[PCOL] 6.1 CNS (Antipsychotics, Antidepressants & Bipolar Disorder)

Which of the following is an excitatory neurotransmitter for the CNS?

A. GABA

B. Glycine

C. Dopamine

D. Norepinephrine

D. Norepinephrine

Explanation: The excitatory neurotransmitters listed for the CNS are Norepinephrine (NE), 5-HT (Serotonin), Acetylcholine (Ach), and Glutamate. GABA and Glycine are inhibitory, while Dopamine has both excitatory and inhibitory actions.

Which of the following is an inhibitory neurotransmitter for the CNS?

A. 5-HT

B. Acetylcholine

C. GABA

D. Glutamate

C. GABA

Explanation: The inhibitory neurotransmitters listed for the CNS are GABA and Glycine. 5-HT, Acetylcholine, and Glutamate are listed as excitatory.

Which neurotransmitter is listed as having both excitatory and inhibitory effects in the CNS?

A. Glutamate

B. Acetylcholine

C. Dopamine

D. Norepinephrine

C. Dopamine

Explanation: Dopamine is explicitly listed as a neurotransmitter that has both excitatory and inhibitory actions in the CNS.

Which process leads to an increase in the effect of a neurotransmitter?

A. Receptor blocker

B. Metabolism by COMT

C. Reuptake inside storage vesicle

D. MAO inhibitor

D. MAO inhibitor

Explanation: Monoamine Oxidase (MAO) is an enzyme responsible for the metabolism (breakdown) of certain neurotransmitters. An MAO inhibitor blocks this breakdown, leading to an increased concentration and prolonged effect of the neurotransmitter. Reuptake, diffusion, and metabolism terminate or decrease the NT effect, and a receptor blocker decreases the NT effect.

What effect does a neurotransmitter reuptake inhibitor have on the level of the neurotransmitter?

A. Decreases the neurotransmitter level

B. Increases the neurotransmitter level

C. Has no effect on the neurotransmitter level

D. Metabolizes the neurotransmitter

B. Increases the neurotransmitter level

Explanation: Reuptake is a mechanism for the termination of neurotransmitter (NT) effects by bringing the NT back into the storage vesicle. A reuptake inhibitor blocks this process, leaving the NT in the synapse for a longer period, thus increasing its effective concentration.

What is the effect on the neurotransmitter activity when a receptor blocker is used?

A. Increases the neurotransmitter activity

B. Decreases the neurotransmitter activity

C. Has no effect on the neurotransmitter activity

D. Increases the neurotransmitter reuptake

B. Decreases the neurotransmitter activity

Explanation: A receptor blocker prevents the neurotransmitter from binding to its target receptor, thereby inhibiting its action and decreasing the neurotransmitter's overall effect or activity.

What is the listed effect of a Norepinephrine (NE) reuptake inhibitor?

A. Inhibitory

B. Sedative

C. Stimulatory

D. Tranquilizing

C. Stimulatory

Explanation: Norepinephrine is an excitatory neurotransmitter. Blocking its reuptake increases its concentration in the synapse, which is listed as having a stimulatory effect.

What is the listed effect of an Acetylcholine (Ach) receptor blocker?

A. Stimulatory

B. Excitatory

C. Inhibitory

D. Augmentative

C. Inhibitory

Explanation: Acetylcholine is an excitatory neurotransmitter. Blocking its receptor prevents it from exerting its excitatory action, which is listed as having an overall inhibitory effect.

Which ions are listed as major Cations associated with the PISO group?

A. Chloride, Bromide, Iodide, Sulfate

B. Phosphate, Iodide, Sulfate, Oxide

C. Potassium, Iodide, Sodium, Oxide

D. None of the above

D. None of the above

Explanation: PISO is listed as the group for major Cations, 1st. While the actual ions are not explicitly spelled out, "Cations" means positively charged ions. The list "PhI-ClO" (PhIClO) is given as 1st Anions, which are negatively charged ions. The options given in A, B, and C are incorrect based on the notes. The question is a DOC.

Which ions are listed as major Anions associated with the PhIClO group?

A. 1st

B. 2nd

C. Both 1st and 2nd

D. Neither 1st nor 2nd

A. 1st

Explanation: PhIClO is listed as the 1st group of major Anions (-).

The opening of which ion channels leads to depolarization?

A. Potassium (K) and Chloride (Cl)

B. Calcium (Ca) and Sodium (Na)

C. Chloride (Cl) and Calcium (Ca)

D. Sodium (Na) and Potassium (K)

B. Calcium (Ca) and Sodium (Na)

Explanation: Depolarization is caused by the opening of positively charged ion (+) channels, specifically Ca and Na, which leads to an influx of these positive ions into the cell. The notes use "CaNa (+)" to indicate this.

The opening of which ion channels leads to hyperpolarization?

A. Sodium (Na) and Calcium (Ca)

B. Potassium (K) and Chloride (Cl)

C. Calcium (Ca) and Chloride (Cl)

D. Sodium (Na) and Chloride (Cl)

B. Potassium (K) and Chloride (Cl)

Explanation: Hyperpolarization is caused by the opening of channels for K (leading to efflux, making the inside more negative) or Cl (leading to influx, making the inside more negative). This is indicated in the notes as "KCl (-)".

What are the chemical compounds that are transmitted via the synapse?

A. Hormones

B. Enzymes

C. Neurotransmitters

D. Lipids

C. Neurotransmitters

Explanation: Neurotransmitters are defined as the chemical compounds that are transmitted via the synapse, serving as the communication mechanism between neurons.

What is the abbreviation for an excitatory postsynaptic potential?

A. IPSP

B. COMT

C. EPSP

D. MAO

C. EPSP

Explanation: EPSP stands for Excitatory Postsynaptic Potential, which is the excitatory signal transmitted via the synapse.

Which process is listed as a passive termination of a neurotransmitter's effect?

A. Reuptake

B. Metabolism by MAO

C. Metabolism by COMT

D. Diffusion

D. Diffusion

Explanation: Diffusion (Passive) is listed as a mechanism for the termination of neurotransmitter effects, as opposed to the active processes of Reuptake and Metabolism (by COMT & MAO).

Which of the following is the precursor for 5-HT (Serotonin)?

A. Melatonin

B. Tyrosine

C. Tryptophan

D. Dopamine

C. Tryptophan

Explanation: The pathway listed is Trp→5-HT→Melatonin, indicating that Tryptophan (Trp) is the precursor to 5-HT (Serotonin).

What is the major excitatory neurotransmitter listed?

A. 5-HT

B. Acetylcholine

C. Norepinephrine

D. Glutamate

D. Glutamate

Explanation: Glutamate is specifically labeled as the "major excitatory NT" in the notes.

The activation of an ionotropic receptor leads to the opening of which channel in an EPSP?

A. Cl channel

B. K channel

C. Na channel

D. Ca channel

C. Na channel

Explanation: For EPSP, the notes state that the activation of an ionotropic receptor causes Na channel opening.

Which change in intracellular ion concentration occurs upon activation of an ionotropic receptor during EPSP?

A. Decrease in Na

B. Increase in Cl

C. Increase in Na

D. Decrease in K

C. Increase in Na

Explanation: Activation of the ionotropic receptor for EPSP leads to Na channel opening, causing an influx and thus an "Increase Na (i)" (increase in intracellular Na).

What is the result of the ion movement associated with the activation of an ionotropic receptor for EPSP?

A. Hyperpolarization

B. Repolarization

C. Stabilization

D. Depolarization

D. Depolarization

Explanation: The increase in intracellular positive Na ions resulting from the ionotropic receptor activation for EPSP leads to Depolarization, as indicated in the notes.

Which inhibitory neurotransmitter primarily acts in the spinal cord?

A. GABA

B. 5-HT

C. Glycine

D. Dopamine

C. Glycine

Explanation: Glycine is listed as the inhibitory neurotransmitter acting in the "Spinal cord," whereas GABA is primarily associated with the "Brain."

Which drug is listed as inhibiting Glycine?

A. Baclofen

B. Barbiturates

C. Strychnine

D. Benzodiazepines

C. Strychnine

Explanation: Glycine (Spinal cord) is listed as the neurotransmitter that is "inhibited by Strychnine = excitatory."

What is the listed effect when Glycine is inhibited by Strychnine?

A. Inhibitory

B. Sedative

C. Excitatory

D. Tranquilizing

C. Excitatory

Explanation: The notes explicitly state that Glycine (an inhibitory NT) is "inhibited by Strychnine = excitatory."

The activation of an ionotropic receptor leads to the opening of which channel in an IPSP?

A. Na channel

B. K channel

C. Cl channel

D. Ca channel

C. Cl channel

Explanation: For IPSP, the notes state that the activation of an ionotropic receptor causes Cl channel opening.

Which change in intracellular ion concentration occurs upon activation of an ionotropic receptor during IPSP?

A. Decrease in Na

B. Increase in Cl

C. Decrease in Cl

D. Increase in Na

B. Increase in Cl

Explanation: Activation of the ionotropic receptor for IPSP leads to Cl channel opening, causing an influx and thus an "Increase Cl" (increase in intracellular Cl).

What is the result of the ion movement associated with the activation of an ionotropic receptor for IPSP?

A. Repolarization

B. Depolarization

C. Hyperpolarization

D. Stabilization

C. Hyperpolarization

Explanation: The increase in intracellular negative Cl ions resulting from the ionotropic receptor activation for IPSP leads to Hyperpolarization, as indicated in the notes.

Which GABA receptor is associated with Cl channel opening in the brain and is a target for BZDs and Barbiturates?

A. GABA-B

B. GABA-C

C. GABA-A

D. GABA-D

C. GABA-A

Explanation: The notes specify that "GABA-A: BZDs, Barbs; Cl ch opening; brain" is a type of GABA receptor.

Which drug is listed as an activator of the GABA-B receptor?

A. Benzodiazepines (BZDs)

B. Barbiturates (Barbs)

C. Strychnine

D. Baclofen

D. Baclofen

Explanation: The notes list "GABA-B: Baclofen" as an association with this receptor type.

The activation of the GABA-B receptor is associated with the opening of which ion channel?

A. Na channel

B. K channel

C. Cl channel

D. Ca channel

B. K channel

Explanation: The notes state that GABA-B is associated with "K ch opening," as well as Ca ch closing.

The activation of the GABA-B receptor is associated with the closing of which ion channel?

A. Na channel

B. K channel

C. Cl channel

D. Ca channel

D. Ca channel

Explanation: The notes state that GABA-B is associated with "Ca ch closing," as well as K ch opening.

The GABA-B receptor primarily acts in which location?

A. Brain

B. Spinal cord

C. GIT

D. Renal

B. Spinal cord

Explanation: The notes associate GABA-B with the "spinal cord," while GABA-A is associated with the "brain."

What is the major neurotransmitter listed in the "BOTH" category?

A. Norepinephrine

B. Acetylcholine

C. Glutamate

D. Dopamine

D. Dopamine

Explanation: Dopamine (D2) is explicitly labeled as the "major NT" in the section for neurotransmitters with both excitatory and inhibitory effects (BOTH).

Activation of the D1 Dopamine receptor causes what effect on renal and splanchnic blood vessels?

A. Vasoconstriction

B. Vasodilation

C. Increased permeability

D. Decreased flow

B. Vasodilation

Explanation: The notes state that D1 acts on "renal and splanchnic BV → vasodilation."

Activation of the D2 Dopamine receptor in the GIT causes what effect?

A. Constipation and contraction

B. Ileus and relaxation

C. Increased peristalsis

D. Diarrhea and contraction

B. Ileus and relaxation

Explanation: The notes state that D2 acts on "GIT → ileus and relaxation."

Which ion moves out of the cell, leading to an inhibitory effect?

A. Na

B. Ca

C. K

D. Cl

C. K

Explanation: The "CHANNEL (OPEN)" table shows that when K channels open, there is a ↓K (decrease in intracellular K), and is listed as inhibitory (K leaves the cell, making the inside more negative).

Which ion moves into the cell, resulting in a positive cell charge and an excitatory effect?

A. Cl

B. K

C. Na

D. H

C. Na

Explanation: The "CHANNEL (OPEN)" table shows that Na channel opening leads to "↑Na" (increase in intracellular Na), a positive cell charge (+), and is listed as "Excitatory."

A decrease in intracellular K results in what charge inside the cell?

A. Positive

B. Negative

C. Neutral

D. Fluctuating

B. Negative

Explanation: The "CHANNEL (OPEN)" table shows that ↓K corresponds to a negative cell charge (-), as the loss of positive charge makes the inside of the cell more negative.

What general term describes the breakdown of personality?

A. Affective disorder

B. Schizophrenia

C. Psychosis

D. Neuroleptic

C. Psychosis

Explanation: Psychosis is the general term encompassing conditions that involve a breakdown of personality, which is one of the general concepts introduced in the notes for the chapter.

Which neurotransmitters are associated with an increase in activity in Schizophrenia?

A. Dopamine, Acetylcholine, GABA

B. Serotonin, Glycine, Dopamine

C. Dopamine, 5-HT, Glutamate

D. Norepinephrine, GABA, Glutamate

C. Dopamine, 5-HT, Glutamate

Explanation: Schizophrenia is specifically linked to an increase in Dopamine (↑DA), an increase in 5-HT (↑5-HT), and an increase in Glutamate (↑Glutamate).

Which of the following is considered a positive symptom of Schizophrenia?

A. Alogia

B. Anhedonia

C. Delusions

D. Avolition

C. Delusions

Explanation: Delusions (false beliefs), hallucinations, disorganized thought/speech, and bizarre behavior are listed as the more obvious symptoms, categorized as positive symptoms.

What is the definition of delusions?

A. Perception-like experiences without external stimulus

B. Low verbal output

C. Inability to feel pleasure

D. False belief

D. False belief

Explanation: Delusions are explicitly defined as "false belief" in the notes.

Hallucinations in Schizophrenia are most commonly of which type?

A. Visual

B. Auditory

C. Tactile

D. Olfactory

B. Auditory

Explanation: Hallucinations are listed with the specific context of "(auditory)" as the most common type.

A fixed, false belief that one is being harassed, tracked, or poisoned is an example of which type of delusion?

A. Grandiose

B. Referential

C. Persecutory

D. Erotomania

C. Persecutory

Explanation: Persecutory and paranoia are listed as types of delusions, referring to the belief of being persecuted.

What is the negative symptom defined as low verbal output?

A. Anhedonia

B. Alogia

C. Avolition

D. Associality

B. Alogia

Explanation: Alogia is defined as "low verbal output" in the list of negative symptoms.

What is the inability to feel pleasure called, a negative symptom of Schizophrenia?

A. Alogia

B. Avolition

C. Anhedonia

D. Associality

C. Anhedonia

Explanation: Anhedonia is defined as the "inability to feel pleasure" or "unable to feel pleasure" in the notes.

What is the negative symptom characterized by a lack of motivation or drive?

A. Flattening of affect

B. Associality

C. Anhedonia

D. Avolition

D. Avolition

Explanation: Avolition is defined as "lack of drive" or "lack of motivation / drive."

Which negative symptom is characterized by a monotonous voice or a single facial expression?

A. Associality

B. Alogia

C. Flattening of affect

D. Anhedonia

C. Flattening of affect

Explanation: Flattening of affect is defined as "monotonous voice, single facial expression" or "monotonous voice / one facial expression."

Antipsychotics are also known by which two other general names?

A. Major Depressants and Tranquilizers

B. Neuroleptics and Major Tranquilizers

C. Minor Tranquilizers and Antidepressants

D. Stimulants and Neuroleptics

B. Neuroleptics and Major Tranquilizers

Explanation: The notes provide the general term for the drug class as "ANTIPSYCHOTICS / NEUROLEPTICS / MAJOR TRANQUILIZERS."

What is the primary goal of treatment for Schizophrenia?

A. Increase Dopamine, 5-HT, and Glutamate

B. Decrease Acetylcholine and increase GABA

C. Decrease Dopamine, 5-HT, and Glutamate

D. Increase only 5-HT and Dopamine

C. Decrease Dopamine, 5-HT, and Glutamate

Explanation: The goal of therapy is to counteract the pathophysiological increase, stating "Goal: Decrease Dopa, 5-HT, Glutamate."

What is the main mechanism of action (MOA) of 1st Generation (Typical) Antipsychotics?

A. Increase Dopamine synthesis

B. Block 5-HT2 receptors

C. Inhibit D2 receptors

D. Block muscarinic receptors

C. Inhibit D2 receptors

Explanation: The primary MOA for 1st Gen. Antipsychotics is listed as "Inhibit D2 receptors" or "D2 blockade - major." This addresses the "DA Theory."

What is the common term used for the additional blocking effects of 1st Generation Antipsychotics?

A. Anti-AChE

B. Anti-HAM

C. Anti-GABA

D. Anti-NMDA

B. Anti-HAM

Explanation: The additional, minor blocking effects are collectively referred to as Anti-HAM, standing for H1 (Histamine), A1 (Alpha-1), and M1/M3 (Muscarinic) receptors.

Blocking the Histamine (H1) receptor by 1st Gen Antipsychotics causes which side effect?

A. Orthostatic hypotension

B. Urinary retention

C. Sedation

D. Extrapyramidal symptoms

C. Sedation

Explanation: The notes link H1 (Histamine) blockade to the side effect of "sedation."

The blocking of which receptor leads to vasodilation and orthostatic hypotension?

A. H1

B. Muscarinic (M1,M3)

C. D2

D. Alpha (α1)

D. Alpha (α1)

Explanation: The notes associate Alpha (α1) blockade with "vasodilation → decrease BP; orthostatic hypotension."

The Muscarinic (M1,M3) receptor blockade by 1st Gen Antipsychotics is associated with what type of effects?

A. Atropine-like effects

B. EPS

C. Hyperprolactinemia

D. Sedative effects

A. Atropine-like effects

Explanation: M1,M3 blockade is linked to "atropine-like effects" (e.g., urinary retention).

Which structural group of 1st Gen Antipsychotics has the highest potency based on the listed ranking?

A. Piperidines

B. Aliphatic

C. Butyrophenone

D. Thioxanthene

C. Butyrophenone

Explanation: The potency ranking is given as: "butyrophenone = piperazine > piperidines > thioxanthene > aliphatic," making Butyrophenone (equal to Piperazine) the highest.

Which relationship defines the potency of 1st Gen Antipsychotics?

A. Potency = D2 receptors / Alpha-1 receptors

B. Potency = Histamine receptors / Muscarinic receptors

C. Potency = D2 receptors / HAM receptors

D. Potency = EPS / Antipsychotic effect

C. Potency = D2 receptors / HAM receptors

Explanation: The notes explicitly state "Potency = D2 receptors / HaM receptors."

A higher potency 1st Gen Antipsychotic has a higher affinity for which receptor?

A. H1

B. D2

C. Muscarinic

D. α1

B. D2

Explanation: Higher potency is defined as "↑ affinity to D2," resulting in ↑D2 affinity and ↓HAM affinity.

Higher D2 receptor affinity in 1st Gen Antipsychotics increases the risk of which adverse effect?

A. Orthostatic hypotension

B. Sedation

C. Extrapyramidal symptoms (EPS)

D. Urinary retention

C. Extrapyramidal symptoms (EPS)

Explanation: Higher potency (and thus ↑D2 affinity) is linked to "↑AE related to D2 antagonism" or "↑D2 affinity = EPS, hyperprolactinemia."

Increased side effects related to H1, α1, and muscarinic antagonism are associated with which characteristic of 1st Gen Antipsychotics?

A. Higher potency

B. Lower potency

C. Higher D2 affinity

D. Lower HAM affinity

B. Lower potency

Explanation: Lower potency is associated with "↑ affinity to Hist., α1, muscarinic" and results in "↑AE related to HaM."

Which Phenothiazine derivative is an Aliphatic type?

A. Fluphenazine

B. Thioridazine

C. Chlorpromazine

D. Prochlorperazine

C. Chlorpromazine

Explanation: Chlorpromazine is listed as the example for "Aliphatic: Chlorpromazine" and "Aliphatic (-promazine)."

Which Phenothiazine derivative is a Piperidine type?

A. Fluphenazine

B. Haloperidol

C. Thiothixene

D. Thioridazine

D. Thioridazine

Explanation: Thioridazine is listed as the example for "Piperidines: Thioridazine" and is a (-ridazine) type.

The Phenothiazine derivative Thioridazine can cause which serious adverse effect?

A. Corneal deposits

B. Blindness

C. Nausea/Vomiting

D. Hyperprolactinemia

B. Blindness

Explanation: Thioridazine (ThioRETINA) is listed as causing "retinal deposits" and can "cause blindness."

Which Phenothiazine derivative is a Piperazine type?

A. Chlorpromazine

B. Thioridazine

C. Fluphenazine

D. Droperidol

C. Fluphenazine

Explanation: Fluphenazine is listed as an example of Piperazines, which are also called (-phenazine) type.

Which Piperazine is specifically indicated for the treatment of nausea and vomiting (n/v)?

A. Fluphenazine

B. Prochlorperazine

C. Chlorpromazine

D. Thiothixene

B. Prochlorperazine

Explanation: Prochlorperazine is specifically listed under Piperazines as "Prochlorperazine - tx n/v."

Which adverse effect is uniquely associated with the Aliphatic Phenothiazine Chlorpromazine?

A. Retinal deposits

B. Corneal deposits

C. Blindness

D. Ileus

B. Corneal deposits

Explanation: Chlorpromazine is listed as causing "corneal deposits" but "Doesn't cause blindness."

Haloperidol is a drug belonging to which structural class of 1st Gen Antipsychotics?

A. Phenothiazine (Aliphatic)

B. Phenothiazine (Piperazine)

C. Butyrophenone

D. Thioxanthene

C. Butyrophenone

Explanation: Haloperidol and Droperidol are listed under "BUTYROPHENONE" and are a (-peridol) type.

Thiothixene is a drug belonging to which structural class of 1st Gen Antipsychotics?

A. Butyrophenone

B. Piperidine

C. Thioxanthenes

D. Aliphatic

C. Thioxanthenes

Explanation: Thiothixene is listed under "THIOXANTHENES" and is a (-thix-) type.

D2 receptor blockade in the Mesolimbic System is responsible for which antipsychotic effect?

A. Extrapyramidal symptoms (EPS)

B. Hyperprolactinemia

C. Treatment of negative symptoms

D. Treatment of positive symptoms

D. Treatment of positive symptoms

Explanation: The notes state: "Mesolimbic System → Antipsychotic → (+) Sx," meaning D2 blockade in this pathway treats positive symptoms.

D2 receptor blockade in the Tuberoinfundibular System leads to which specific adverse effect?

A. Extrapyramidal symptoms (EPS)

B. Orthostatic hypotension

C. Hyperprolactinemia

D. Sedation

C. Hyperprolactinemia

Explanation: The notes state: "Tuberoinfundibular System (Prolactin) → ↓ DA → ↑ PRL release (hyperprolactinemia)."

D2 receptor blockade in the Nigro-Striatal System is responsible for which side effect?

A. Hyperprolactinemia

B. Extrapyramidal symptoms (EPS)

C. Antipsychotic effect

D. Sedation

B. Extrapyramidal symptoms (EPS)

Explanation: The notes state: "Nigro-Striatal System → EPS," which is the neurological pathway associated with motor side effects.

What is the primary mechanism of action (MOA) of 2nd Generation (Atypical) Antipsychotics that distinguishes them from 1st Generation agents?

A. Inhibition of D2 receptors

B. Inhibition of D4 and 5-HT2A receptors

C. Inhibition of H1 and muscarinic receptors

D. Inhibition of MAO enzyme

B. Inhibition of D4 and 5-HT2A receptors

Explanation: The MOA of 2nd Generation (Atypical) Antipsychotics is primarily characterized by the blockade of both the Dopamine D4 receptor and the Serotonin 5-HT2A receptor (often with greater potency than D2 blockade), which is often referred to as the 5-HT Theory. This dual-action is thought to be responsible for their improved side-effect profile, particularly the lower incidence of Extrapyramidal Symptoms (EPS).

Blocking the D4 receptor, a key mechanism of Atypical Antipsychotics, results in which clinical advantage compared to Typical Antipsychotics?

A. Increased D2 affinity

B. Lower risk of suicidality

C. Less Extrapyramidal Symptoms (EPS)

D. Lower risk of weight gain

C. Less Extrapyramidal Symptoms (EPS)

Explanation: The notes explicitly state that the inhibition of the D4 receptor leads to "Less EPS." D2 antagonism in the nigrostriatal pathway causes EPS, and D4 antagonism avoids this pathway, giving Atypical Antipsychotics their advantage of low EPS effects.

In the treatment of positive symptoms of Schizophrenia, how does the efficacy of 2nd Generation Antipsychotics compare to 1st Generation Antipsychotics?

A. 2nd Gen is less effective than 1st Gen

B. 2nd Gen is more effective than 1st Gen

C. 2nd Gen is equally effective as 1st Gen

D. 2nd Gen is ineffective

C. 2nd Gen is equally effective as 1st Gen

Explanation: The notes state that the "Tx of (+) Sx: 1st Gen = 2nd Gen." This indicates that Atypical Antipsychotics are equally effective as Typical Antipsychotics in controlling positive symptoms like hallucinations and delusions.

In the treatment of negative symptoms of Schizophrenia, how does the efficacy of 2nd Generation Antipsychotics compare to 1st Generation Antipsychotics?

A. 2nd Gen is less effective than 1st Gen

B. 2nd Gen is more effective than 1st Gen

C. 2nd Gen is equally effective as 1st Gen

D. 2nd Gen is ineffective

B. 2nd Gen is more effective than 1st Gen

Explanation: The notes state that the "Tx of (-) Sx: 2nd Gen > 1st Gen." This superior efficacy in treating negative symptoms (alogia, anhedonia, etc.) is a major advantage of 2nd Generation Antipsychotics, largely attributed to their 5-HT2A receptor blockade.

Which drug is the prototype 2nd Generation Antipsychotic?

A. Olanzapine

B. Risperidone

C. Clozapine

D. Aripiprazole

C. Clozapine

Explanation: Clozapine is listed as the "Prototype 2nd gen antipsychotic." It was the first atypical antipsychotic developed and demonstrated efficacy, particularly for treatment-resistant Schizophrenia.

Clozapine is never given as a 1st line therapy due to the risk of which serious group of side effects (SAM)?

A. Sedation, Avolition, Motor impairment

B. Seizures, Agranulocytosis, Myocarditis

C. Somnolence, Arrhythmia, Memory loss

D. Syncope, Angioedema, Metabolic syndrome

B. Seizures, Agranulocytosis, Myocarditis

Explanation: The notes list "SAM (seizures, agranulocytosis, myocarditis) effects" as the reason Clozapine is not a first-line agent. Agranulocytosis (a dangerous drop in white blood cells) is the most critical risk that requires mandatory monitoring.

Which serious adverse effect associated with Clozapine requires mandatory weekly monitoring of White Blood Cells (WBC) for the first 6 months?

A. Myocarditis

B. Seizures

C. Hyperprolactinemia

D. Agranulocytosis

D. Agranulocytosis

Explanation: The risk of agranulocytosis necessitates "WBC monitoring every week for the 1st 6 months of therapy and every 3 weeks thereafter."

Clozapine has the highest risk of which neurological side effect compared to other Atypical Antipsychotics?

A. Extrapyramidal Symptoms (EPS)

B. QT Prolongation

C. Seizure

D. Akathisia

C. Seizure

Explanation: Clozapine is listed as having the "Highest risk of seizure." Paradoxically, it is also listed as causing "No EPS," highlighting its unique side-effect profile.

Which serious adverse effect is associated with Clozapine, despite having No Extrapyramidal Symptoms (EPS)?

A. QT Prolongation

B. Weight gain

C. Hyperprolactinemia

D. Myocarditis

D. Myocarditis

Explanation: Myocarditis is listed as one of the SAM effects (seizures, agranulocytosis, myocarditis), which are the serious adverse effects responsible for Clozapine's restricted use.

Olanzapine is a 2nd Generation Antipsychotic belonging to which structural class?

A. Dibenzoxazepine

B. Thienobenzodiazepine

C. Benzisoxazole

D. Dibenzothiazepine

B. Thienobenzodiazepine

Explanation: Olanzapine is listed under the "Thienobenzodiazepine" structural class.

Which 2nd Generation Antipsychotic is primarily used to induce sedation?

A. Olanzapine

B. Ziprasidone

C. Quetiapine

D. Risperidone

C. Quetiapine

Explanation: The notes state that Quetiapine is "used to induce sedation." Quetiapine belongs to the Dibenzothiazepine structural class.

Which 2nd Generation Antipsychotic is known to have a significant side effect of weight gain?

A. Quetiapine

B. Olanzapine

C. Ziprasidone

D. Aripiprazole

B. Olanzapine

Explanation: Olanzapine is specifically listed with the side effect: "S/E: Weight gain."

Which 2nd Generation Antipsychotic is listed as a first line agent and does not have muscarinic effects?

A. Olanzapine

B. Risperidone

C. Quetiapine

D. Clozapine

B. Risperidone

Explanation: Risperidone is listed as "First line" and "Does not have muscarinic effects."

The drug Risperidone belongs to which structural class?

A. Dibenzothiazepine

B. Benzisothiazol

C. Benzisoxazole

D. Piperazinyl/Quinoline

C. Benzisoxazole

Explanation: Risperidone is listed under the "Benzisoxazole" structural class, along with Paliperidone.

What is the major side effect listed for Risperidone, similar to high-potency 1st Gen Antipsychotics?

A. Weight gain

B. Sedation

C. QT Prolongation

D. Hyperprolactinemia

D. Hyperprolactinemia

Explanation: Risperidone is listed with the side effect: "S/E: Hyperprolactinemia." This effect occurs due to D2 blockade in the tuberoinfundibular pathway, leading to a decrease in DA and a subsequent increase in Prolactin (PRL) release.

Which 2nd Generation Antipsychotic is associated with the side effect of QT Prolongation?

A. Olanzapine

B. Paliperidone

C. Aripiprazole

D. Loxapine

B. Paliperidone

Explanation: Paliperidone is listed with the side effect: "S/E: QT Prolongation."

Which structural class is Loxapine categorized under?

A. Thienobenzodiazepine

B. Dibenzoxazepine

C. Benzamide

D. Dihydroindoles

B. Dibenzoxazepine

Explanation: Loxapine is listed under the "-XAPINES" section, specifically the "Dibenzoxazepine" structural class.

Which structural class is Ziprasidone categorized under?

A. Benzisothiazol

B. Dibenzodiazepine

C. Benzisoxazole

D. Diphenylbutylpiperidines

A. Benzisothiazol

Explanation: Ziprasidone is listed under the "Benzisothiazol" structural class.

Aripiprazole is categorized under which structural class?

A. Benzisothiazol

B. Benzamide

C. Piperazinyl/Quinoline

D. Dihydroindoles

C. Piperazinyl/Quinoline

Explanation: Aripiprazole is listed under the "Piperazinyl/Quinoline" structural class.

Which three Atypical Antipsychotics are listed as being "Weight neutral"?

A. Aripiprazole, Molindone, Amisulpride

B. Clozapine, Olanzapine, Quetiapine

C. Risperidone, Paliperidone, Ziprasidone

Extrapyramidal Syndrome (EPS) is a group of movement disorders caused by the effect of antipsychotics on which two neurotransmitter systems?

A. Norepinephrine and Serotonin

B. Dopamine and Acetylcholine

C. GABA and Glycine

D. Glutamate and Dopamine

B. Dopamine and Acetylcholine

Explanation: EPS is described as "Movement disorders due to cholinergic stimulation" which results from the Dopamine receptor blockade (↓DA) leading to a relative increase in Acetylcholine effects (↑ACh) in the nigrostriatal pathway.

The first line treatment for most Extrapyramidal Syndrome (EPS) symptoms are drugs belonging to which class?

A. Beta-blockers

B. Benzodiazepines

C. Centrally acting anticholinergics

D. Serotonin antagonists

C. Centrally acting anticholinergics

Explanation: The notes explicitly state that EPS is treated with "1st line tx: centrally acting anticholinergics." This class counteracts the relative excess of ACh that causes the movement disorders.

Which of the following drugs is listed as a centrally acting anticholinergic used to treat EPS?

A. Propranolol

B. Diphenhydramine

C. Benztropine

D. Diazepam

C. Benztropine

Explanation: Benztropine, Biperiden, and Trihexyphenidyl (BBT) are listed as the centrally acting anticholinergics used for EPS treatment. Scopolamine is also listed in the "BBTS" mnemonic, although it is primarily used for motion sickness.

Which form of Extrapyramidal Syndrome (EPS) is described as "Uncontrolled restlessness"?

A. Dystonia

B. Pseudoparkinsonism

C. Tardive Dyskinesia

D. Akathisia

D. Akathisia

Explanation: Akathisia is defined as "Uncontrolled restlessness."

Which specific type of Extrapyramidal Syndrome (EPS) is not treated with anticholinergics?

A. Pseudoparkinsonism

B. Dystonia

C. Akathisia

D. Tardive Dyskinesia

C. Akathisia

Explanation: Akathisia is noted as the "Only EPS that is not treated with anticholinergics."

Which two drug classes are used in the management of Akathisia?

A. BZD and β-blockers

B. Anticholinergics and D2 agonists

C. MAO inhibitors and COMT inhibitors

D. Antihistamines and D2 antagonists

A. BZD and β-blockers

Explanation: The management for Akathisia is listed as: "Mgt: BZD,β-blockers (Propranolol)."

Dystonia is also known by which two other descriptive names?

A. Tremors / Rigidity

B. Retrocollis / Torticollis

C. Akinesia / Postural instability

D. Uncontrolled restlessness / Tic-like motion

B. Retrocollis / Torticollis

Explanation: Dystonia is listed as "Aka Retrocollis / Torticollis / Twisting of Neck."

What is the first type of Extrapyramidal Syndrome (EPS) to appear during antipsychotic treatment?

A. Pseudoparkinsonism

B. Akathisia

C. Tardive Dyskinesia

D. Dystonia

D. Dystonia

Explanation: Dystonia is identified as the "1st EPS seen."

Which drug is used for the management of Dystonia and is a 1st generation antihistamine with antimuscarinic effects?

A. Benztropine

B. Diphenhydramine

C. Propranolol

D. Diazepam

B. Diphenhydramine

Explanation: Dystonia management includes "IV Diphenhydramine" which is noted as a "1st gen antihistamine" with "Antimuscarinic effects."

Pseudoparkinsonism is due to the severe depletion of which neurotransmitter?

A. Acetylcholine

B. Serotonin

C. Dopamine

D. Norepinephrine

C. Dopamine

Explanation: Pseudoparkinsonism is described as "Due to severe depletion of Dopamine."

Which of the following is a sign or symptom of Pseudoparkinsonism (TRAP)?

A. Retrocollis

B. Akathisia

C. Akinesia

D. Tic-like motion

C. Akinesia

Explanation: The symptoms of Pseudoparkinsonism are listed by the mnemonic TRAP: Tremors,Rigidity,Akinesia (limited movement), and Postural instability / imbalance.