Lecture 5 Concepts (Antipsychotics)

Which cluster of manifestations defines psychoses? A. Schizophrenia; delusions, sensory hallucinations, and dysphoria B. Preserved reality testing with severe ANS symptoms like sweating and panic C. Generalized anxiety disorder and isolated panic attacks without cognitive disruption D. Mild dysthymia accompanied by peripheral neuropathic pain

A. Schizophrenia; delusions, sensory hallucinations, and dysphoria

What distinguishes neuroses from psychoses? A. Complete loss of reality testing with prominent auditory hallucinations B. In touch with reality but has a lot of ANS issues like sweating, panic, and dysphoria C. Organic brain damage localized exclusively to the motor cortex D. Primary generalized tonic-clonic seizure activity

B. In touch with reality but has a lot of ANS issues like sweating, panic, and dysphoria

Which clinical conditions are categorized under neuroses secondary to ANS dysfunction? A. Treatment-resistant schizophrenia and catatonia B. Anxiety disorders, Mood, and panic disorders caused by ANS dysfunctions C. Idiopathic Parkinson's disease and Lewy body dementia D. Bipolar I disorder with acute mania and psychosis

B. Anxiety disorders, Mood, and panic disorders caused by ANS dysfunctions

In schizophrenia, delusions and sensory hallucinations are classified as: A. Negative symptoms B. Cognitive deficits C. Autonomic symptoms D. Positive symptoms

D. Positive symptoms

Which symptoms serve as classic examples of negative symptoms in schizophrenia? A. Auditory hallucinations and persecutory delusions B. Pressured speech and grandiose ideas C. Flat affect, lack of pleasure in daily activities, withdrawal D. Akathisia and acute dystonic reactions

C. Flat affect, lack of pleasure in daily activities, withdrawal

Which constellation of symptoms characterizes the manic phase of bipolar disorder? A. Apathy, psychomotor slowing, and hypersomnia B. Euphoria, distractibility, irritability, and grandiosity C. Flat affect, anhedonia, and social withdrawal D. Visual hallucinations, catatonia, and mutism

B. Euphoria, distractibility, irritability, and grandiosity

What is the fundamental receptor target blocked by typical antipsychotics? A. Serotonin $5\text{-HT}_{2\text{A}}$ receptors exclusively B. Muscarinic $M_1$ acetylcholine receptors C. Dopamine receptors D. Alpha-1 adrenergic receptors

C. Dopamine receptors

What dual receptor blockade defines atypical antipsychotics? A. Block histamine $H_1$ and $\text{GABA-A}$ receptors B. Block NMDA and AMPA glutamate receptors C. Block beta-adrenergic and dopamine $D_1$ receptors D. Block dopamine and serotonin receptors

D. Block dopamine and serotonin receptors

Which unique clinical role is served by Pimavanserin? A. First-line monotherapy for acute schizophrenia B. Approved exclusively for major depressive disorder C. Only used in Parkinson’s Disease Psychosis D. First-line treatment for acute status epilepticus

C. Only used in Parkinson’s Disease Psychosis

What are the genetic risk percentages for developing schizophrenia in monozygotic twins and in offspring of two affected parents, respectively? A. 46% risk in monozygotic twins and 40% chance if both parents have it B. 100% in monozygotic twins and 90% if both parents have it C. 10% in monozygotic twins and 5% if both parents have it D. 25% in monozygotic twins and 50% if both parents have it

A. 46% risk in monozygotic twins and 40% chance if both parents have it

Which non-genetic etiology or neurotransmitter system alteration can trigger schizophrenia? A. Exclusive deficiency of histamine in the systemic circulation B. Drug abuse, increased dopaminergic neurotransmission, serotonergic involvement, GABAergic interneurons, and glutamatergic involvement (NMDAR antagonists like Ketamine) C. Excess dietary sodium leading to central hyperosmolality D. Isolated loss of peripheral acetylcholine receptors

B. Drug abuse, increased dopaminergic neurotransmission, serotonergic involvement, GABAergic interneurons, and glutamatergic involvement (NMDAR antagonists like Ketamine)

Treating schizophrenia with Typical Antipsychotics involves blocking which specific dopamine receptor subtype? A. $D_1$ receptors exclusively B. $D_4$ receptors exclusively C. $D_2$ receptors D. $D_5$ receptors exclusively

C. $D_2$ receptors

What dual receptor blockade is produced when treating schizophrenia with Atypical Antipsychotics? A. Block both $D_2$ and Serotonin receptors B. Block both $D_1$ and $H_1$ receptors C. Block both $M_1$ and $\alpha_2$ receptors D. Block both NMDA and GABA receptors

A. Block both $D_2$ and Serotonin receptors

Which central dopamine pathway is directly responsible for mediating extrapyramidal symptoms (EPS)? A. Mesolimbic tract B. Mesocortical tract C. Tuberoinfundibular tract D. Nigrostriatal tract

D. Nigrostriatal tract

Overactivity within which dopamine pathway gives rise to the positive symptoms of schizophrenia? A. Mesocortical tract B. Mesolimbic tract C. Nigrostriatal tract D. Tuberoinfundibular tract

B. Mesolimbic tract

Dysfunction and hypoactivity within which dopamine pathway cause the negative symptoms of schizophrenia? A. Nigrostriatal tract B. Tuberoinfundibular tract C. Mesocortical tract D. Mesolimbic tract

C. Mesocortical tract

Which dopamine pathway regulates prolactin secretion and is responsible for drug-induced hyperprolactinemia? A. Mesolimbic tract B. Nigrostriatal tract C. Tuberoinfundibular tract D. Mesocortical tract

C. Tuberoinfundibular tract

What adverse motor spectrum can potentially be caused by all antipsychotic medications? A. Extrapyramidal symptoms (EPS) B. Irreversible peripheral demyelination C. Acute flaccid spinal paralysis D. Myasthenia gravis exacerbation

A. Extrapyramidal symptoms (EPS)

Antagonism at which specific receptor site directly triggers extrapyramidal symptoms (EPS)? A. $5\text{-HT}_{1\text{A}}$ receptor B. $D_2$ receptor C. $\alpha_2$-adrenergic receptor D. Muscarinic $M_3$ receptor

B. $D_2$ receptor

Under normal physiological conditions, what occurs when dopamine stimulates $D_2$ receptors located on the pituitary stalk? A. They stimulate the surge of luteinizing hormone B. They block the release of prolactin C. They induce massive secretion of growth hormone D. They trigger the immediate release of oxytocin

B. They block the release of prolactin

What endocrine adverse effect is shared by all $D_2$ receptor antagonists? A. Severe hypothyroidism B. Acute adrenal insufficiency C. Hyperprolactinemia D. Diabetes insipidus

C. Hyperprolactinemia

Which anatomical brain region within the nigrostriatal tract is implicated in generating extrapyramidal side effects? A. Substantia nigra B. Nucleus accumbens C. Pituitary stalk D. Prefrontal cortex

A. Substantia nigra

Which neuroanatomical structures comprise the tuberoinfundibular pathway responsible for hyperprolactinemia? A. Basal ganglia and striatum B. Amygdala and hippocampus C. Hypothalamus & Pituitary gland D. Cerebellum and pons

C. Hypothalamus & Pituitary gland

Excessive dopamine signaling in which brain structure specifically causes the POSITIVE SYMPTOMS of schizophrenia? A. Prefrontal cortex B. Substantia nigra C. Hypothalamus D. Nucleus accumbens (NAc)

D. Nucleus accumbens (NAc)

Low dopamine activity in which brain region leads to the NEGATIVE SYMPTOMS of schizophrenia? A. Prefrontal cortex B. Nucleus accumbens C. Pituitary gland D. Striatum

A. Prefrontal cortex

How does NMDAR hypofunction on GABA interneurons lead to positive symptoms like auditory hallucinations and delusions? A. Decreases dopamine in the NAc leading to motor paralysis B. High Dopamine in the NAc (nucleus accumbens) leading to POSITIVE SYMPTOMS C. Increases serotonin in the prefrontal cortex causing flat affect D. Blocks dopamine release in the pituitary causing prolactin surge

B. High Dopamine in the NAc (nucleus accumbens) leading to POSITIVE SYMPTOMS

What structural features characterize Fluphenazine Enanthate? A. 7-long carbon chain B. 10-long carbon chain C. Unbranched ring structure with zero carbons D. Sulfamated aromatic ring

A. 7-long carbon chain

What structural feature characterizes Fluphenazine Decanoate? A. 7-long carbon chain B. 10-long carbon chain C. 3-ring ester group D. Fluorinated benzisoxazole core

B. 10-long carbon chain

How does the clinical duration of action of Fluphenazine Decanoate compare to Fluphenazine Enanthate? A. Fluphenazine Decanoate has a significantly shorter duration of action B. Both have identical durations of 24 hours C. Fluphenazine Decanoate lasts longer than Fluphenazine Enanthate D. Fluphenazine Decanoate must be administered daily due to rapid clearance

C. Fluphenazine Decanoate lasts longer than Fluphenazine Enanthate

Which pair of antipsychotic agents belongs to the high-potency group? A. Chlorpromazine and Thioridazine B. Perphenazine and Loxapine C. Haloperidol, fluphenazine D. Clozapine and Quetiapine

C. Haloperidol, fluphenazine

Which pair of antipsychotic agents belongs to the mid-potency group? A. Haloperidol and Fluphenazine B. Perphenazine, loxapine C. Chlorpromazine and Thioridazine D. Olanzapine and Risperidone

B. Perphenazine, loxapine

Which agent is categorized as a low-potency typical antipsychotic? A. Haloperidol B. Fluphenazine C. Perphenazine D. Chlorpromazine

D. Chlorpromazine

How does caffeine consumption affect serum clozapine levels and side effects? A. Caffeine is metabolized by CYP1A2 and will INCREASE the levels of clozapine + SE B. Caffeine induces CYP1A2 and decreases clozapine levels C. Caffeine has zero interaction with clozapine metabolism D. Caffeine increases clozapine excretion by blocking renal reabsorption

A. Caffeine is metabolized by CYP1A2 and will INCREASE the levels of clozapine + SE

What effect does cigarette smoking have on CYP1A2 activity and clozapine blood levels? A. Inhibits CYP1A2 $\rightarrow$ INCREASES serum levels of clozapine B. Induces CYP1A2 $\rightarrow$ DECREASE serum levels of clozapine C. Has no effect on CYP1A2 or clozapine levels D. Blocks Phase II glucuronidation of clozapine

B. Induces CYP1A2 $\rightarrow$ DECREASE serum levels of clozapine

Rank the short-term weight gain and metabolic risk of these antipsychotics from highest to lowest: Clozapine, Olanzapine, Quetiapine, Loxapine, Asenapine. A. Asenapine > Loxapine > Quetiapine > Olanzapine > Clozapine B. Quetiapine > Clozapine > Olanzapine > Asenapine > Loxapine C. Clozapine > Olanzapine > Quetiapine >>>> Loxapine > Asenapine D. Loxapine > Asenapine > Clozapine > Olanzapine > Quetiapine

C. Clozapine > Olanzapine > Quetiapine >>>> Loxapine > Asenapine

Why should Olanzapine and other high-risk weight-gaining antipsychotics be avoided in diabetic patients? A. Because they cause severe hypoglycemia B. Because they cause rapid renal clearance of insulin C. Due to weight gain D. Because they cause severe ketoacidosis independent of glucose

C. Due to weight gain

Which heteroatom is contained in the Benzisoxazole ring structure? A. Oxygen (O) B. Sulfur (S) C. Phosphorus (P) D. Chlorine (Cl)

A. Oxygen (O)

Which heteroatom is contained in the Benzisothiazole ring structure? A. Oxygen (O) B. Nitrogen only (N) C. Sulfur (S) D. Fluorine (F)

C. Sulfur (S)

Rank short-term weight gain risk from highest to lowest among these SGAs: Clozapine, Olanzapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone. A. Ziprasidone > Aripiprazole > Risperidone > Quetiapine > Olanzapine > Clozapine B. Clozapine > olanzapine > quetiapine > risperidone > aripiprazole > ziprasidone C. Risperidone > Quetiapine > Olanzapine > Clozapine > Ziprasidone > Aripiprazole D. Aripiprazole > Ziprasidone > Clozapine > Olanzapine > Quetiapine > Risperidone

B. Clozapine > olanzapine > quetiapine > risperidone > aripiprazole > ziprasidone

Which pair of antipsychotics carries the lowest risk of causing Extrapyramidal Symptoms (EPS)? A. Haloperidol and Fluphenazine B. Risperidone and Paliperidone C. Quetiapine and Clozapine D. Loxapine and Perphenazine

C. Quetiapine and Clozapine

Which atypical antipsychotic possesses one of the lowest risks for hyperprolactinemia? A. Risperidone B. Paliperidone C. Haloperidol D. Aripiprazole

D. Aripiprazole

A patient presents with acute autonomic instability, panic, and sweating while maintaining intact reality testing. This condition is best categorized as a: A. Psychosis B. Neurosis C. Schizophrenic delusion D. Dystonic crisis

B. Neurosis

A patient exhibits flat affect, social withdrawal, and lack of pleasure in daily activities. These represent which category of schizophrenic manifestations? A. Positive symptoms B. Negative symptoms C. Extrapyramidal symptoms D. Autonomic neuroses

B. Negative symptoms

Blocking $D_2$ receptors in the tuberoinfundibular pathway leads to which clinical manifestation? A. Extrapyramidal symptoms B. Positive symptoms C. Negative symptoms D. Hyperprolactinemia

D. Hyperprolactinemia