Loxapine succinate MCQs With Answer

Loxapine succinate MCQs With Answer — This concise introduction covers the inhaled antipsychotic loxapine succinate, its pharmacology, clinical use, and safety essentials for B. Pharm students. Loxapine succinate (Adasuve) is an inhalation formulation used for rapid management of acute agitation in adults with schizophrenia or bipolar I disorder. Key topics include mechanism of action (D2/5-HT2 antagonism), inhalation delivery (Staccato device), pulmonary safety (bronchospasm risk and REMS), pharmacokinetics, adverse effects, drug interactions and monitoring. Understanding these facets helps pharmacy students counsel patients, anticipate complications, and choose appropriate therapy. ‘Now let’s test your knowledge with 50 MCQs on this topic.’

Q1. What is the primary pharmacologic mechanism of loxapine?

• Selective serotonin reuptake inhibition
• GABA-A receptor modulation
• Dopamine D2 receptor antagonism
• NMDA receptor antagonism

Correct Answer: Dopamine D2 receptor antagonism

Q2. Loxapine belongs structurally to which tricyclic class?

• Phenothiazines
• Dibenzoxazepines
• Butyrophenones
• Thioxanthenes

Correct Answer: Dibenzoxazepines

Q3. Loxapine succinate (Adasuve) is formulated for which route of administration?

• Oral capsule
• Intramuscular injection
• Inhalation via a Staccato device
• Transdermal patch

Correct Answer: Inhalation via a Staccato device

Q4. The inhaled formulation of loxapine is specifically indicated for acute agitation in adults with:

• Major depressive disorder
• Schizophrenia or bipolar I disorder
• Generalized anxiety disorder
• Alzheimer’s disease

Correct Answer: Schizophrenia or bipolar I disorder

Q5. A major safety concern unique to inhaled loxapine is:

• Severe neutropenia
• Bronchospasm
• Hepatotoxicity
• Renal failure

Correct Answer: Bronchospasm

Q6. Because of bronchospasm risk, loxapine succinate is contraindicated in patients with:

• Hypothyroidism
• Asthma or chronic obstructive pulmonary disease
• Type 1 diabetes mellitus
• History of peptic ulcer disease

Correct Answer: Asthma or chronic obstructive pulmonary disease

Q7. Which monitoring is recommended prior to administering inhaled loxapine?

• Baseline spirometry/airway assessment
• Routine liver biopsy
• Fasting blood glucose only
• Baseline electroencephalogram (EEG)

Correct Answer: Baseline spirometry/airway assessment

Q8. The Staccato delivery system used with loxapine succinate is best described as:

• A dry-powder inhaler that thermally vaporizes drug for deep lung delivery
• A pressurized metered-dose aerosol propellant device
• A nebulized saline suspension
• An oral inhaler that delivers liquid aerosol by manual pump

Correct Answer: A dry-powder inhaler that thermally vaporizes drug for deep lung delivery

Q9. Loxapine’s antagonism of which serotonin receptor contributes to atypical antipsychotic–like effects?

• 5-HT1A
• 5-HT2A
• 5-HT3
• 5-HT4

Correct Answer: 5-HT2A

Q10. Which serious movement disorder can result from long-term dopamine blockade with loxapine?

• Neurogenic bladder
• Tardive dyskinesia
• Peripheral neuropathy
• Myasthenia gravis

Correct Answer: Tardive dyskinesia

Q11. Which adverse effect is commonly associated with loxapine due to histamine H1 blockade?

• Insomnia
• Sedation
• Hypertensive crisis
• Diarrhea

Correct Answer: Sedation

Q12. Loxapine is metabolized primarily in the liver by which enzyme family?

• CYP450 enzymes (including CYP1A2)
• Alcohol dehydrogenase
• Monoamine oxidase B only
• UDP-glucuronosyltransferase exclusively

Correct Answer: CYP450 enzymes (including CYP1A2)

Q13. A major metabolite of loxapine that has antidepressant properties is:

• Nortriptyline
• Amoxapine
• Clomipramine
• Amitriptyline

Correct Answer: Amoxapine

Q14. Which acute extrapyramidal reaction to loxapine is treated with an anticholinergic agent such as benztropine?

• Akathisia
• Acute dystonia
• Tardive dyskinesia
• Parkinsonism

Correct Answer: Acute dystonia

Q15. The regulatory program that restricts distribution of inhaled loxapine due to respiratory risks is known as:

• REMS (Risk Evaluation and Mitigation Strategy)
• ETASU (Emergency Therapy Authorization System)
• BBR (Black Box Restriction)
• FDA-ONLY program

Correct Answer: REMS (Risk Evaluation and Mitigation Strategy)

Q16. Which of the following is a contraindication to using inhaled loxapine without extreme caution?

• History of seizure disorder with adequate control
• Patients with known hypersensitivity to loxapine
• Patients currently treated with SSRIs for depression
• History of controlled hypertension

Correct Answer: Patients with known hypersensitivity to loxapine

Q17. Which serious syndrome is associated with antipsychotics including loxapine and requires immediate discontinuation?

• Serotonin syndrome
• Neuroleptic malignant syndrome
• Stevens-Johnson syndrome
• Rhabdomyolysis unrelated to drug

Correct Answer: Neuroleptic malignant syndrome

Q18. Compared with clozapine, loxapine has which safety advantage?

• No risk of metabolic syndrome
• Does not require routine ANC monitoring for agranulocytosis
• Complete absence of extrapyramidal symptoms
• Guaranteed absence of QT prolongation

Correct Answer: Does not require routine ANC monitoring for agranulocytosis

Q19. Which counseling point is most important for a patient receiving inhaled loxapine in a clinic setting?

• Avoid dairy products for 48 hours
• Report any new shortness of breath immediately
• Double the dose if symptoms persist
• Use a spacer for improved delivery

Correct Answer: Report any new shortness of breath immediately

Q20. The time to onset of clinical effect for inhaled loxapine in agitation is typically:

• Several days
• Several hours
• Within 10 minutes
• After two weeks

Correct Answer: Within 10 minutes

Q21. Which class-wide black-box warning applies to loxapine and other antipsychotics when used in elderly dementia patients?

• Increased risk of suicidality
• Increased mortality in elderly patients with dementia-related psychosis
• Fetal toxicity in all trimesters
• Mandatory cardiac monitoring for 6 months

Correct Answer: Increased mortality in elderly patients with dementia-related psychosis

Q22. Concomitant use of loxapine with strong CYP1A2 inhibitors would most likely cause:

• Decreased loxapine plasma levels
• No change in pharmacokinetics
• Increased loxapine plasma levels and risk of toxicity
• Immediate renal elimination

Correct Answer: Increased loxapine plasma levels and risk of toxicity

Q23. Which adverse effect is most directly due to alpha-1 adrenergic blockade by loxapine?

• Orthostatic hypotension
• Hyperreflexia
• Hyperthermia
• Hypoglycemia

Correct Answer: Orthostatic hypotension

Q24. For a pharmacy student explaining inhaled loxapine, which patient population must be explicitly screened out before use?

• Patients with uncontrolled glaucoma
• Patients with chronic respiratory disease (e.g., COPD, asthma)
• Patients on beta-blockers
• Patients with hypothyroidism

Correct Answer: Patients with chronic respiratory disease (e.g., COPD, asthma)

Q25. Which lab monitoring is routinely required for patients receiving a single inhaled dose of loxapine in acute agitation?

• Complete blood count every week
• No routine blood monitoring; clinical observation for respiratory status
• Frequent liver enzyme panels
• Daily fasting lipid profile

Correct Answer: No routine blood monitoring; clinical observation for respiratory status

Q26. Which neurotransmitter receptor antagonism by loxapine contributes to anticholinergic side effects?

• Muscarinic receptor antagonism
• Glycine receptor antagonism
• NMDA receptor antagonism
• Opioid receptor antagonism

Correct Answer: Muscarinic receptor antagonism

Q27. The inhaled loxapine product requires administration in a setting with immediate access to:

• Renal dialysis
• Bronchodilators and equipment to manage bronchospasm
• Continuous insulin infusion
• Emergency neuroleptic malignant syndrome kit

Correct Answer: Bronchodilators and equipment to manage bronchospasm

Q28. Which clinical effect differentiates loxapine from high-potency typical antipsychotics like haloperidol?

• Loxapine has more marked anticholinergic and sedative effects
• Loxapine causes no extrapyramidal symptoms
• Loxapine is completely free of metabolic effects
• Loxapine has no effect on serotonin receptors

Correct Answer: Loxapine has more marked anticholinergic and sedative effects

Q29. In the event of an acute dystonic reaction caused by loxapine, the recommended immediate pharmacologic treatment is:

• Intravenous benzodiazepine only
• Intravenous or intramuscular anticholinergic such as benztropine or diphenhydramine
• Beta-agonist inhaler
• Administer another antipsychotic

Correct Answer: Intravenous or intramuscular anticholinergic such as benztropine or diphenhydramine

Q30. Which statement about loxapine’s impact on QT interval is most accurate?

• Loxapine has no potential to affect cardiac conduction
• Loxapine may prolong the QT interval; caution with other QT-prolonging drugs
• Loxapine shortens the QT interval
• Loxapine only affects PR interval, not QT

Correct Answer: Loxapine may prolong the QT interval; caution with other QT-prolonging drugs

Q31. Which description best fits the class designation of loxapine in antipsychotic taxonomy?

• Atypical antipsychotic with exclusive 5-HT2A activity
• Typical (first-generation) antipsychotic with mixed receptor profile
• Antidepressant rather than antipsychotic
• Selective D1 receptor agonist

Correct Answer: Typical (first-generation) antipsychotic with mixed receptor profile

Q32. A pharmacy counseling point after a clinic-administered inhaled dose of loxapine should include observation for how long for respiratory events?

• No observation necessary
• At least 2 hours with appropriate monitoring
• Observation for 10 minutes only
• 24-hour inpatient observation mandatory

Correct Answer: At least 2 hours with appropriate monitoring

Q33. Loxapine’s clinical sedative effects are primarily mediated by antagonism at which receptor?

• Beta-2 adrenergic receptor
• Histamine H1 receptor
• NMDA receptor
• GABA-B receptor

Correct Answer: Histamine H1 receptor

Q34. Which statement about the oral form of loxapine versus the inhaled succinate formulation is correct?

• The oral form is inhaled using the same device
• The inhaled succinate is designed for rapid onset and is used for acute agitation
• The oral and inhaled forms are identical in distribution and onset
• The inhaled form is used for chronic maintenance therapy only

Correct Answer: The inhaled succinate is designed for rapid onset and is used for acute agitation

Q35. Which enzyme induction (e.g., smoking/CYP1A2 induction) would most likely do what to loxapine levels?

• Increase loxapine plasma concentration
• Decrease loxapine plasma concentration
• No effect on loxapine metabolism
• Immediately cause bronchospasm

Correct Answer: Decrease loxapine plasma concentration

Q36. Which psychiatric emergency is inhaled loxapine specifically intended to treat?

• Acute agitation associated with schizophrenia or bipolar I disorder
• Major depressive disorder with suicidal ideation
• Chronic negative symptoms of schizophrenia
• Maintenance therapy for bipolar depression

Correct Answer: Acute agitation associated with schizophrenia or bipolar I disorder

Q37. Compared to many atypical antipsychotics, loxapine’s risk of metabolic syndrome is generally:

• Higher and well documented
• Lower but metabolic effects may still occur
• Completely absent
• Only present when given intravenously

Correct Answer: Lower but metabolic effects may still occur

Q38. Which action is most appropriate if a patient develops bronchospasm after inhaled loxapine?

• Administer a short-acting bronchodilator and provide respiratory support
• Give an extra inhaled dose of loxapine
• Wait and observe without intervention
• Prescribe oral antibiotics immediately

Correct Answer: Administer a short-acting bronchodilator and provide respiratory support

Q39. Which is true regarding repeat dosing of inhaled loxapine in the same 24-hour period?

• Multiple doses can be given hourly as needed
• Clinical protocols limit repeat dosing; follow approved label and REMS guidance
• Repeat dosing is recommended to achieve sedation
• Repeat dosing is mandated by REMS

Correct Answer: Clinical protocols limit repeat dosing; follow approved label and REMS guidance

Q40. Which drug interaction is of particular concern with loxapine due to additive sedation?

• Concurrent use of benzodiazepines or other CNS depressants
• Concurrent use of ACE inhibitors
• Concurrent use of antacids
• Concurrent use of metformin

Correct Answer: Concurrent use of benzodiazepines or other CNS depressants

Q41. Which of the following adverse effects is least likely with loxapine?

• Dry mouth and constipation
• Extrapyramidal symptoms
• Severe agranulocytosis requiring weekly CBC monitoring
• Orthostatic hypotension

Correct Answer: Severe agranulocytosis requiring weekly CBC monitoring

Q42. In pharmacology exams, loxapine is often contrasted with which antipsychotic known for high metabolic risk and agranulocytosis monitoring?

• Haloperidol
• Clozapine
• Risperidone
• Fluphenazine

Correct Answer: Clozapine

Q43. Which physiological parameter should be assessed if a patient receives loxapine and reports muscle rigidity and fever?

• Serum creatine kinase for possible neuroleptic malignant syndrome
• Fasting blood glucose only
• Serum potassium exclusively
• Serum magnesium only

Correct Answer: Serum creatine kinase for possible neuroleptic malignant syndrome

Q44. Pharmacologically, loxapine’s antagonism at muscarinic receptors would predict which side effect?

• Bradycardia
• Salivation and hypermotility
• Dry mouth and constipation
• Increased lacrimation

Correct Answer: Dry mouth and constipation

Q45. For B.Pharm students, which pharmacokinetic concept is important when counseling about inhaled loxapine?

• It bypasses first-pass hepatic metabolism for rapid effect
• It is not systemically absorbed at all
• It is eliminated unchanged in urine exclusively
• It requires activation by gut flora

Correct Answer: It bypasses first-pass hepatic metabolism for rapid effect

Q46. Loxapine’s therapeutic classification is best described as:

• Mood stabilizer
• Antipsychotic (neuroleptic)
• Anxiolytic benzodiazepine
• Selective serotonin reuptake inhibitor

Correct Answer: Antipsychotic (neuroleptic)

Q47. Which patient education point is appropriate for someone receiving inhaled loxapine in clinic?

• Inform the patient that they may experience rapid calming within minutes
• Tell the patient to expect maximum benefit after one month
• Advise the patient to self-administer at home as needed
• Recommend daily use for sleep maintenance

Correct Answer: Inform the patient that they may experience rapid calming within minutes

Q48. Which adverse pulmonary event prompted the requirement for REMS for inhaled loxapine?

• Pulmonary fibrosis after long-term use
• Acute bronchospasm requiring intervention
• Asymptomatic cough only
• Chronic bronchiectasis development

Correct Answer: Acute bronchospasm requiring intervention

Q49. In terms of potency, loxapine is generally considered:

• High-potency typical antipsychotic (like haloperidol)
• Medium-potency antipsychotic
• Purely atypical with no dopamine blockade
• Non-psychotropic antibiotic

Correct Answer: Medium-potency antipsychotic

Q50. When teaching about drug interactions, which co-prescribed agent would raise concern for additive QT prolongation with loxapine?

• Metformin
• Ziprasidone (another QT-prolonging antipsychotic)
• Folic acid
• Vitamin D supplement

Correct Answer: Ziprasidone (another QT-prolonging antipsychotic)

G S Sachin

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