cology exam 4 practice- AP

Significant elevations in prolactin levels would least likely be produced by: a. Aripiprazole b. Fluphenazine c. Haloperidol d. Pimozide e. All of the above f. Only A, B and C are correct

a. Aripiprazole *partial D2* which allows less EPS, metabolic syndrome, and gynecomastia

Which of these agents has lower affinity for D2 dopamine receptors compared to its affinity for H1 histaminergic receptors? a. Clozapine b. Pimozide c. Fluphenazine d. Haloperidol e. All the above are correct f. None of the above are correct

a. Clozapine

Although most of the atypical antipsychotic agents have a lower incidence of causing extrapyramidal symptoms, which of the following drugs has the least risk of this side effect? a. Lurasidone b. Clozapine c. Olanzapine d. Risperidone e. All of the above drugs have a similar risk f. Both A and C have a similar low risk.

a. Lurasidone *(5HT-7 protective effect)* b- D2 is at end of the affinity list d- greater risk

Many low potency typical antipsychotic drugs block alpha-1 adrenergic receptors. The side effect(s) produced by blocking these receptors would include: a. Postural hypotension b. Weight gain c. Dry mouth d. Sedation e. All the above are correct f. Only A, B and C are correct

a. Postural hypotension dizzy, reflex tachy b- H1 (metabolic synd) c-musc d-H1

Although most of the atypical antipsychotic agents have a lower incidence of causing extrapyramidal symptoms, which of the following drugs has the most risk of this side effect? a. Risperidone b. Clozapine c. Olanzepine d. Lurasidone

a. Risperidone Risperidone and Paliperidone (worst EPS and gynecomastia)

Which of the following is/are true about antipsychotic drug therapy? a. The mechanism of action of antipsychotics is mostly unknown. b. Atypical antipsychotic agents do not cause extrapyramidal side effects. c. The side effects of antipsychotic agents can always be reversed by anticholinergic therapy. d. Most antipsychotic agents are more effective in decreasing the negative cognitive symptoms as compared to the positive symptoms of schizophrenia e. All the above are correct f. None of the above are correct

a. The mechanism of action of antipsychotics is mostly unknown.

Many low potency typical antipsychotic drugs block alpha-1 adrenergic receptors. The side effect(s) produced by blocking these receptors would include: a. Increased blood pressure b. Dizziness c. Dry mouth d. Sedation e. All the above are correct f. Only A, B and C are correct

b. Dizziness postural hypotn, reflex tachy

Some of the major clinical benefits of most of the newer atypical antipsychotics include: a. Much safer therapeutic index in elderly patients with dementia compared to haloperidol b. Reduced likelihood of developing gynecomastia compared to haloperidol. c. Decreased likelihood of weight gain compared to haloperidol d. Better clinical efficacy toward positive symptoms of schizophrenia compared to haloperidol. e. All of the choices are correct f. None of the choices are correct

b. Reduced likelihood of developing gynecomastia compared to haloperidol. a-nope c-inc risk d- no better efficacy just less SE

Antimuscarinic side effects might be expected to occur during treatment with: a. Ziprasidone b. Pimozide c. Clozapine d. Haloperidol e. All the above choices are correct f. Only A and C are correct

c. Clozapine

Which of the following is/are true about antipsychotic drug therapy? a. The side effects of antipsychotic agents are reversed by discontinuation of antipsychotic therapy in all patients. b. Atypical antipsychotic agents do not cause extrapyramidal side effects. c. Clozapine is the drug of choice for treatment-resistant psychosis. d. Most antipsychotic agents are more effective in decreasing the negative symptoms as compared to the positive symptoms of schizophrenia e. All the above are true statements f. Only A and C are true statements

c. Clozapine is the drug of choice for treatment-resistant psychosis. a-nope b-less risk d-positive symp

Antihistaminergic side effects are less likely to occur during treatment with: a. Chlorpromazine b. Thioridazine c. Haloperidol d. Clozapine e. All the above are correct f. Only A, B and C are correct

c. Haloperidol

Antipsychotic-induced tardive dyskinesia: a. Responds favorably to therapy with anticholinergic agents b. Is most common in male patients treated on a long-term basis c. Is characterized by excessive, uncontrollable limb movements d. Is due to down-regulation of D2 dopamine receptors in striatum e. All of the above choices are correct f. Both A and C are correct

c. Is characterized by excessive, uncontrollable limb movements a- makes ir *worse* b-females d-up-regulation/ *sensitization*

Some of the major clinical benefits of Ziprasidone includes: a. Reduced likelihood of developing cardiac arrhythmias compared to Thioridazine. b. Better safety in elderly patients with dementia compared to Haloperidol. c. Lower incidence of hyperprolactinemia compared to Haloperidol. d. Absence of extrapyramidal syndrome. e. All the above choices are correct f. Both A and C are correct

c. Lower incidence of hyperprolactinemia compared to Haloperidol. a- both of these have the worst QT prolongation b-MOA unknown d-can still occur just less risk

Some of the major clinical benefits of most of the newer atypical antipsychotics includes: a. Much safer therapeutic index in the elderly compared to Haloperidol. b. Reduced likelihood of developing cardiac arrhythmias compared to Chlorpromazine. c. Reduced likelihood of sedation compared to Thioridazine. d. Much better clinical efficacy toward negative symptoms of schizophrenia compared to Haloperidol. e. All the above are correct f. None of the above are correct

c. Reduced likelihood of sedation compared to Thioridazine. (huge SE of thioridazine- +++) a-nope b-inc risk d-a little better but not much

Which of the following drugs has clinically serious antagonist effects at alpha-1 receptors? a. Haloperidol b. Pimozide c. Thioridazine d. Lurasidone e. All the above are correct f. Only A and C are correct

c. Thioridazine (+++)

Antihistaminergic side effects are most likely to occur during treatment with: a. Lurasidone b. Aripiprazole c. Haloperidol d. Clozapine e. All the above choices are correct f. Only A and C are correct

d. Clozapine

Some of the major clinical benefits of most of the newer atypical antipsychotics includes: a. Much safer therapeutic index in the elderly compared to haloperidol. b. Reduced likelihood of developing cardiac arrhythmias compared to chlorpromazine. c. Reduced likelihood of sedation compared to haloperidol. d. Lower incidence of hyperprolactinemia e. All the above are correct f. Only A, B and C are correct

d. Lower incidence of hyperprolactinemia a-same for all b-inc risk of arryth c-haloperidol doesnt have much sedation (H1)

Tardive dyskinesia: a. Is due to a down-regulation of D2 receptors in caudate-putamen. b. Is decreased by concurrent therapy with L-DOPA. c. Is characterized by severe restlessness and agitation. d. May last for years after discontinuation of D2 antagonist treatment e. All of the choices are correct f. None of the choices are correct

d. May last for years after discontinuation of D2 antagonist treatment a-up reg b- more severe c- describes akathisia

Which of the following drugs has clinically significant antagonist effects at 5HT-2 receptors? a) Loxapine b) Haloperidol c) Olanzapine d) Ziprasidone e) All the above are correct f) None of the above are correct

e) All the above are correct

Which of the following is/are true about antipsychotic drug therapy? a. Many atypical antipsychotic agents have an increased risk of sudden death due to disruption of cardiac conductivity. b. About 7% of patients suffering from psychosis do not respond to antipsychotic drug therapy c. About 30% of patients show only limited improvement after taking antipsychotic drugs. d. There is a 10% mortality rate if a patient develops Malignant Syndrome from taking haloperidol e. All of the choices are correct f. None of the choices are correct

e. All of the choices are correct d-nonspecific SE

Antimuscarinic side effects might be expected to occur during treatment with: a. Clozapine b. Thioridazine c. Olanzepine d. Chlorpromazine e. All the above are correct f. Only A, B and C are correct

e. All the above are correct (remember d is a low potency so we need a shit ton of it to see effect and then the SE occurs)

The dopamine hypothesis of schizophrenia states that: a. Mesolimbic dopamine activity is higher than normal. b. Mesocortical dopamine activity is lower than normal. c. The alterations in mesolimbic dopamine activity are responsible for the positive symptoms of schizophrenia. d. The alterations in mesocortical dopamine activity are responsible for the negative symptoms of schizophrenia. e. All the above choices are correct f. Both A and C are correct

e. All the above choices are correct

Which of these agents has higher affinity for alpha-1 adrenergic receptors compared to its affinity for D2 dopamine receptors? a. Thioridazine b. Risperidone c. Chlorpromazine d. Clozapine e. All the above choices are correct f. Only A and C are correct

e. All the above choices are correct

Antihistaminergic side effects are most likely to occur during treatment with: a. Thioridazine b. Perphenazine c. Chlorpromazine d. Clozapine e. All the above choices are correct f. Both A and C are correct

e. All the above choices are correct -remember that most of these are low potency agents so we have to use a shit ton to get therapeutic effect which causes SE

Based on the Characteristics of an Ideal Psychotherapeutic Drug by Hollisberg and Csernasnsky (1990), which of the following factors would a newer atypical antipsychotic agent (e.g., ziprasidone) compare more favorably to an older typical antipsychotic agent (e.g., thioridazine)? a) Be effective rapidly. b) Benefit most or all patients for who it is indicated. c) Have minimum toxicity in the therapeutic range d) Not be lethal in overdose e) All the above are correct f) None of the above are correct

f) None of the above are correct

Antimuscarinic side effects might be expected to occur during treatment with: a. Olanzapine b. Thiothixene c. Clozapine d. Haloperidol e. All the above choices are correct f. Both A and C are correct

f. Both A and C are correct

Which of these agents has higher affinity for alpha-1 adrenergic receptors compared to its affinity for D2 dopamine receptors? a. Risperidone b. Lurasidone c. Thioridazine d. Haloperidol e. All the above choices are correct f. Both A and C are correct

f. Both A and C are correct

Which of the following antipsychotic agents has a higher affinity for D2 dopamine receptors compared to 5HT2A receptors? a. Haloperidol b. Olanzapine c. Lurasidone d. Chlorpromazine e. All the above choices are correct f. Both A and C are correct

f. Both A and C are correct b- H1=5HT-2A=mACh> D2>alpha1 d- both categories have one +

Which of the following is/are true about antipsychotic drug therapy? a. Antipsychotic agents are more effective in decreasing the positive symptoms as compared to the negative symptoms of schizophrenia b. Atypical antipsychotic agents have much less severe side effects than typical antipsychotic drugs. c. About 10-30% of patients show no efficacy or only limited efficacy for positive symptoms of schizophrenia. d. The extrapyramidal side effects of antipsychotic agents are reversed by discontinuation of antipsychotic therapy in all patients. e. All the above choices are correct f. Both A and C are correct

f. Both A and C are correct b-might not have EPS but are worse for *metabolic syndrome* d-nope, thats why it takes years to see a dec in mov

Based on the Characteristics of an Ideal Psychotherapeutic Drug by Hollisberg and Csernasnsky (1990), which of the following factors would a newer atypical antipsychotic agent (e.g., Quetiapine) compare more favorably to older typical antipsychotic agents (e.g., chlorpromazine)? a. Be non-habituating. b. Be adaptable to both inpatients and outpatients. c. Not be lethal in overdose d. Have a minimum of secondary side effects e. All the above are correct f. None of the above are correct

f. None of the above are correct

Which of the following drugs has clinically serious antagonist effects at alpha-1 receptors? a. Pimozide b. Haloperidol c. Olanzapine d. Aripiprazole e. All the above are correct f. None of the above are correct

f. None of the above are correct

Tardive dyskinesia: a. Is most likely to develop in patients treated on a long-term basis (over a year) with Lurasidone. b. Responds favorably to therapy with anticholinergic agents c. Is characterized by akathisia and motor rigidity d. Develops within weeks after the initiation of haloperidol treatment e. All of the above are correct f. None of the above are correct

f. None of the above are correct a-most likely with a typical agent b-bad c-continuous movemnt d-within mo-years

Which of the following antipsychotic agents has a higher affinity for D2 dopamine receptors compared to 5HT2A receptors? a. Haloperidol b. Clozapine c. Lurasidone d. Olanzapine e. All the above choices are correct f. Only A and C are correct

f. Only A and C are correct

Which of the following drugs has clinically serious antagonist effects at alpha-1 receptors? a. Thioridazine b. Pimozide c. Chlorpromazine d. Lurasidone e. All the above choices are correct f. Only A and C are correct

f. Only A and C are correct

Some of the major clinical benefits of most of the newer atypical antipsychotics includes: a. Reduced likelihood of postural hypotension compared to Thioridazine. b. Better efficacy towards positive symptoms of schizophrenia. c. Lower incidence of hyperprolactinemia. d. Absence of extrapyramidal syndrome. e. All the above choices are correct f. Only A and C are correct

f. Only A and C are correct b- they are the same efficacy just lower risk of SE d-lower risk but can still occur

Which of the following is/are false about antipsychotic drug therapy? a. The side effects of antipsychotic agents can always be reversed by discontinuation of antipsychotic therapy. b. Atypical antipsychotic agents do not cause extrapyramidal side effects. c. Combinations of antipsychotic drugs have been shown to be more effective for treatment-resistant psychosis than monotherapy. d. Most antipsychotic agents are more effective in decreasing the positive symptoms as compared to the negative symptoms of schizophrenia e. All the above are false statements f. Only A, B and C are false statements

f. Only A, B and C are *false* statements a- not always b-lower risk c- show little benefit

Significant elevations in prolactin levels would most likely be produced by: a. Pimozide b. Haloperidol c. Fluphenazine d. Aripiprazole e. All of the above f. Only A, B and C are correct

f. Only A, B and C are correct

Which of the following drugs has clinically serious antagonist effects at alpha-1 receptors? a. Thioridazine b. Paliperidone c. Chlorpromazine d. Haloperidol e. All the above are correct f. Only A, B and C are correct

f. Only A, B and C are correct

Which of these agents has higher affinity for D2 dopamine receptors compared to its affinity for muscarinic acetylcholine receptors? a. Haloperidol b. Risperidone c. Fluphenazine d. Clozapine e. All the above are correct f. Only A, B and C are correct

f. Only A, B and C are correct

Antipsychotic-induced tardive dyskinesia: a. Is most likely to develop in female patients treated on a long-term basis b. Responds favorably to therapy with cholinergic agonists c. Is characterized by excessive, uncontrollable limb movements d. Is due to down-regulation of D2 dopamine receptors in striatum e. All of the above are correct f. Only A, B and C are correct

f. Only A, B and C are correct d- upregulation