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Match receptor activity to its clinical side effect:

Question 1Match receptor activity to its clinical side effect:

Alpha-1 adreneric receptor blockade     

 

Muscarinic cholinergic receptor blockade

 

Histamine H1 receptor blockade                

 

Question 2A 28-year-old man has been diagnosed with schizophrenia at age 19. He has a body mass index of 30, fasting triglycerides of 220 mg/dL, and fasting glucose of 114 mg/dL. Which of the following is most likely to worsen his metabolic profile?

 

Select one:

 

 a.Clozapine

 

b.Lurasidone

 

 c.Aripiprazole

 

 d.Ziprasidone

 

Question 3A patient on aripiprazole complains that they cannot sit still. They fidget throughout their appointment and state that they feel like they are crawling out of their skin. Assessment is consistent with akathisia.

 

Select one:

 

 a.These symptoms are likely due to undertreated psychosis.

 

 b.These symptoms may become chronic if not treated.

 

 c.These symptoms would best respond to a beta blocker.

 

d.These symptoms would best respond to a conventional antipsychotic.

 

Question 4Atypical antipsychotics, also known as second-generation antipsychotics, are referred to as atypical because:

 

Select one:

 

 a.They have the clinical profile of equal positive symptom antipsychotic actions but low extrapyramidal symptoms and less hyperprolactinemia compared to conventional antipsychotics.

 

b.They are low-potency versus high-potency.

 

 c.They are not approved for the treatment of bipolar disorder or treatment-resistant depression.

 

 d.They cause more extrapyramidal symptoms than typical antipsychotics.

 

Question 5Failure to give with about a 500 calorie meal can result in lowering oral absorption by half and inconsistent efficacy for which medication?

 

Select one:

 

 a.Ziprasidone

 

b.Risperidone

 

 c.Sertraline

 

 d.Quetiapine

 

Question 6When considering metabolic risk associated with atypical antipsychotics which of the following statements is true?

 

Select one:

 

 a.Increased appetite and weight gain are believed to be the primary cause of metabolic syndrome in patients taking atypical antipsychotics.

 

b.Patients taking atypical antipsychotics are at increased risk for diabetes and cardiovascular disease.

 

 c.If a patient does not have metabolic risk factors at the initiation of an atypical antipsychotic, they are unlikely to develop them later in treatment.

 

 d.All atypical antipsychotics are equally likely to cause metabolic syndrome.

 

Question 7When prescribing atypical antipsychotic medications, it is important to consider which of the following?

 

Select one:

 

 a.Atypical antipsychotics are unlikely to cause side effects.

 

 b.There is elevated risk of cerebrovascular events for all patient populations taking atypical antipsychotics.

 

c.Atypical antipsychotics are not approved for the treatment of geriatric dementia-related psychosis and carry increased risk of mortality in this population.

 

 d.Atypical antipsychotics do not require monitoring for tardive dyskinesia.

 

Question 8Which antipsychotic carries a risk of QTc prolongation?

 

Select one:

 

 a.Clozapine

 

 b.OIanzapine

 

 c.Ziprasidone

 

d.Perphenazine

 

Question 9Which atypical antipsychotic carries the highest risk for EPS?

 

Select one:

 

 a.Clozapine

 

 b.Olanzapine

 

 c.Risperidone

 

d.Ziprasidone

 

Question 10Which of the following antipsychotics is least likely to cause sedation?

 

Select one:

 

a.Clozapine

 

 b.Aripiprazole

 

c.Olanzapine

 

 d.Quetiapine

 

Question 11Which of the following antipsychotics is least likely to cause significant weight gain?

 

Select one:

 

 a.Clozapine

 

 b.Olanzapine

 

 c.Risperidon

 

 d.Ziprasidone

 

Question 12Which of the following is true when you consider EPS and Tardive dyskinesia as antipsychotic side effects?

 

Select one:

 

 a.Use of the AIMS test assesses for all movement disorders.

 

 b.EPS and Tardive dyskinesia are the result of dopamine blockade in the nigrostriatal pathway.

 

c.Atypical antipsychotics do not pose risk for EPS and tardive dyskinesia.

 

 d.Tardive dyskinesia is a reversible side effects.

 

Question 13Which of the following statements about long-acting injectable (LAI) antipsychotics is true?

 

Select one:

 

 a.There is strong evidence for the efficacy of LAIs in non-adherent patients.

 

 b.LAIs are often an affordable alternative for patients stable on oral antipsychotics.

 

 c.LAI antipsychotics have a short half-life and reach clinical efficacy quickly.

 

 d.Patients with a history of neuroleptic malignant syndrome should not be initiated on LAI antipsychotics.

 

Question 14Which of the following statements about metabolic syndrome is true?

 

Select one:

 

 a.Metabolic syndrome is a rare medication side effect.

 

 b.Fasting blood glucose is the most important indicator in the development of metabolic syndrome.

 

 c.Thyroid (TSH/T4) monitoring should occur at baseline and every 6 months.

 

 d.Diet and lifestyle education should be included as a strategy for reducing risk of metabolic syndrome.

 

Question 15Which of the following statements about the development of schizophrenia is true?

 

Select one:

 

a.Schizophrenia is a classically inherited illness determined by genetics.

 

b.Identical twins with genes for schizophrenia are equally likely to develop the disorder.

 

c.Stress from the environment can cause abnormal expression or abnormal silencing of normal genes which are associated with schizophrenia.

 

d.Environmental factors are not believed to contribute to the development of schizophrenia.

 

Question 16Which of the following statements best describes the mesocortical dopamine pathway?

 

Select one:

 

 a.Hyperactivity of the mesocortical dopamine pathway may account for positive symptoms of schizophrenia.

 

 b.Hypoactivity of the mesocortical dopamine pathway may play a role in aggressive or hostile symptoms of psychosis.

 

c.Hyperactivity of the mesocortical dopamine pathway is attributed affective symptoms of schizophrenia.

 

 d.Hypoactivity of the mesocortical dopamine pathway is thought to be associated with negative and cognitive symptoms of schizophrenia.

 

Question 17Which of the following statements best describes the mesolimbic dopamine pathway?

 

Select one:

 

 a.Hyperactivity of the mesolimbic dopamine pathway may account for positive symptoms of schizophrenia.

 

b.Hypoactivity of the mesolimbic dopamine pathway may play a role in aggressive or hostile symptoms of psychosis.

 

 c.Amphetamine and cocaine inhibition of the mesolimbic dopamine pathway is attributed to the stimulant effects of these drugs.

 

 d.Hyperactivity of the mesolimbic dopamine pathway is attributed affective symptoms of schizophrenia.

 

Question 18Which of the following statements best describes the nigrostriatal dopamine pathway?

 

Select one:

 

 a.The nigrostriatal dopamine pathway is dysregulated in schizophrenia.

 

 b.Hyperactivity of D2 receptors in the nigrostriatal dopamine pathway is associated with Parkinson’s disease.

 

c.Chronic blockade of D2 receptors in the nigrostriatal dopamine pathway may result in tardive dyskinesia.

 

 d.Movement disorders attributed to the nigrostriatal dopamine pathway are best treated with antipsychotic medications.

 

Question 19Which of the following statements best describes the tuberoinfundibular dopamine pathway?

 

Select one:

 

 a.When functioning properly, neurons in this pathway cause prolactin release.

 

b.Neuronal functioning in the tuberoinfundibular pathway is altered in schizophrenia.

 

 c.Inhibition of dopamineric neurons in the tuberoinfundibullar pathway leads to increased prolactin levels.

 

 d.Antipsychotic drugs increase dopamine activity in the nigrostriatal dopamine pathway.

 

Question 20Which of the following statements is true about adverse antipsychotic side effects?

 

Select one:

 

 a.Parkinsonism is considered a psychiatric emergency.

 

 b.Neuroleptic malignant syndrome could be mistaken for another side effect early in its progression.

 

c.Akathisia could become chronic if left untreated.

 

 d.Acute dystonia is a relatively mild side effect and likely to resolve on its own.

 

Question 21Which of the following statements is true about conventional antipsychotics?

 

Select one:

 

 a.Conventional antipsychotics are thought to block dopamine at the D2 receptor equally in dopamine neural circuits.

 

 b.Dopamine blockade in the mesolimbic dopamine pathway results in improved affect and motivation.

 

 c.The percent of D2 receptor blockade to achieve antipsychotic effect is significantly smaller than the percent of D2 receptor blockade at which adverse extrapyramidal side effects become apparent.

 

d.Conventional antipsychotics are considered first line treatment for psychosis.

 

Question 22Which of the following statements is true about dopamine?

 

Select one:

 

a.Tyrosine is a precursor to dopamine.

 

b.The clinical effect of antipsychotic drugs is due to binding at all dopamine receptors (D1-5).

 

 c.The dopamine reuptake pump is the primary mechanism for removing dopamine from the synaptic cleft.

 

 d.Dopamine activity is independent of (not influenced by) the activity of other neurotransmitters.

 

Question 23Which of the following statements is true about tardive dyskinesia?

 

Select one:

 

 a.Tardive dyskinesia is a movement disorder characterized by tremors, slow movement, and muscle stiffness.

 

 b.Tardive dyskinesia is an acute side effect of antipsychotic medication and resolves with discontinuation of the offending medication.

 

c.Elderly patients may develop tardive dyskinesia sooner in treatment than younger patients.

 

 d.The FDA approved drug, Valbenazine, is an inexpensive treatment option for most patients.

 

Question 24Which of the following statements is true regarding cognitive symptoms of psychosis?

 

Select one:

 

 a.Cognitive symptoms include blunted affect, stereotyped thinking, and anhedonia.

 

 b.Cognitive symptoms are the strongest correlate of real-world functioning in schizophrenia.

 

 c.Cognitive symptoms are due to a blockage of dopamine in the prefrontal cortex.

 

d.Cognitive symptoms often improve when treated with conventional antipsychotics.

 

Question 25Which of the following statements is true when switching antipsychotics?

 

Select one:

 

 a.If a patient improves before cross taper is complete, it is best to hold the taper and continue the patient on two antipsychotics.

 

 b.For antipsychotics with high anticholinergic, antihistaminergic and anti-alpha1 adrenergic side effects, it is best to taper slowly to minimize withdrawal effects.

 

c.When switching to aripiprazole, it is best to start with a low dose and titrate dose up slowly.

 

 d.When switching from clozapine, clozapine can be stopped abruptly.

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