Drugs in Psychiatric Disorders Practice Questions

Q: Which of the following is a typical antipsychotic drug?

Haloperidol. ***Haloperidol*** - **Haloperidol** is a **first-generation (typical)** antipsychotic that primarily blocks **D2 dopamine receptors** in the brain. - It is often used for acute psychotic episodes and has a higher risk of **extrapyramidal symptoms (EPS)** compared to atypical antipsychotics. *Clozapine* - **Clozapine** is an **atypical (second-generation)** antipsychotic, known for its effectiveness in **treatment-resistant schizophrenia**. - Its mechanism involves broader receptor binding, including **dopamine** and **serotonin** receptors, and it carries risks like **agranulocytosis** and **myocarditis**. *Risperidone* - **Risperidone** is an **atypical (second-generation)** antipsychotic, known for its mixed **D2 dopamine** and **5-HT2A serotonin** receptor antagonism. - It has a lower risk of EPS than typical antipsychotics but can cause dose-dependent **hyperprolactinemia**. *Olanzapine* - **Olanzapine** is an **atypical (second-generation)** antipsychotic with broad receptor binding, including **dopamine, serotonin, histamine, and muscarinic receptors**. - It is associated with a significant risk of **metabolic side effects**, such as weight gain, hyperglycemia, and dyslipidemia.

Q: What is the most common side effect of haloperidol?

Akathisia. ***Akathisia*** - **Akathisia** is one of the **most common extrapyramidal symptoms (EPS)** associated with haloperidol, occurring in **20-75% of patients**. - It is characterized by a feeling of **inner restlessness** and an **inability to stay still**, often manifesting as pacing, rocking, or shifting weight. - Haloperidol, a high-potency **first-generation antipsychotic**, has a high propensity to cause EPS, including akathisia, due to its **strong dopamine D2 receptor blockade** in the nigrostriatal pathway. - Along with drug-induced parkinsonism, akathisia is among the most frequently encountered side effects with haloperidol use. *Hypotension* - While orthostatic hypotension can occur with antipsychotics, particularly those with strong **alpha-1 adrenergic blockade** (e.g., lower potency first-generation antipsychotics like chlorpromazine, or some second-generation antipsychotics), it is not the most common side effect of haloperidol. - Haloperidol has relatively **weak alpha-1 blocking activity** compared to other antipsychotics. *Dryness of mouth* - **Dryness of mouth (xerostomia)** is a common anticholinergic side effect of some antipsychotics, but it is not the most common or prominent side effect of haloperidol. - Haloperidol has relatively **weak anticholinergic activity** compared to lower potency antipsychotics. *Tic disorder* - **Tic disorders** are characterized by sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations. - While haloperidol can be used to **treat severe tics** (e.g., in Tourette syndrome), it is not a common side effect of the medication itself; rather, it is a condition that antipsychotics like haloperidol may target therapeutically.

Q: Sedation as an adverse effect is most commonly associated with which of the following atypical antipsychotics?

Quetiapine. ***Quetiapine*** - **Quetiapine** is known for its strong **H1 histamine receptor blockade**, which directly contributes to its prominent sedating effects. - This sedation is often dose-dependent and can be beneficial for patients with insomnia or agitation, but it is also a common complaint and reason for discontinuation. - Among the options listed, quetiapine is classically taught as the **most sedating** atypical antipsychotic. *Risperidone* - While risperidone can cause some sedation [1], it is generally less sedating than quetiapine or olanzapine and is more commonly associated with **extrapyramidal symptoms (EPS)**, especially at higher doses [1]. - Its mechanism of action primarily involves **D2 dopamine receptor blockade** and **5-HT2A serotonin receptor blockade** [1]. *Olanzapine* - **Olanzapine** also causes significant sedation [1] due to its strong antagonism of **H1 histamine receptors** and **alpha-1 adrenergic receptors**. - Clinically, olanzapine's sedative effects are comparable to quetiapine, though quetiapine is traditionally emphasized in exam contexts as the most sedating among these options. - Olanzapine is additionally notable for significant **metabolic side effects** like weight gain and dyslipidemia. *Aripiprazole* - **Aripiprazole** acts as a **partial agonist** at D2 dopamine receptors and 5-HT1A serotonin receptors, and an antagonist at 5-HT2A serotonin receptors, which results in minimal sedation. - It is often considered to be more **activating** or have a **neutral** effect on sedation compared to other atypical antipsychotics.

Q: Which of the antidepressants is used in low doses as a hypnotic?

trazodone. ***trazodone*** - **Trazodone** is an antidepressant that is frequently prescribed off-label at low doses as a **hypnotic** due to its potent **histamine H1 receptor antagonism** and **alpha-1 adrenergic blocking effects**, inducing sedation. - Its sedative properties differentiate it from other antidepressants that are primarily stimulating. *fluoxetine* - **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)** known for its **activating** effects, making it a poor choice for a hypnotic. - It is more likely to cause **insomnia** and agitation rather than sedation. *fluvoxamine* - **Fluvoxamine** is another **SSRI** primarily used for **obsessive-compulsive disorder (OCD)**. - Like other SSRIs, its primary action is not sedation, and it can sometimes lead to **sleep disturbances**. *bupropion* - **Bupropion** is a **norepinephrine-dopamine reuptake inhibitor (NDRI)** known for its **stimulating effects** and lack of sexual side effects. - It is often avoided in patients with **insomnia** due to its activating properties and is not used as a hypnotic.

Q: Antipsychotic drug causing retinal pigment disorder is which?

Thioridazine. ***Thioridazine*** - **Thioridazine** is a **first-generation antipsychotic** known to cause **retinal pigmentary changes** (pigmentary retinopathy) at high doses, particularly above 800 mg/day. - This condition can lead to **vision loss** due to the deposition of melanin-like pigment in the retina and progressive retinal degeneration. - This is a dose-related toxic effect and is one of the reasons thioridazine is less commonly used today. *Clozapine* - **Clozapine** is primarily associated with severe side effects like **agranulocytosis** and **myocarditis**. - It is not typically known to cause **retinal pigment disorder** as a common or significant side effect. *Chlorpromazine* - **Chlorpromazine**, another first-generation antipsychotic, is more commonly linked to **corneal and lenticular opacities** (blue-gray discoloration of the eye) than retinal pigment changes. - While it can affect the eye, its primary ocular toxicity differs from the **retinal pigment disorder** caused by thioridazine. *None of the options* - This option is incorrect because **Thioridazine** is a well-established cause of **retinal pigment disorder**. - There is a specific antipsychotic drug listed that causes this condition.

Question 1

Which of the following is a typical antipsychotic drug?

Accepted Answer

Haloperidol

Answer

Risperidone

Answer

Olanzapine

Answer

Clozapine

Question 2

What is the most common side effect of haloperidol?

Accepted Answer

Akathisia

Answer

Hypotension

Answer

Dryness of mouth

Answer

Tic disorder

Question 3

Sedation as an adverse effect is most commonly associated with which of the following atypical antipsychotics?

Accepted Answer

Quetiapine

Answer

Risperidone

Answer

Olanzapine

Answer

Aripiprazole

Question 4

Which of the antidepressants is used in low doses as a hypnotic?

Accepted Answer

trazodone

Answer

fluoxetine

Answer

fluvoxamine

Answer

bupropion

Question 5

Antipsychotic drug causing retinal pigment disorder is which?

Accepted Answer

Thioridazine

Answer

Clozapine

Answer

Chlorpromazine

Answer

None of the options

Drugs in Psychiatric Disorders — MCQs

Drugs in Psychiatric Disorders — MCQs

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