MCQ Quiz: Pharmaceutical Dosage Formulations of Psychotropic Drugs

The effectiveness and tolerability of psychotropic medications are profoundly influenced by their dosage formulation. Beyond the active ingredient, the drug delivery system plays a critical role in optimizing pharmacokinetics, improving adherence, and managing side effects. From orally disintegrating tablets that prevent “cheeking” to long-acting injectables that solve adherence challenges, understanding these formulations is a key pharmacy skill. This quiz will test your knowledge on the various dosage forms used for psychotropic drugs and the clinical rationale behind their use.

1. A major advantage of an Orally Disintegrating Tablet (ODT) formulation for an antipsychotic is:

• a. It provides a longer duration of action.
• b. It prevents patients from “cheeking” and later spitting out the medication.
• c. It has a better taste than the standard tablet.
• d. It is less expensive to manufacture.

Answer: b. It prevents patients from “cheeking” and later spitting out the medication.

2. A patient is prescribed olanzapine as a short-acting intramuscular (IM) injection. What is the most likely clinical scenario for its use?

• a. For long-term, once-monthly maintenance therapy.
• b. For the management of acute agitation.
• c. For a patient who cannot swallow pills.
• d. As a first-line treatment for depression.

Answer: b. For the management of acute agitation.

3. Long-Acting Injectable (LAI) antipsychotics are primarily designed to:

• a. Provide a faster onset of action than oral tablets.
• b. Improve medication adherence for patients with chronic psychotic disorders.
• c. Eliminate all side effects of the medication.
• d. Be administered intravenously by the patient at home.

Answer: b. Improve medication adherence for patients with chronic psychotic disorders.

4. A patient is prescribed paliperidone palmitate. The pharmacist recognizes this as a long-acting injectable that is administered:

• a. Once a week
• b. Every two weeks
• c. Once a month
• d. Once every three months

Answer: c. Once a month

5. Which of the following is a common vehicle used for long-acting depot injections of antipsychotics?

• a. Sterile water
• b. An oily (oleaginous) vehicle
• c. An alcohol-based solution
• d. A saline solution

Answer: b. An oily (oleaginous) vehicle

6. A key counseling point for a patient receiving an LAI antipsychotic is:

• a. The importance of returning to the clinic on schedule for their next injection.
• b. That they can miss a dose by several weeks without consequence.
• c. That the injection will cure their illness.
• d. To massage the injection site vigorously to speed up absorption.

Answer: a. The importance of returning to the clinic on schedule for their next injection.

7. A patient is prescribed an SSRI as an oral solution instead of a tablet. A likely reason for this is:

• a. The patient has dysphagia (difficulty swallowing).
• b. The oral solution has a faster onset of action.
• c. The oral solution has fewer side effects.
• d. The oral solution is less expensive.

Answer: a. The patient has dysphagia (difficulty swallowing).

8. Why must an oral overlap be provided when starting most LAI antipsychotics?

• a. To increase the total dose of the antipsychotic.
• b. To reach therapeutic concentrations of the LAI, which can take several weeks.
• c. It is not necessary to provide an overlap.
• d. To treat injection site reactions.

Answer: b. To reach therapeutic concentrations of the LAI, which can take several weeks.

9. The use of extended-release (XR/ER) formulations for psychotropic drugs like quetiapine or venlafaxine is designed to:

• a. Allow for once-daily dosing and potentially reduce side effects.
• b. Provide a more rapid peak concentration.
• c. Make the tablets easier to crush.
• d. Increase the total amount of drug absorbed.

Answer: a. Allow for once-daily dosing and potentially reduce side effects.

10. A patient is prescribed the Risperdal Consta LAI. This formulation uses what technology to achieve its long duration of action?

• a. An oily vehicle
• b. Encapsulation of the drug in biodegradable polymer microspheres.
• c. A crystal suspension.
• d. Attachment of a long fatty acid chain.

Answer: b. Encapsulation of the drug in biodegradable polymer microspheres.

11. A key counseling point for a patient prescribed an extended-release tablet is:

• a. The tablet can be crushed or chewed for faster effect.
• b. The tablet must be swallowed whole and not crushed or chewed.
• c. The tablet should be taken on an empty stomach.
• d. The patient may see the tablet “ghost” in their stool.

Answer: b. The tablet must be swallowed whole and not crushed or chewed.

12. A “sublingual” formulation of a drug like asenapine is designed to be:

• a. Swallowed with water.
• b. Placed under the tongue to dissolve and be absorbed directly into the bloodstream.
• c. Chewed thoroughly.
• d. Applied to the skin.

Answer: b. Placed under the tongue to dissolve and be absorbed directly into the bloodstream.

13. A major advantage of a sublingual or ODT formulation is that it:

• a. Has a longer half-life.
• b. Bypasses first-pass metabolism in the liver.
• c. Is more potent.
• d. Is available for all psychotropic drugs.

Answer: b. Bypasses first-pass metabolism in the liver.

14. A pharmacist’s role in managing these various formulations includes:

• a. Ensuring the patient understands the correct administration for their specific dosage form.
• b. Identifying if a different formulation could improve a patient’s adherence or tolerability.
• c. Counseling on the difference between short-acting and long-acting injections.
• d. All of the above.

Answer: d. All of the above.

15. A patient taking a once-daily extended-release medication for ADHD complains that it wears off before the end of the school day. The pharmacist could recognize this as a potential issue with:

• a. The drug’s formulation and duration of action.
• b. A lack of efficacy of the drug itself.
• c. A drug-drug interaction.
• d. Patient non-adherence.

Answer: a. The drug’s formulation and duration of action.

16. Which of the following is NOT an advantage of an LAI antipsychotic?

• a. Improved adherence
• b. Reduced risk of relapse
• c. Easy and immediate discontinuation of the drug if a serious side effect occurs.
• d. More predictable plasma concentrations.

Answer: c. Easy and immediate discontinuation of the drug if a serious side effect occurs.

17. Orally disintegrating tablets are a good option for patients who:

• a. Have difficulty swallowing (dysphagia).
• b. Might be “cheeking” their medication.
• c. Need a rapid onset of action.
• d. All of the above.

Answer: d. All of the above.

18. The “depot” in a depot injection refers to:

• a. The needle used for the injection.
• b. The area in the muscle where the drug is deposited and slowly released.
• c. The pharmacy where the injection is prepared.
• d. The brand name of the drug.

Answer: b. The area in the muscle where the drug is deposited and slowly released.

19. Which of the following is NOT a common dosage form for a psychotropic medication?

• a. Oral tablet
• b. Intravenous bolus for chronic maintenance
• c. Long-acting intramuscular injection
• d. Orally disintegrating tablet

Answer: b. Intravenous bolus for chronic maintenance

20. A key consideration when switching a patient from an oral antipsychotic to its LAI equivalent is:

• a. Using the correct conversion dose and initiation schedule.
• b. Ensuring the patient is tolerant of the oral formulation first.
• c. Both a and b.
• d. Neither a nor b.

Answer: c. Both a and b.

21. A patient complains that their extended-release capsule is appearing in their stool. The pharmacist should explain that:

• a. The medication is not working.
• b. This is a medical emergency.
• c. This is a normal occurrence known as a “ghost tablet,” and the medication has been properly absorbed.
• d. They should crush the capsules from now on.

Answer: c. This is a normal occurrence known as a “ghost tablet,” and the medication has been properly absorbed.

22. An intranasal spray formulation for a psychotropic drug would offer what potential advantage?

• a. A long duration of action.
• b. A very rapid onset of action due to absorption through the nasal mucosa.
• c. Lower cost.
• d. No side effects.

Answer: b. A very rapid onset of action due to absorption through the nasal mucosa.

23. The choice of dosage form can significantly impact a patient’s adherence.

• a. True
• b. False

Answer: a. True

24. A pharmacist must be knowledgeable about how to properly reconstitute and administer LAI formulations.

• a. True
• b. False

Answer: a. True

25. The ultimate reason for developing different dosage formulations of psychotropic drugs is to:

• a. Make the medications more expensive.
• b. Meet the diverse clinical needs of patients and improve treatment outcomes.
• c. Make the drugs more difficult to administer.
• d. Comply with a marketing request.

Answer: b. Meet the diverse clinical needs of patients and improve treatment outcomes.

26. A transdermal patch delivery system for a psychotropic drug (e.g., methylphenidate or selegiline) provides:

• a. Rapid, pulsatile drug delivery.
• b. Localized effect on the skin only.
• c. Continuous, systemic drug delivery over a prolonged period.
• d. A way to avoid all side effects.

Answer: c. Continuous, systemic drug delivery over a prolonged period.

27. What is a key counseling point for any transdermal patch?

• a. Apply it to the same spot every time.
• b. Cut the patch to adjust the dose.
• c. Rotate the application site to avoid skin irritation.
• d. Apply a heating pad over the patch to increase absorption.

Answer: c. Rotate the application site to avoid skin irritation.

28. An orally dissolving film (e.g., Suboxone) is a dosage form designed to:

• a. Be swallowed whole.
• b. Be applied to the skin.
• c. Dissolve on or under the tongue for transmucosal absorption.
• d. Be injected.

Answer: c. Dissolve on or under the tongue for transmucosal absorption.

29. The term “pharmacokinetics” refers to what the body does to the drug. A drug’s dosage form is a primary determinant of its pharmacokinetic profile.

• a. True
• b. False

Answer: a. True

30. A key advantage of an LAI is that it:

• a. Ensures the patient receives the medication for the duration of the injection interval.
• b. Is easy for patients to self-administer.
• c. Is painless.
• d. Works immediately.

Answer: a. Ensures the patient receives the medication for the duration of the injection interval.

31. The development of different dosage forms is a key topic in which field of study?

• a. Pharmaceutics and Drug Delivery
• b. Pharmacogenomics
• c. Medicinal Chemistry
• d. Toxicology

Answer: a. Pharmaceutics and Drug Delivery

32. A patient with severe nausea may benefit from which formulation of an antiemetic?

• a. A large oral tablet.
• b. An orally disintegrating tablet or a rectal suppository.
• c. An oral solution with a bad taste.
• d. A chewable tablet.

Answer: b. An orally disintegrating tablet or a rectal suppository.

33. The technology behind long-acting injectables often involves creating a “depot” in the muscle using:

• a. An oily vehicle.
• b. A polymer microsphere system.
• c. A drug crystal suspension.
• d. All of the above are possible technologies.

Answer: d. All of the above are possible technologies.

34. The pharmacist’s role includes identifying patients who might benefit from a change in dosage formulation.

• a. True
• b. False

Answer: a. True

35. A “sprinkle” capsule formulation is designed to:

• a. Be swallowed whole only.
• b. Be opened so the contents can be sprinkled on soft food for patients with dysphagia.
• c. Be dissolved in a carbonated beverage.
• d. Be used as a topical powder.

Answer: b. Be opened so the contents can be sprinkled on soft food for patients with dysphagia.

36. Why is adherence particularly critical for LAIs?

• a. If a patient misses their scheduled injection, they will be without medication for an extended period.
• b. The injections are very expensive.
• c. The injection site reactions are severe.
• d. It is not critical.

Answer: a. If a patient misses their scheduled injection, they will be without medication for an extended period.

37. Which of the following is NOT an advantage of an ODT?

• a. Useful for patients with difficulty swallowing.
• b. Rapid onset of action.
• c. Prevents “cheeking.”
• d. Provides a month-long duration of action.

Answer: d. Provides a month-long duration of action.

38. The choice of dosage form can be a key part of “patient-centered care.”

• a. True
• b. False

Answer: a. True

39. A key consideration for any long-acting formulation is:

• a. If an adverse effect occurs, the drug cannot be easily removed from the body.
• b. It is easy to stop the therapy immediately.
• c. It has a faster onset of action.
• d. It is always cheaper than the immediate-release form.

Answer: a. If an adverse effect occurs, the drug cannot be easily removed from the body.

40. A pharmacist’s knowledge of dosage forms is critical for preventing medication errors.

• a. True
• b. False

Answer: a. True

41. An example of a medication error related to dosage form would be:

• a. A nurse crushing an extended-release tablet to administer through a feeding tube.
• b. A patient swallowing a sublingual tablet.
• c. A patient cutting a transdermal patch in half.
• d. All of the above.

Answer: d. All of the above.

42. The pharmacokinetic profile of an LAI is characterized by:

• a. A high initial peak followed by a rapid decline.
• b. A slow rise to a steady-state concentration which is then maintained for a prolonged period.
• c. Immediate absorption and elimination.
• d. A flat line with no absorption.

Answer: b. A slow rise to a steady-state concentration which is then maintained for a prolonged period.

43. A patient who has trouble remembering to take a daily pill might be a good candidate for which formulation?

• a. An ODT
• b. A short-acting injection
• c. An oral solution
• d. A long-acting injection

Answer: d. A long-acting injection

44. A pharmacist’s role in counseling on a psychotropic medication must include instructions on:

• a. The specific dosage form and how to use it correctly.
• b. The mechanism of action in detail.
• c. The cost of manufacturing.
• d. The chemical structure.

Answer: a. The specific dosage form and how to use it correctly.

45. Which of the following is NOT a primary reason for developing different formulations?

• a. To improve adherence.
• b. To alter the pharmacokinetic profile.
• c. To meet the needs of special patient populations (e.g., pediatrics, dysphagia).
• d. To make the drug more difficult for pharmacists to dispense.

Answer: d. To make the drug more difficult for pharmacists to dispense.

46. A “loading dose” strategy is often required when initiating an LAI to:

• a. Prevent side effects.
• b. Reach therapeutic concentrations more quickly.
• c. Make the injection less painful.
• d. Test for an allergic reaction.

Answer: b. Reach therapeutic concentrations more quickly.

47. The selection of an appropriate needle size is a critical part of administering an LAI.

• a. True
• b. False

Answer: a. True

48. An extended-release tablet uses technology to:

• a. Speed up the dissolution of the drug.
• b. Control the rate at which the drug is released from the tablet over time.
• c. Make the tablet taste better.
• d. Increase the size of the drug molecule.

Answer: b. Control the rate at which the drug is released from the tablet over time.

49. The overall goal of creating new dosage formulations is to:

• a. Improve the therapeutic utility and safety profile of a drug.
• b. Make more money for the manufacturer.
• c. Complicate the work of a pharmacist.
• d. Use more excipients.

Answer: a. Improve the therapeutic utility and safety profile of a drug.

50. The ultimate reason for a pharmacist to master the knowledge of different dosage formulations is to:

• a. Ensure that each patient receives their medication in the form that is safest, most effective, and most appropriate for their individual needs.
• b. Pass the pharmaceutics exam.
• c. Be able to compound any formulation.
• d. Impress physicians with their knowledge.

Answer: a. Ensure that each patient receives their medication in the form that is safest, most effective, and most appropriate for their individual needs.