Antipsychotic Medications Flashcards
What is the primary purpose of antipsychotic drugs?
a) Treating depression
b) Managing anxiety
c) Treating schizophrenia
d) Improving memory
c) Treating schizophrenia
What challenge is associated with the use of antipsychotic medications?
a) Development of allergies
b) Difficulty in maintaining balance between symptom relief and side effects
c) Increased risk of cardiovascular diseases
d) Enhanced cognitive abilities
b) Difficulty in maintaining balance between symptom relief and side effects
Are antipsychotic drugs curative for schizophrenia?
a) Yes, they eliminate chronic thought disorders
b) No, they only alleviate symptoms temporarily
c) Yes, they permanently cure schizophrenia
d) No, they worsen the symptoms
b) No, they only alleviate symptoms temporarily
What is one of the effects of antipsychotic drugs on individuals with schizophrenia?
a) Intensification of hallucinations and delusions
b) Decrease in psychotic symptoms
c) Increase in chronic thought disorders
d) Inability to function in a supportive environment
b) Decrease in psychotic symptoms
Schizophrenia Manifestations ?
- Delusions
- Hallucinations (usually auditory)
- Disturbances in thought.
At what stage of life does schizophrenia typically start?
a) Childhood
b) Late adolescence or early adulthood
c) Middle age
d) Elderly age
b) Late adolescence or early adulthood
Approximately what percentage of the population is affected by schizophrenia?
a) 0.1%
b) 1%
c) 5%
d) 10%
b) 1%
Which of the following best describes schizophrenia?
a) A temporary disorder
b) A curable condition
c) A chronic and disabling disorder
d) A common illness in elderly populations
c) A chronic and disabling disorder
What is believed to be a significant contributing factor to schizophrenia?
a) Environmental factors only
b) Social upbringing
c) Genetic component
d) Lifestyle choices
c) Genetic component
Which neuronal pathways are possibly dysfunctional in schizophrenia?
a) Serotonergic
b) GABAergic
c) Mesolimbic or mesocortical dopaminergic
d) Glutamatergic
c) Mesolimbic or mesocortical dopaminergic
Which generation of antipsychotic drugs includes Chlorpromazine and Haloperidol?
a) First generation
b) Second generation
c) Third generation
d) Fourth generation
a) First generation
Which generation of antipsychotic drugs is referred to as “Conventional”?
a) First generation
b) Second generation
c) Third generation
d) Fourth generation
a) First generation
Which drug belongs to the second generation (Atypical) of antipsychotic drugs?
a) Chlorpromazine
b) Haloperidol
c) Risperidone
c) Risperidone
Which generation of antipsychotic drugs includes Clozapine?
a) First generation
b) Second generation
c) Third generation
d) Fourth generation
b) Second generation
First-generation antipsychotic drugs (Conventional):
“2”
Chlorpromazine
Haloperidol
Second Generation (Atypical):
Risperidone
Lorasidone
Quetiapine
Clozapine
What is the primary mechanism of action of first-generation antipsychotic drugs?
a) Blocking serotonin receptors
b) Blocking dopamine D2 receptors
c) Enhancing GABAergic transmission
d) Inhibiting glutamatergic neurotransmission
b) Blocking dopamine D2 receptors
Which symptom is first-generation antipsychotic drugs more likely to cause, especially those binding tightly to dopaminergic receptors?
a) Hypertension
b) Extrapyramidal symptoms (EPS)
c) Respiratory depression
d) Gastrointestinal disturbances
b) Extrapyramidal symptoms (EPS)
Which first-generation antipsychotic drug is less likely to cause extrapyramidal symptoms (EPS) due to its lower potency in binding to dopaminergic receptors?
a) Chlorpromazine
b) Haloperidol
c) Risperidone
d) Lurasidone
a) Chlorpromazine
What is the conclusion regarding the clinical effectiveness of first-generation antipsychotic drugs compared to each other?
a) One drug is clinically superior to others
b) No one drug is clinically more effective than another
c) Second-generation drugs are always more effective
d) First-generation drugs are more effective than second-generation drugs
b) No one drug is clinically more effective than another
True or False?
First-generation antipsychotic drugs, especially those that bind tightly to dopaminergic receptors like haloperidol, are more likely to cause extrapyramidal symptoms (EPS).
True
True or False?
The antipsychotic effects of first-generation antipsychotic drugs primarily result from competitive blockade of dopamine D2 receptors.
True
Which of the following is a characteristic of second-generation antipsychotic drugs?
a) They primarily block dopamine D2 receptors only.
b) They have a higher incidence of extrapyramidal symptoms (EPS).
c) They are not associated with any metabolic adverse effects.
d) They block both serotonin and dopamine receptors and have a higher risk of metabolic adverse effects.
d) They block both serotonin and dopamine receptors and have a higher risk of metabolic adverse effects.
Which receptors do second-generation antipsychotic drugs primarily block?
a) Dopamine D2 receptors only
b) Serotonin receptors only
c) Both serotonin and dopamine receptors
d) GABA receptors
c) Both serotonin and dopamine receptors
Compared to first-generation antipsychotic drugs, second-generation drugs have:
a) A higher incidence of extrapyramidal symptoms (EPS)
b) A lower incidence of extrapyramidal symptoms (EPS)
c) No effect on EPS
d) Similar incidence of EPS
b) A lower incidence of extrapyramidal symptoms (EPS)
What is a potential metabolic adverse effect associated with second-generation antipsychotic drugs?
a) Hypoglycemia
b) Hypotension
c) Hypercholesterolemia
d) Bradycardia
c) Hypercholesterolemia
a higher risk of metabolic adverse effects such as diabetes, hypercholesterolemia, and weight gain.
Which of the following is NOT a metabolic adverse effect associated with second-generation antipsychotic drugs?
a) Weight gain
b) Diabetes
c) Hypertension
d) Hyperlipidemia
c) Hypertension
One of the effects of antipsychotic drugs is Blockade of alpha receptors»_space; orthostatic hypotension.
Why are second-generation agents often preferred as first-line therapy for schizophrenia?
a) They are more affordable
b) to minimize the risk of EPS associated with the first-generation.
c) They are more widely available
d) They have a higher potency
b) to minimize the risk of EPS associated with the first-generation.
What is a primary reason for using second-generation antipsychotics over first-generation ones?
a) They are more affordable
b) They have equivalent efficacy with fewer extrapyramidal symptoms (EPS)
c) They have a longer duration of action
d) They have fewer drug interactions
b) They have equivalent efficacy with fewer extrapyramidal symptoms (EPS)
How does the efficacy of second-generation antipsychotics compare to that of first-generation antipsychotics?
a) Second-generation antipsychotics are always more effective
b) First-generation antipsychotics are always more effective
c) The efficacy of both types is not equal
d) efficacy is equivalent to, and occasionally exceed the efficacy of first-generation antipsychotics
d) efficacy is equivalent to, and occasionally exceed the efficacy of first-generation antipsychotics
What guides drug selection for schizophrenia treatment?
a) Patient’s age
b) Patient’s weight
c) Individual patient response and comorbid conditions
d) Drug availability in the market
c) Individual patient response and comorbid conditions
What percentage of patients with schizophrenia are considered refractory to both first- and second-generation antipsychotics?
a) Less than 5%
b) Approximately 30%
c) Approximately 10% to 20%
d) More than 50%
c) Approximately 10% to 20%
What is a significant advantage of clozapine for refractory patients?
a) It has fewer metabolic adverse effects
b) It has a lower risk of cardiovascular side effects
c) It has a minimal risk of extrapyramidal symptoms (EPS)
d) It has a shorter duration of action
c) It has a minimal risk of extrapyramidal symptoms (EPS)
Why is the use of clozapine limited to refractory patients?
a) It is too expensive
b) It has a lower efficacy compared to other antipsychotics
c) It carries serious adverse effects
d) It is not available in most countries
c) It carries serious adverse effects
Which serious adverse effect is associated with the use of clozapine?
a) Headaches
b) Insomnia
c) Bone marrow suppression or severe agranulocytosis
d) Dry mouth and constipation
c) Bone marrow suppression or severe agranulocytosis
What should be monitored regularly in patients taking clozapine?
a) Blood sugar levels
b) Liver function tests
c) White blood cell count (WBCs)
d) Blood pressure fluctuations
c) White blood cell count (WBCs)
G.R
Use of clozapine is limited to refractory patients
because of serious adverse effects.
*Seizures
*Cardiovascular side effects, such as orthostasic hypotension
*Bone marrow suppression or Severe agranulocytosis (WBCs
should e monitored)
Which receptors are primarily targeted by first-generation antipsychotic drugs?
a) Serotonin receptors
b) Dopamine receptors
c) GABA receptors
d) NMDA receptors
b) Dopamine receptors
Which neurotransmitter is primarily affected by both first-generation and most second-generation antipsychotic drugs?
a) Serotonin
b) Dopamine
c) Acetylcholine
d) Glutamate
b) Dopamine
Which subtype of serotonin receptors is particularly inhibited by most second-generation antipsychotic drugs?
a) 5-HT1A
b) 5-HT2A
c) 5-HT3
d) 5-HT7
b) 5-HT2A
What is the main effect of blocking D2 dopamine receptors in the brain?
a) Increased dopamine release
b) Decreased dopamine release
c) Increased serotonin release
d) Decreased serotonin release
b) Decreased dopamine release
Which generation of antipsychotic drugs primarily targets both dopamine and serotonin receptors?
a) First-generation
b) Second-generation
c) Third-generation
d) Fourth-generation
b) Second-generation
Mechanism of action of Antipsychotics
- Dopamine antagonism:
All of the first-generation and most of the second-
generation antipsychotic drugs block D2 dopamine
receptors in the brain and the periphery.
- Serotonin receptor-blocking activity:
Most of the second-generation agents inhibit
serotonin receptors (5-HT), particularly 5-HT2A
receptors.
Which of the following receptors are also blocked by many antipsychotic agents, potentially contributing to undesirable adverse effects?
a) Cholinergic, adrenergic, and serotonin receptors
b) Cholinergic, adrenergic, and histamine receptors
c) Adrenergic, histamine, and dopamine receptors
d) Serotonin, histamine, and cholinergic receptors
b) Cholinergic, adrenergic, and histamine receptors
Although it is unknown if blocking cholinergic, adrenergic, and histamine receptors plays a role in treating psychosis symptoms, what is a known consequence of these actions?
a) Decreased sedation
b) Reduced risk of extrapyramidal symptoms
c) Increased risk of undesirable adverse effects
d) Improved cognitive function
c) Increased risk of undesirable adverse effects
How does food typically affect the absorption of antipsychotics from the gastrointestinal tract (GIT)?
a) Food significantly enhances absorption
b) Food slightly delays absorption
c) Food has no significant effect on absorption
d) Food decreases absorption
c) Food has no significant effect on absorption
Where are antipsychotic medications primarily metabolized?
a) Kidneys
b) Brain
c) Liver
d) Stomach
c) Liver
Which statement about the metabolites of antipsychotic drugs is true?
a) All metabolites are inactive
b) Some metabolites are inactive
c) Some metabolites are active and have been developed as pharmacological agents themselves.
d) Metabolites have no pharmacological activity
c) Some metabolites are active and have been developed as pharmacological agents themselves.
What is a notable advantage of long-acting injectable (LAI) formulations of antipsychotics?
a) They have a faster onset of action compared to oral medications
b) They have fewer adverse effects
c) They have a longer duration of action, allowing for less frequent dosing
d) They are less expensive than oral medications
c) They have a longer duration of action, allowing for less frequent dosing
Who among the following patient populations may benefit most from long-acting injectable (LAI) formulations of antipsychotics?
a) Patients with mild anxiety disorders
b) Patients with acute depressive episodes
c) Outpatients and individuals who struggle with compliance with oral medications
d) Patients with acute manic episodes
c) Outpatients and individuals who struggle with compliance with oral medications
Long-acting injectable (LAI) formulations of antipsychotics offer a therapeutic duration of action that can extend up to:
a) 1 week
b) 4 weeks
c) 6 days
d) 12 weeks
d) 12 weeks
up to 6 or even 12 weeks
Second generation antipsychotic drug limited to refractory patients because of its severe side effects like seizures , CVS side effects such as orthostatic hypotension and bone marrow suppression or severe agranulocytosis ,is
Clozapine
First generation antipsychotic drug have anti histamine effect, and may lead to sedation سندس
Chlorpromazine
Actions of Antipsychotics
• Antipsychotic effects (reduce positive ad negative
symptoms of Schizophrenia)
• Extrapyramidal effects
• Antiemetic effects
• Anticholinergic effects
• Other effects
1. Blockade of alpha receptors»_space; orthostatic hypotension.
2. Alter temperature-regulating mechanisms > poikilothermia
3. In the pituitary, they block D2 receptors»_space; increase in
prolactin release.
4. Sedation occurs with those drugs that are potent antagonists
of the H1-histamine receptor, such as chlorpromazine.
5. Sexual dysfunction.
6. Weight gain > more significant with the second-generation
agents.
Positive Symptoms of schizophrenia
• Hallucinations
• Delusions
Negative Symptoms of schizophrenia
Blunted affect
Apathy
Impaired attention
Cognitive impairment
T \ F
All antipsychotic drugs can reduce positive
symptoms by blocking D2 receptors in the
mesolimbic system of the brain.
True
Schizophrenia negative symptoms response to antipsychotics?
Not as responsive to therapy, particularly
with the first-generation antipsychotics.
Many second-generation agents, such as
clozapine, can ameliorate the negative
symptoms to some extent.
Extrapyramidal effects
• Dystonias
• Parkinson-like symptoms
• Akathisia (motor restlessness)
• Tardive dyskinesia
Which of the following is not a type of extrapyramidal effect associated with antipsychotic medications?
a) Dystonias
b) Akathisia
c) Nystagmus
d) Tardive dyskinesia
c) Nystagmus
EPS are believed to be primarily caused by:
a) Serotonin receptor blockade
b) Dopamine receptor blockade in the nigrostriatal pathway
c) Histamine receptor blockade
d) GABA receptor stimulation
b) Dopamine receptor blockade in the nigrostriatal pathway
Second-generation antipsychotics are preferred over first-generation antipsychotics primarily because:
a) They are more effective in treating positive symptoms of schizophrenia
b) They have fewer side effects, including EPS “ Extrapyramidal symptoms “
c) They are less expensive
d) They have less sedative effects
b) They have fewer side effects, including EPS
Some of the antipsychotics, such as………………,
and………………., produce anticholinergic effects. These
effects include:
• Blurred vision
• Dry mouth
• Confusion
• Constipation
• Urine retention.
chlorpromazine and clozapine
The antiemetic effects of antipsychotic medications are primarily mediated by:
a) Blocking H1 receptors in the chemoreceptor trigger zone
b) Blocking serotonin receptors in the chemoreceptor trigger zone
c) Blocking dopamine (D2) receptors in the chemoreceptor trigger zone
d) Blocking acetylcholine receptors in the chemoreceptor trigger zone
c) Blocking dopamine (D2) receptors in the chemoreceptor trigger zone
Which of the following is not typically associated with anticholinergic effects of antipsychotic medications?
a) Blurred vision
b) Dry mouth
c) Diarrhea
d) Constipation
c) Diarrhea
Anticholinergic effects of certain antipsychotics such as chlorpromazine and clozapine are may :
a) Increase the incidence of extrapyramidal symptoms (EPS)
b) Reduce the incidence of extrapyramidal symptoms (EPS)
c) Cause sedation and drowsiness
d) Lead to weight gain and metabolic changes
b) Reduce the incidence of extrapyramidal symptoms (EPS)
Therapeutic Uses of antipsychotic drugs
- Treatment of schizophrenia:
- Prevention of nausea and vomiting:
The older antipsychotics (such as chlorpromazine) is
useful in the treatment of drug-induced nausea.
Other uses:
1. As tranquilizers مهدئات to manage agitated and disruptive
behavior
2. To treat intractable hiccups (chlorpromazine)
3. To treat Irritability secondary to autism التوحد (haloperidol).
4. To treat some forms of depression.
Which statement about the treatment of schizophrenia with antipsychotics is correct?
a) Atypical antipsychotics “ 2nd generation” are more effective than first-generation antipsychotics in treating negative symptoms.
b) First-generation antipsychotics are most effective in treating negative symptoms of schizophrenia.
c) Antipsychotics are not effective in treating any symptoms of schizophrenia.
d) Antipsychotics are primarily used to treat cognitive symptoms of schizophrenia.
a) Atypical antipsychotics “ 2nd generation” are more effective than first-generation antipsychotics in treating negative symptoms.
Older antipsychotics like chlorpromazine are particularly useful in the treatment of:
a) Depression
b) Anxiety disorders
c) Drug-induced nausea and vomiting
d) Bipolar disorder
c) Drug-induced nausea and vomiting
T/F
The antipsychotics are the only efficacious
pharmacological treatment for schizophrenia.
True
Which type of antipsychotic is generally preferred for the treatment of negative symptoms of schizophrenia?
a) First-generation antipsychotics
b) Atypical antipsychotics = 2nd generation
c) Both are equally effective
d) Antipsychotics are not effective for treating negative symptoms
b) Atypical antipsychotics = 2nd generation
The mechanism by which antipsychotics alleviate symptoms of schizophrenia primarily involves:
a) Increasing dopamine release in the prefrontal cortex
b) Blocking dopamine receptors in the mesolimbic pathway
c) Enhancing serotonin signaling in the basal ganglia
d) Stimulating GABA receptors in the striatum
b) Blocking dopamine receptors in the mesolimbic pathway
Antipsychotic medications are used as tranquilizers primarily to:
a) Induce sleep
b) Manage agitated and disruptive behavior
c) Treat anxiety disorders
d) Enhance cognitive function
b) Manage agitated and disruptive behavior
Chlorpromazine is particularly effective in the treatment of:
a)epilepsy
b) Bipolar disorder
c) Generalized anxiety disorder
d) Intractable hiccups
d) Intractable hiccups
……………is utilized to treat irritability secondary to autism primarily :
a) chlorpromazine
b) haloperidole
c)clozapine
b) haloperidole
Adverse effects of antipsychotics ?
- Extrapyramidal effects:
• Dystonias
• Akathisias
• Parkinson-like symptoms of
• Bradykinesia • Rigidity • Tremors
• Tardive dyskinesia. - Tardive dyskinesia:
- Neuroleptic malignant syndrome:حصريا للعيلة هدي dr.f مهممممم
This is potentially fatal reaction to antipsychotic drugs
is characterized by:
• Muscle rigidity
• Fever
• Altered mental status and stupor
• Unstable blood pressure
• Myoglobinemia - Other adverse effects:
- Drowsiness and Confusion
- Dry mouth, Urine retention, Constipation and Loss of
visual accommodation (antimuscarinic activity) - Lowered blood pressure and Orthostatic hypotension
(blockade of alpha-adrenergic receptors) - Loss of thermoregulation
- Amenorrhea , infertility, gynecomastia, galactorrhea and
Erectile dysfunction. - Weight gain
Impaired Glucose and lipid profiles - QT prolongation.
Which of the following is not considered an extrapyramidal effect associated with antipsychotic medications?
a) Dystonias
b) Akathisia
c) Dysphoria
d) Tardive dyskinesia
c) Dysphoria
Benztropine is primarily used to minimize extrapyramidal effects by:
a) Blocking dopamine receptors
b) Enhancing GABAergic transmission
c) Inhibiting acetylcholine receptors
d) Increasing serotonin levels
c) Inhibiting acetylcholine receptors
Akathisia, a common extrapyramidal side effect, may respond best to which type of medication?
a) Anticholinergics
b) Beta blockers
c) Benzodiazepines
d) b&c
d) b&c
In extrapyramidal symptoms after using antipsychotic drugs Balance could be restored, and extrapyramidal effects minimized»_space;…………….. (anticholinergic)
……,…………may respond to ß blockers or benzodiazepines,
rather than anticholinergic.
Benztropine
Akathisia
Tardive dyskinesia: A/E of antibiotics
• Long-term dopamine receptor blockade >
dopamine receptors upregulation»_space; neuron
become supersensitive to dopamine»_space;
dopaminergic input overpower the cholinergic
input»_space; excess movement in the patient.
• Involuntary movements, including bilateral and
facial jaw movements and “fly-catching”
motions of the tongue.
• Tardive dyskinesia might be irreversible and
may persists after discontinuation of therapy.
Tardive dyskinesia is characterized by:
a) Muscle weakness and fatigue
b) Involuntary movements, including facial and jaw movements
c) Rapid eye movements during sleep
d) Excessive sweating and palpitations
b) Involuntary movements, including facial and jaw movements
The development of tardive dyskinesia is associated with:
a) Low dopamine receptor occupancy
b) Short-term use of antipsychotic medications
c) Long-term dopamine receptor blockade
d) Increased serotonin levels in the basal ganglia
c) Long-term dopamine receptor blockade
Tardive dyskinesia may persist even after discontinuation of antipsychotic therapy because:
a) The medication permanently alters dopamine receptor sensitivity
b) The medication induces irreversible damage to the basal ganglia
c) Symptoms of tardive dyskinesia are usually psychosomatic
d) It is primarily a psychological reaction to long-term medication use
a) The medication permanently alters dopamine receptor sensitivity
Tardive dyskinesia is characterized by involuntary movements, including:
a) Tremors and rigidity
b) Muscle weakness and atrophy
c) Bilateral and facial jaw movements, and “fly-catching” motions of the tongue
d) Numbness and tingling in the extremities
c) Bilateral and facial jaw movements, and “fly-catching” motions of the tongue
Neuroleptic malignant syndrome:A/E of antipsychotics
This is potentially fatal reaction to antipsychotic drugs
is characterized by:
• Muscle rigidity
• Fever
• Altered mental status and stupor
• Unstable blood pressure
• Myoglobinemia
Treatment necessitates discontinuation of the
antipsychotic agent and supportive therapy.
Administration of dantrolene or bromocriptine may
be helpful.
Neuroleptic malignant syndrome (NMS) is characterized by which of the following symptoms?
a) Muscle weakness and atrophy
b) Involuntary facial movements
c) Muscle rigidity, fever, altered mental status, unstable blood pressure, and myoglobinemia
d) Excessive sweating and palpitations
c) Muscle rigidity, fever, altered mental status, unstable blood pressure, and myoglobinemia
The treatment approach for neuroleptic malignant syndrome (NMS) primarily involves:
a) Increasing the dosage of the antipsychotic agent
b) Adding a benzodiazepine for sedation
c) Discontinuation of the antipsychotic agent and supportive therapy
d) Switching to a different antipsychotic agent
c) Discontinuation of the antipsychotic agent and supportive therapy
Administration of dantrolene or bromocriptine may
be helpful.
Which of the following medications is commonly used in the treatment of neuroleptic malignant syndrome (NMS) to reduce muscle rigidity?
a) Haloperidol
b) Lorazepam
c) Dantrolene
d) Olanzapine
c) Dantrolene
Antipsychotic medications should be used cautiously in patients with epilepsy primarily due to their potential effect on:
a) Increasing the risk of hypoglycemia
b) Lowering the seizure threshold
c) Inducing hyperactivity
d) Decreasing blood pressure
b) Lowering the seizure threshold
When prescribing antipsychotics for patients with mood disorders, clinicians should monitor them closely for:
a) Weight gain and metabolic syndrome
b) Neurological side effects such as tremors
c) Worsening of mood and suicidal ideation or behaviors
d) Development of extrapyramidal symptoms (EPS)
c) Worsening of mood and suicidal ideation or behaviors
Cautions and contraindications:
• All antipsychotics may lower the seizure threshold
and should be used cautiously in patients with
epilepsy
• They increase risk for mortality when used in elderly
patients with dementia-related behavioral
disturbances and psychosis.
• Antipsychotics used in patients with mood disorders
should also be monitored for worsening of mood
and suicidal ideation or behaviors.
