Antipsychotics MCQs With Answer provides B. Pharm students a focused review of antipsychotic pharmacology, clinical uses, mechanisms, adverse effects, and therapeutic monitoring. This collection emphasizes key concepts such as typical versus atypical agents, D2 receptor blockade, 5-HT2A interactions, extrapyramidal symptoms, metabolic syndrome, clozapine monitoring, depot formulations, and relevant CYP-mediated interactions. Designed for classroom revision and exam preparation, the questions challenge understanding of pharmacokinetics, receptor profiles, side-effect management, and drug selection for schizophrenia, bipolar disorder, and acute agitation. Clear explanations reinforce learning and clinical relevance, helping students apply pharmacological principles to real-world patient care.
Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which mechanism best explains the primary antipsychotic effect of most typical antipsychotics?
- Partial agonism at 5-HT1A receptors
- Antagonism of dopamine D2 receptors
- Agonism of GABA-A receptors
- Inhibition of NMDA receptors
Correct Answer: Antagonism of dopamine D2 receptors
Q2. Which atypical antipsychotic is associated with a high risk of agranulocytosis requiring regular WBC monitoring?
- Risperidone
- Olanzapine
- Clozapine
- Haloperidol
Correct Answer: Clozapine
Q3. Which adverse effect is most characteristically associated with long-term D2 blockade in the nigrostriatal pathway?
- Weight gain
- Tardive dyskinesia
- Neutropenia
- Hypotension
Correct Answer: Tardive dyskinesia
Q4. Aripiprazole differs from many antipsychotics because it acts primarily as a:
- Full dopamine D2 antagonist
- Partial dopamine D2 agonist
- 5-HT3 receptor antagonist
- Muscarinic receptor agonist
Correct Answer: Partial dopamine D2 agonist
Q5. Which antipsychotic has the highest propensity for causing metabolic syndrome (weight gain, hyperglycaemia, dyslipidaemia)?
- Ziprasidone
- Haloperidol
- Olanzapine
- Fluphenazine
Correct Answer: Olanzapine
Q6. Which receptor blockade is primarily responsible for antipsychotic-induced orthostatic hypotension?
- Histamine H1 receptor blockade
- Alpha-1 adrenergic receptor blockade
- Muscarinic M2 receptor blockade
- Dopamine D2 receptor blockade
Correct Answer: Alpha-1 adrenergic receptor blockade
Q7. Which antipsychotic is most strongly associated with QT interval prolongation?
- Risperidone
- Ziprasidone
- Olanzapine
- Haloperidol (oral)
Correct Answer: Ziprasidone
Q8. Which adverse syndrome presents with fever, muscle rigidity, autonomic instability, and elevated CK and is a rare emergency of antipsychotic therapy?
- Serotonin syndrome
- Neuroleptic malignant syndrome
- Parkinsonism
- Tardive dyskinesia
Correct Answer: Neuroleptic malignant syndrome
Q9. Which enzyme is most important in the hepatic metabolism of many antipsychotics including risperidone and aripiprazole?
- CYP1A2
- CYP3A4
- CYP2D6
- MAO-A
Correct Answer: CYP2D6
Q10. Which formulation is used to improve adherence by providing sustained antipsychotic release over weeks?
- Immediate-release oral tablets
- Transdermal patch
- Depot intramuscular injection
- Inhaled aerosol
Correct Answer: Depot intramuscular injection
Q11. Which anticholinergic drug is commonly used to treat acute extrapyramidal symptoms caused by antipsychotics?
- Propranolol
- Biperiden
- Metoclopramide
- Flumazenil
Correct Answer: Biperiden
Q12. Which typical antipsychotic is most likely to cause significant anticholinergic effects and sedation?
- Chlorpromazine
- Haloperidol
- Fluphenazine
- Perphenazine
Correct Answer: Chlorpromazine
Q13. Which monitoring parameter is mandatory when initiating clozapine therapy?
- Lipid profile monthly
- White blood cell count and ANC regularly
- Fasting glucose weekly
- ECG every day
Correct Answer: White blood cell count and ANC regularly
Q14. Which antipsychotic is classified as a benzisoxazole derivative and commonly causes hyperprolactinaemia?
- Risperidone
- Quetiapine
- Olanzapine
- Aripiprazole
Correct Answer: Risperidone
Q15. Which symptom is most characteristic of acute dystonia as an extrapyramidal side effect?
- Bradykinesia and shuffling gait
- Sudden sustained muscle contractions and abnormal postures
- Involuntary choreiform movements of face
- Slow tremor at rest
Correct Answer: Sudden sustained muscle contractions and abnormal postures
Q16. Which property of atypical antipsychotics contributes to lower risk of extrapyramidal symptoms compared to typical agents?
- Higher affinity for muscarinic receptors
- Preferential 5-HT2A antagonism with transient D2 blockade
- Stronger D2 receptor blockade with irreversible binding
- Selective H1 agonism
Correct Answer: Preferential 5-HT2A antagonism with transient D2 blockade
Q17. Which antipsychotic is known for causing sedation through potent H1 histamine receptor antagonism?
- Ziprasidone
- Quetiapine
- Haloperidol
- Aripiprazole
Correct Answer: Quetiapine
Q18. Which antipsychotic has a mechanism that includes inhibition of dopamine reuptake transporters as a primary action?
- Risperidone
- Clozapine
- No major antipsychotic acts primarily by inhibiting dopamine reuptake
- Haloperidol
Correct Answer: No major antipsychotic acts primarily by inhibiting dopamine reuptake
Q19. Which interaction increases plasma levels of antipsychotics metabolized by CYP3A4?
- Co-administration with rifampicin
- Co-administration with carbamazepine
- Co-administration with ketoconazole
- Co-administration with phenytoin
Correct Answer: Co-administration with ketoconazole
Q20. Which clinical use beyond schizophrenia is commonly approved for many antipsychotics?
- Treatment of bacterial infections
- Bipolar mania and acute agitation
- Insulin replacement therapy
- Anticoagulation in atrial fibrillation
Correct Answer: Bipolar mania and acute agitation
Q21. Which antipsychotic is least likely to increase prolactin levels due to its partial agonist activity?
- Risperidone
- Haloperidol
- Aripiprazole
- Paliperidone
Correct Answer: Aripiprazole
Q22. A patient on antipsychotic therapy develops a resting tremor, bradykinesia, and rigidity. These features most closely resemble:
- Akathisia
- Parkinsonism
- Tardive dyskinesia
- Dystonia
Correct Answer: Parkinsonism
Q23. Which laboratory test should be monitored periodically for patients on long-term olanzapine therapy?
- Serum creatine kinase weekly
- Lipid profile and fasting blood glucose
- Complete blood count monthly for agranulocytosis
- Serum lithium levels
Correct Answer: Lipid profile and fasting blood glucose
Q24. Which antipsychotic is commonly used in treatment-resistant schizophrenia after other agents fail?
- Haloperidol
- Clozapine
- Ziprasidone
- Risperidone
Correct Answer: Clozapine
Q25. What is the principal pharmacodynamic action of risperidone contributing to antipsychotic efficacy?
- Muscarinic M3 receptor activation
- Dopamine D2 and serotonin 5-HT2A receptor antagonism
- GABA reuptake inhibition
- NMDA receptor potentiation
Correct Answer: Dopamine D2 and serotonin 5-HT2A receptor antagonism
Q26. Which adverse effect is most associated with high-potency typical antipsychotics like haloperidol?
- Severe anticholinergic effects
- Pronounced extrapyramidal symptoms
- Marked orthostatic hypotension
- Severe weight gain
Correct Answer: Pronounced extrapyramidal symptoms
Q27. Which statement about depot antipsychotic preparations is correct?
- They are only available for atypical antipsychotics
- They provide steady plasma levels and improve adherence
- They require daily administration
- They are rapidly cleared within hours
Correct Answer: They provide steady plasma levels and improve adherence
Q28. Which antipsychotic has significant anticholinergic activity and may worsen glaucoma or urinary retention?
- Chlorpromazine
- Risperidone
- Haloperidol
- Ziprasidone
Correct Answer: Chlorpromazine
Q29. Which clinical sign suggests akathisia as an antipsychotic adverse effect?
- Subjective inner restlessness and inability to sit still
- Involuntary rhythmic movements of the tongue
- Fever and muscle stiffness
- Gradual onset of involuntary facial movements after years
Correct Answer: Subjective inner restlessness and inability to sit still
Q30. Which medication is recommended to manage severe neuroleptic malignant syndrome?
- Metoclopramide
- Dantrolene
- Haloperidol
- Prochlorperazine
Correct Answer: Dantrolene
