Antipsychotics are a cornerstone of treatment for severe mental illnesses like schizophrenia and bipolar disorder. As their use expands, a deep understanding of their complex pharmacology, diverse side effect profiles, and the principles of patient-centered care is essential for every pharmacist. This quiz for PharmD students will test your knowledge of the mechanisms, clinical uses, adverse effects, and monitoring requirements for both first- and second-generation antipsychotic agents.
1. First-generation antipsychotics (FGAs), like haloperidol, primarily exert their therapeutic effect by blocking which receptor?
- Serotonin 5-HT2A
- Dopamine D2
- Histamine H1
- Alpha-1 adrenergic
Answer: Dopamine D2
2. Second-generation antipsychotics (SGAs), like olanzapine, differ from FGAs because they are antagonists at both D2 receptors and which other key receptor?
- Serotonin 5-HT2A
- Muscarinic M1
- GABA-A
- Beta-2 adrenergic
Answer: Serotonin 5-HT2A
3. The “dopamine hypothesis” of schizophrenia suggests that the positive symptoms (e.g., hallucinations) are caused by an excess of dopamine in the:
- Nigrostriatal pathway.
- Mesolimbic pathway.
- Mesocortical pathway.
- Tuberoinfundibular pathway.
Answer: Mesolimbic pathway.
4. Blockade of dopamine in the nigrostriatal pathway is responsible for which major side effect of antipsychotics?
- Weight gain.
- Sedation.
- Extrapyramidal Symptoms (EPS).
- Dry mouth.
Answer: Extrapyramidal Symptoms (EPS).
5. A patient on a high-potency FGA develops a painful, sustained muscle spasm in their neck. This is a classic presentation of which type of EPS?
- Akathisia
- Acute dystonia
- Pseudoparkinsonism
- Tardive dyskinesia
Answer: Acute dystonia
6. A patient reports an unbearable inner restlessness and an inability to sit still shortly after starting an antipsychotic. This is known as:
- Dystonia
- Akathisia
- Tardive dyskinesia
- A seizure
Answer: Akathisia
7. A major advantage of most second-generation antipsychotics compared to first-generation agents is a:
- Lower risk of metabolic side effects.
- Lower risk of extrapyramidal symptoms.
- Higher potency for D2 blockade.
- Complete absence of side effects.
Answer: Lower risk of extrapyramidal symptoms.
8. Which of the following is NOT considered a first-generation (typical) antipsychotic?
- Haloperidol
- Fluphenazine
- Chlorpromazine
- Risperidone
Answer: Risperidone
9. A significant and common concern with many second-generation antipsychotics, particularly olanzapine and clozapine, is the risk of:
- Weight loss and hypoglycemia.
- Metabolic syndrome (weight gain, hyperglycemia, dyslipidemia).
- Severe hair loss.
- Renal failure.
Answer: Metabolic syndrome (weight gain, hyperglycemia, dyslipidemia).
10. Tardive dyskinesia (TD) is a serious, potentially irreversible side effect characterized by involuntary movements of the face and tongue. It is most associated with:
- Short-term use of SSRIs.
- Long-term use of dopamine receptor antagonists, especially FGAs.
- Benzodiazepine withdrawal.
- An overdose of lithium.
Answer: Long-term use of dopamine receptor antagonists, especially FGAs.
11. A patient on an antipsychotic develops a high fever, “lead pipe” muscle rigidity, altered mental status, and autonomic instability. This is a medical emergency known as:
- Serotonin syndrome.
- A hypertensive crisis.
- Neuroleptic Malignant Syndrome (NMS).
- Agranulocytosis.
Answer: Neuroleptic Malignant Syndrome (NMS).
12. Which antipsychotic requires regular, mandatory blood monitoring due to the risk of severe, life-threatening agranulocytosis?
- Aripiprazole
- Quetiapine
- Olanzapine
- Clozapine
Answer: Clozapine
13. Blockade of dopamine in the tuberoinfundibular pathway by an antipsychotic can lead to an increase in which hormone?
- Cortisol
- Prolactin
- Thyroid-stimulating hormone (TSH)
- Insulin
Answer: Prolactin
14. Which second-generation antipsychotic is most notorious for causing hyperprolactinemia?
- Aripiprazole
- Quetiapine
- Risperidone
- Ziprasidone
Answer: Risperidone
15. Aripiprazole is unique among antipsychotics because it acts as a:
- Full D2 receptor agonist.
- D2 partial agonist.
- Pure 5-HT2A antagonist.
- Potent muscarinic antagonist.
Answer: D2 partial agonist.
16. The “negative symptoms” of schizophrenia, such as apathy and social withdrawal, are thought to be related to a dopamine deficit in which pathway?
- Mesolimbic
- Nigrostriatal
- Mesocortical
- Tuberoinfundibular
Answer: Mesocortical
17. A pharmacist should counsel a patient taking quetiapine that it has a very common side effect of:
- Insomnia.
- Sedation.
- Nausea.
- A skin rash.
Answer: Sedation.
18. The primary indication for the use of antipsychotic medications is:
- Generalized anxiety disorder.
- Schizophrenia.
- Major depressive disorder (as monotherapy).
- Panic disorder.
Answer: Schizophrenia.
19. A key monitoring parameter for any patient on a second-generation antipsychotic is:
- Their weight, BMI, and metabolic labs (glucose, lipids).
- Their serum sodium level.
- Their liver function tests only.
- Their international normalized ratio (INR).
Answer: Their weight, BMI, and metabolic labs (glucose, lipids).
20. A long-acting injectable (LAI) antipsychotic is a formulation designed to:
- Provide a rapid onset of action for acute agitation.
- Improve medication adherence in patients who struggle with oral therapy.
- Be administered by the patient at home.
- Have fewer side effects than oral formulations.
Answer: Improve medication adherence in patients who struggle with oral therapy.
21. Anticholinergic side effects (dry mouth, constipation, blurred vision) are most prominent with which type of antipsychotic?
- Low-potency first-generation antipsychotics like chlorpromazine.
- High-potency first-generation antipsychotics like haloperidol.
- Most second-generation antipsychotics.
- Aripiprazole.
Answer: Low-potency first-generation antipsychotics like chlorpromazine.
22. A key counseling point for a patient starting an orally disintegrating tablet (ODT) formulation of an antipsychotic is:
- To chew the tablet thoroughly.
- To swallow the tablet whole with a full glass of water.
- That it is designed to dissolve on the tongue without water, which can be useful for patients who may “cheek” or spit out their medication.
- To take it with a high-fat meal.
Answer: That it is designed to dissolve on the tongue without water, which can be useful for patients who may “cheek” or spit out their medication.
23. The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults recommends avoiding antipsychotics for what condition in patients with dementia?
- Psychosis
- Schizophrenia
- Behavioral disturbances (e.g., agitation), due to an increased risk of stroke and mortality.
- Bipolar disorder
Answer: Behavioral disturbances (e.g., agitation), due to an increased risk of stroke and mortality.
24. The leadership skill of “patient advocacy” is critical when a pharmacist:
- Helps a patient with schizophrenia navigate insurance barriers to obtain a needed LAI formulation.
- Insists that a patient take a medication with intolerable side effects.
- Reports a patient for being non-adherent.
- Refuses to speak with the patient’s caregiver.
Answer: Helps a patient with schizophrenia navigate insurance barriers to obtain a needed LAI formulation.
25. A pharmacist in any practice setting must be aware of the potential for QTc prolongation with many antipsychotics. This is a risk for developing which life-threatening arrhythmia?
- Atrial fibrillation
- Bradycardia
- Torsades de pointes
- Atrioventricular block
Answer: Torsades de pointes
26. Which of the following is a primary role for a pharmacist in managing antipsychotic therapy?
- To diagnose schizophrenia.
- To educate the patient and caregivers on the medication, its side effects, and the importance of adherence.
- To prescribe the antipsychotic.
- To administer the medication in the hospital.
Answer: To educate the patient and caregivers on the medication, its side effects, and the importance of adherence.
27. A pharmacist using a “Dashboard Presentation” in a hospital could track:
- The appropriate metabolic monitoring rates for all patients on second-generation antipsychotics.
- The pharmacy’s daily profit margin.
- The schedule for the pharmacy technicians.
- The number of visitors in the hospital.
Answer: The appropriate metabolic monitoring rates for all patients on second-generation antipsychotics.
28. An “analytics and reporting system” could be used to identify patients on antipsychotics who might be at high risk for a drug interaction, such as:
- A patient taking two agents that both prolong the QTc interval.
- A patient also prescribed a multivitamin.
- A patient with a history of a broken bone.
- A patient who is a non-smoker.
Answer: A patient taking two agents that both prolong the QTc interval.
29. The use of a “difficult conversations” framework would be most helpful when a pharmacist needs to:
- Discuss the potential for long-term side effects like tardive dyskinesia with a patient and their family.
- Explain how to take a once-daily tablet.
- Ring up a patient’s prescription at the register.
- Take a patient’s blood pressure.
Answer: Discuss the potential for long-term side effects like tardive dyskinesia with a patient and their family.
30. The ultimate goal of antipsychotic therapy in schizophrenia is to:
- Completely cure the disease.
- Reduce symptoms, improve functioning, and enhance the patient’s quality of life.
- Keep the patient sedated at all times.
- Ensure the patient remains hospitalized indefinitely.
Answer: Reduce symptoms, improve functioning, and enhance the patient’s quality of life.
31. From a “human factors” perspective, the fact that aripiprazole comes in multiple oral strengths and two different LAI formulations with different dosing intervals can increase the risk of:
- A medication error.
- Improved adherence.
- A lower cost.
- Fewer side effects.
Answer: A medication error.
32. A “Clinical Decision Support” alert in an EHR should be designed to fire when:
- A prescriber orders a duplicate antipsychotic from the same class.
- A patient is due for their metabolic monitoring labs.
- An interacting medication is prescribed.
- All of the above.
Answer: All of the above.
33. The principle of “shared decision-making” is critical when choosing an antipsychotic because:
- The pharmacist should make the decision for the patient.
- The choice involves a trade-off between efficacy and a side effect profile that should align with the patient’s preferences and lifestyle.
- The physician’s choice is the only one that matters.
- The patient should make the decision without any clinical input.
Answer: The choice involves a trade-off between efficacy and a side effect profile that should align with the patient’s preferences and lifestyle.
34. A pharmacist’s knowledge of “pharmacogenomics” can be applied to antipsychotic therapy, as:
- All patients respond to these drugs in the same way.
- Genetic variations in CYP450 enzymes (like CYP2D6) can predict a patient’s metabolism of certain antipsychotics, affecting their risk of side effects.
- A patient’s genetics can guarantee a cure.
- It is not a relevant field for antipsychotics.
Answer: Genetic variations in CYP450 enzymes (like CYP2D6) can predict a patient’s metabolism of certain antipsychotics, affecting their risk of side effects.
35. A “business plan” for a new mental health service in a pharmacy would need to include:
- The cost of the antipsychotic medications.
- The reimbursement model for the pharmacist’s clinical services.
- The marketing plan to local providers.
- All of the above.
Answer: All of the above.
36. A pharmacist “forging ahead” would view the management of patients on complex antipsychotic regimens as:
- A core clinical responsibility and an opportunity to demonstrate pharmacist value.
- A task to be avoided.
- The sole responsibility of the physician.
- A simple dispensing function.
Answer: A core clinical responsibility and an opportunity to demonstrate pharmacist value.
37. The service of “deprescribing” might be considered for an antipsychotic when:
- It has been successfully treating a patient’s schizophrenia for years.
- It was prescribed for a short-term, off-label use (like insomnia) and is being continued indefinitely without a clear indication.
- The patient is experiencing no side effects.
- The patient is newly diagnosed.
Answer: It was prescribed for a short-term, off-label use (like insomnia) and is being continued indefinitely without a clear indication.
38. The use of an “antidote” is most relevant for which antipsychotic-related emergency?
- The management of acute dystonia with an anticholinergic agent like diphenhydramine or benztropine.
- Agranulocytosis from clozapine.
- Metabolic syndrome from olanzapine.
- Tardive dyskinesia.
Answer: The management of acute dystonia with an anticholinergic agent like diphenhydramine or benztropine.
39. A key “Cardiovascular Principle” to remember with antipsychotics is their potential to:
- Lower blood pressure significantly.
- Cause bradycardia.
- Prolong the QTc interval.
- Strengthen the force of heart contraction.
Answer: Prolong the QTc interval.
40. A pharmacist’s understanding of “health disparities” is important because:
- The diagnosis and treatment of schizophrenia can vary across different racial and ethnic groups.
- Access to newer, more expensive antipsychotics may be limited for some populations.
- The stigma of mental illness can be a greater barrier in some communities.
- All of the above.
Answer: All of the above.
41. The principle of “adherence” is a major challenge in schizophrenia care. A pharmacist can help by:
- Using motivational interviewing.
- Recommending simpler regimens or LAI formulations.
- Providing education on the importance of treatment.
- All of the above.
Answer: All of the above.
42. Which antipsychotic should be taken with food (a ~350-500 calorie meal) to ensure adequate absorption?
- Olanzapine
- Risperidone
- Ziprasidone and Lurasidone
- Haloperidol
Answer: Ziprasidone and Lurasidone
43. A pharmacist in any “practice setting” should be prepared to:
- Recognize the signs of tardive dyskinesia.
- Manage the side effects of common antipsychotics.
- Counsel a patient on a new antipsychotic prescription.
- All of the above.
Answer: All of the above.
44. The use of a “negotiation” framework could be helpful when:
- A pharmacist is discussing a switch to a more appropriate antipsychotic with a prescriber.
- A patient is demanding an early refill.
- A technician is asking for a raise.
- All of the above.
Answer: All of the above.
45. A key principle of “geriatric sensitivity” when managing antipsychotics is that:
- Older adults are more sensitive to side effects like EPS and anticholinergic effects.
- Higher doses are generally required in older adults.
- Antipsychotics are completely safe in this population.
- The Beers Criteria does not apply to antipsychotics.
Answer: Older adults are more sensitive to side effects like EPS and anticholinergic effects.
46. A pharmacist’s “leadership” is demonstrated by:
- Advocating for better mental health services in their community.
- Taking the lead on developing an antipsychotic monitoring program in their hospital.
- Mentoring a student who is interested in psychiatric pharmacy.
- All of the above.
Answer: All of the above.
47. A “human resources” issue related to antipsychotic use could be:
- A pharmacy technician who needs a reasonable accommodation due to a side effect of their own prescribed antipsychotic.
- The pharmacy’s budget for these medications.
- The marketing plan for a new LAI.
- The design of the EHR.
Answer: A pharmacy technician who needs a reasonable accommodation due to a side effect of their own prescribed antipsychotic.
48. In which practice setting would a pharmacist have the most comprehensive access to the data needed to manage antipsychotic therapy (e.g., labs, provider notes)?
- An institutional/hospital or integrated ambulatory care setting.
- A community pharmacy with no EHR access.
- A mail-order pharmacy.
- A supermarket pharmacy.
Answer: An institutional/hospital or integrated ambulatory care setting.
49. An important “policy” issue related to antipsychotics is:
- The regulation of REMS programs for drugs like clozapine.
- The laws governing the use of LAIs.
- Insurance coverage and prior authorization criteria.
- All of the above.
Answer: All of the above.
50. The core “psychiatric principle” behind antipsychotic use is that they primarily treat which type of disorder?
- Anxiety disorders.
- Mood disorders.
- Psychotic disorders.
- Substance use disorders.
Answer: Psychotic disorders.
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