic Medications

The pharmacology of antipsychotic medications is a complex field centered on the modulation of key neurotransmitter systems in the brain to treat psychotic disorders. A deep understanding of their mechanisms of action, receptor binding profiles, and associated side effects is critical for safe and effective use. This quiz will test your knowledge on the pharmacology of first- and second-generation antipsychotics.

1. The primary therapeutic effect of all currently available antipsychotic medications is mediated through the blockade of which receptor?

• a. Serotonin 5-HT2A
• b. Histamine H1
• c. Dopamine D2
• d. Muscarinic M1

Answer: c. Dopamine D2

2. Second-generation (“atypical”) antipsychotics differ from first-generation (“typical”) agents because they also have potent antagonist activity at which receptor?

• a. Dopamine D1
• b. Serotonin 5-HT2A
• c. NMDA
• d. GABA-A

Answer: b. Serotonin 5-HT2A

3. The blockade of dopamine D2 receptors in the nigrostriatal pathway is responsible for which major side effect of antipsychotics?

• a. Weight gain
• b. Sedation
• c. Extrapyramidal Symptoms (EPS)
• d. Dry mouth

Answer: c. Extrapyramidal Symptoms (EPS)

4. A patient on a high-potency first-generation antipsychotic develops a painful, sustained muscle spasm in their neck. This is known as:

• a. Akathisia
• b. Pseudoparkinsonism
• c. Acute dystonia
• d. Tardive dyskinesia

Answer: c. Acute dystonia

5. The metabolic side effects (weight gain, dyslipidemia, hyperglycemia) associated with many atypical antipsychotics are linked to their antagonist activity at which receptors?

• a. Dopamine D2 and Serotonin 5-HT2A
• b. Histamine H1 and Serotonin 5-HT2C
• c. Muscarinic M1 and Alpha-1 adrenergic
• d. NMDA and GABA

Answer: b. Histamine H1 and Serotonin 5-HT2C

6. Which antipsychotic carries a significant risk of agranulocytosis, requiring mandatory white blood cell monitoring through a REMS program?

• a. Haloperidol
• b. Aripiprazole
• c. Olanzapine
• d. Clozapine

Answer: d. Clozapine

7. Aripiprazole’s unique mechanism of action is best described as:

• a. Pure D2 antagonism
• b. Pure 5-HT2A antagonism
• c. D2 partial agonism
• d. Selective serotonin reuptake inhibition

Answer: c. D2 partial agonism

8. Blockade of dopamine receptors in the tuberoinfundibular pathway leads to an elevation of which hormone?

• a. Testosterone
• b. Cortisol
• c. Prolactin
• d. Insulin

Answer: c. Prolactin

9. A patient on an antipsychotic complains of a severe inner restlessness and an inability to sit still, constantly pacing. This side effect is known as:

• a. Dystonia
• b. Akathisia
• c. Tardive Dyskinesia
• d. Parkinsonism

Answer: b. Akathisia

10. Tardive Dyskinesia (TD) is a potentially irreversible movement disorder characterized by involuntary movements of the face and tongue. It is thought to be caused by:

• a. An acute blockade of dopamine receptors.
• b. A long-term upregulation and supersensitivity of dopamine receptors.
• c. A blockade of serotonin receptors.
• d. An increase in acetylcholine.

Answer: b. A long-term upregulation and supersensitivity of dopamine receptors.

11. Which of the following is a long-acting injectable (LAI) formulation of an antipsychotic?

• a. Olanzapine orally disintegrating tablet
• b. Risperidone oral solution
• c. Paliperidone palmitate injection
• d. Haloperidol immediate-release injection

Answer: c. Paliperidone palmitate injection

12. The primary purpose of a long-acting injectable antipsychotic is to:

• a. Provide a faster onset of action.
• b. Improve medication adherence.
• c. Reduce the risk of metabolic side effects.
• d. Be used as a first-line agent for all patients.

Answer: b. Improve medication adherence.

13. A patient taking a low-potency first-generation antipsychotic like chlorpromazine is at high risk for which side effects?

• a. Sedation, hypotension, and anticholinergic effects.
• b. Extrapyramidal symptoms only.
• c. Weight loss and insomnia.
• d. It has no side effects.

Answer: a. Sedation, hypotension, and anticholinergic effects.

14. Which of the following drugs is a VMAT2 inhibitor used to treat Tardive Dyskinesia?

• a. Benztropine
• b. Propranolol
• c. Valbenazine
• d. Lorazepam

Answer: c. Valbenazine

15. A pharmacist’s role in managing antipsychotic therapy includes:

• a. Counseling on the importance of adherence.
• b. Monitoring for metabolic and motor side effects.
• c. Identifying drug interactions.
• d. All of the above.

Answer: d. All of the above.

16. Which antipsychotic is generally considered to have the highest risk for weight gain and metabolic syndrome?

• a. Aripiprazole
• b. Ziprasidone
• c. Haloperidol
• d. Olanzapine

Answer: d. Olanzapine

17. The sedative effects of many antipsychotics are due to their blockade of which receptor?

• a. Dopamine D2
• b. Histamine H1
• c. Serotonin 5-HT2A
• d. Alpha-2 adrenergic

Answer: b. Histamine H1

18. Clozapine is often reserved for treatment-resistant schizophrenia because of its superior efficacy, particularly for:

• a. Positive symptoms only.
• b. Negative symptoms and reducing suicidal behavior.
• c. Cognitive symptoms only.
• d. It is not superior.

Answer: b. Negative symptoms and reducing suicidal behavior.

19. A patient is prescribed ziprasidone. What is a key counseling point regarding administration?

• a. It must be taken on an empty stomach.
• b. It must be taken with a meal of at least 500 calories for adequate absorption.
• c. It can be taken with or without food.
• d. It should only be taken at bedtime.

Answer: b. It must be taken with a meal of at least 500 calories for adequate absorption.

20. A pharmacist should recommend regular monitoring of which parameters for a patient on an atypical antipsychotic?

• a. Weight, waist circumference, blood pressure, fasting glucose, and lipids.
• b. Only a complete blood count (CBC).
• c. Only liver function tests.
• d. No monitoring is necessary.

Answer: a. Weight, waist circumference, blood pressure, fasting glucose, and lipids.

21. A patient on an antipsychotic develops a shuffling gait, cogwheel rigidity, and a resting tremor. This is known as:

• a. Acute dystonia
• b. Akathisia
• c. Drug-induced parkinsonism (pseudoparkinsonism)
• d. Tardive dyskinesia

Answer: c. Drug-induced parkinsonism (pseudoparkinsonism)

22. How do atypical antipsychotics cause fewer extrapyramidal symptoms?

• a. They have a lower affinity for D2 receptors.
• b. They have a high affinity for 5-HT2A receptors, which increases dopamine release in the nigrostriatal pathway.
• c. They dissociate more rapidly from the D2 receptor.
• d. Both b and c are proposed mechanisms.

Answer: d. Both b and c are proposed mechanisms.

23. Which antipsychotic has a particularly high risk of causing QTc prolongation?

• a. Aripiprazole
• b. Lurasidone
• c. Ziprasidone
• d. Brexpiprazole

Answer: c. Ziprasidone

24. The term “pharmacodynamics” refers to:

• a. What the body does to the drug.
• b. The process of drug absorption.
• c. What the drug does to the body, including its receptor binding profile.
• d. The cost of the drug.

Answer: c. What the drug does to the body, including its receptor binding profile.

25. A pharmacist counseling a patient on a new antipsychotic should emphasize that:

• a. The full therapeutic effect may take several weeks to develop.
• b. They should not stop the medication abruptly without talking to their doctor.
• c. Both a and b.
• d. Neither a nor b.

Answer: c. Both a and b.

26. Which of the following is NOT a first-generation (“typical”) antipsychotic?

• a. Haloperidol
• b. Chlorpromazine
• c. Fluphenazine
• d. Risperidone

Answer: d. Risperidone

27. The orthostatic hypotension seen with some antipsychotics is due to blockade of which receptor?

• a. Dopamine D2
• b. Alpha-1 adrenergic
• c. Serotonin 5-HT1A
• d. Muscarinic M1

Answer: b. Alpha-1 adrenergic

28. Acute dystonia is most effectively treated with:

• a. An increase in the antipsychotic dose.
• b. An anticholinergic agent like benztropine or diphenhydramine.
• c. A beta-blocker like propranolol.
• d. A benzodiazepine like lorazepam.

Answer: b. An anticholinergic agent like benztropine or diphenhydramine.

29. The choice between different antipsychotics is often guided by:

• a. Minimizing the most problematic side effects for an individual patient.
• b. The patient’s prior history of response.
• c. The need for a specific formulation (e.g., LAI).
• d. All of the above.

Answer: d. All of the above.

30. The “dopamine hypothesis” suggests that positive symptoms of schizophrenia are due to hyperactivity in the mesolimbic pathway.

• a. True
• b. False

Answer: a. True

31. Which antipsychotic must be taken with food (at least 350 calories) to ensure proper absorption?

• a. Olanzapine
• b. Aripiprazole
• c. Lurasidone
• d. Quetiapine

Answer: c. Lurasidone

32. Paliperidone is the active metabolite of:

• a. Olanzapine
• b. Risperidone
• c. Clozapine
• d. Haloperidol

Answer: b. Risperidone

33. Smoking tobacco can induce the metabolism of which antipsychotics, potentially requiring higher doses in smokers?

• a. Risperidone and aripiprazole
• b. Olanzapine and clozapine
• c. Haloperidol and fluphenazine
• d. Ziprasidone and lurasidone

Answer: b. Olanzapine and clozapine

34. The primary goal of maintenance pharmacotherapy in schizophrenia is to:

• a. Cure the disease.
• b. Prevent relapse of psychosis.
• c. Be used for only 6 months.
• d. Eliminate all negative symptoms.

Answer: b. Prevent relapse of psychosis.

35. A pharmacist’s role in antipsychotic therapy is crucial for medication safety due to the high potential for adverse effects and drug interactions.

• a. True
• b. False

Answer: a. True

36. Akathisia is often managed with:

• a. An increase in the antipsychotic dose.
• b. A beta-blocker like propranolol or a benzodiazepine.
• c. An anticholinergic agent.
• d. An antidepressant.

Answer: b. A beta-blocker like propranolol or a benzodiazepine.

37. Which of the following is NOT a common side effect of first-generation antipsychotics?

• a. Extrapyramidal symptoms (EPS)
• b. Hyperprolactinemia
• c. Sedation
• d. Significant weight loss

Answer: d. Significant weight loss

38. The “-apine” suffix generally refers to which class of atypical antipsychotics?

• a. The dibenzazepine derivatives (e.g., olanzapine, quetiapine).
• b. The benzisoxazole derivatives (e.g., risperidone).
• c. The D2 partial agonists (e.g., aripiprazole).
• d. The butyrophenones (e.g., haloperidol).

Answer: a. The dibenzazepine derivatives (e.g., olanzapine, quetiapine).

39. A key counseling point for an orally disintegrating tablet (ODT) is to handle it with dry hands.

• a. True
• b. False

Answer: a. True

40. The overall goal of antipsychotic pharmacology is to:

• a. Modulate dopaminergic and serotonergic pathways to treat psychosis while minimizing side effects.
• b. Block every dopamine receptor in the brain as strongly as possible.
• c. Increase the levels of serotonin only.
• d. Cure schizophrenia.

Answer: a. Modulate dopaminergic and serotonergic pathways to treat psychosis while minimizing side effects.

41. Which side effect of antipsychotics is considered a medical emergency?

• a. Mild sedation
• b. Dry mouth
• c. Neuroleptic Malignant Syndrome (NMS)
• d. Weight gain of 5 pounds

Answer: c. Neuroleptic Malignant Syndrome (NMS)

42. Neuroleptic Malignant Syndrome is characterized by fever, extreme muscle rigidity (“lead pipe” rigidity), and autonomic instability.

• a. True
• b. False

Answer: a. True

43. The risk of metabolic syndrome is highest with which two atypical antipsychotics?

• a. Aripiprazole and lurasidone
• b. Ziprasidone and haloperidol
• c. Clozapine and olanzapine
• d. Risperidone and paliperidone

Answer: c. Clozapine and olanzapine

44. A pharmacist must verify that a patient on clozapine has a current and acceptable _____ before dispensing.

• a. Liver function test
• b. Serum creatinine
• c. Absolute Neutrophil Count (ANC)
• d. EKG

Answer: c. Absolute Neutrophil Count (ANC)

45. Adherence to antipsychotic medication is often poor due to:

• a. Side effects
• b. Lack of insight into the illness
• c. Stigma
• d. All of the above

Answer: d. All of the above

46. A patient is taking an antipsychotic that is a substrate of CYP3A4. If they are started on a potent CYP3A4 inhibitor like ketoconazole, the antipsychotic level will likely:

• a. Decrease
• b. Increase
• c. Stay the same
• d. Become undetectable

Answer: b. Increase

47. A pharmacist plays a crucial role in the transition of care for a patient with schizophrenia being discharged from the hospital.

• a. True
• b. False

Answer: a. True

48. Which atypical antipsychotic is generally considered to have the lowest risk of metabolic side effects?

• a. Olanzapine
• b. Quetiapine
• c. Aripiprazole and ziprasidone
• d. Clozapine

Answer: c. Aripiprazole and ziprasidone

49. The management of psychotic disorders is a complex, long-term process.

• a. True
• b. False

Answer: a. True

50. The ultimate reason to learn the pharmacology of antipsychotics is to:

• a. Be able to safely and effectively manage these complex medications to improve the lives of patients with serious mental illness.
• b. Pass the psychiatry exam.
• c. Memorize all the receptor binding affinities.
• d. Be able to diagnose schizophrenia.

Answer: a. Be able to safely and effectively manage these complex medications to improve the lives of patients with serious mental illness.