Lippincott chapter 11: Antipsychotics Flashcards
11.1 An adolescent male is newly diagnosed with schizo-
phrenia. Which of the following antipsychotic agents
may have the best chance to improve his apathy and
blunted affect?
A. Chlorpromazine.
B. Fluphenazine.
C. Haloperidol.
D. Risperidone.
E. Thioridazine.
Correct answer = D. Risperidone is the only antipsychotic
on the list that has some reported benefit in improving the
negative symptoms of schizophrenia. It is a second-gen-
eration antipsychotic, and the other drugs listed are first-
generation antipsychotic agents. All of the agents have
the potential to diminish the hallucinations and delusional
thought processes (positive symptoms)
11.2 Which one of the following antipsychotics has been
shown to be a partial agonist at the dopamine D2
receptor?
A. Aripiprazole.
B. Clozapine.
C. Haloperidol.
D. Risperidone.
E. Thioridazine.
Correct answer = A. Aripiprazole is the agent that acts as a
partial agonist at D2
receptors. Theoretically, the drug would
enhance action at these receptors when there is a low con-
centration of dopamine and would block the actions of high
concentrations of dopamine. All of the other drugs are only
antagonistic at D2
receptors, with haloperidol being particu-
larly potent.
11.3 A 21-year-old male has recently begun pimozide
therapy for Tourette disorder. His parents bring him
to the emergency department. They describe that he
has been having “different-appearing tics” than before,
such as prolonged contraction of the facial muscles.
While being examined, he experiences opisthotonos
(type of extrapyramidal spasm of the body in which
the head and heels are bent backward and the body is
bowed forward). Which of the following drugs would be
beneficial in reducing these symptoms?
A. Benztropine.
B. Bromocriptine.
C. Lithium.
D. Prochlorperazine.
E. Risperidone.
Correct answer = A. The patient is experiencing EPS due
to pimozide, and a muscarinic antagonist such as benztro-
pine would be effective in reducing the symptoms. The other
drugs would have no effect or, in the case of prochlorpera-
zine and risperidone, might increase the symptoms.
11.4 A 28-year-old woman with schizoaffective disorder
(combination of mood and psychotic symptoms)
reports difficulty falling asleep. Which of the following
would be most beneficial in this patient?
A. Lithium.
B. Chlorpromazine.
C. Haloperidol.
D. Paliperidone.
E. Ziprasidone.
Correct answer = D. Paliperidone is the only agent that is
FDA approved for schizoaffective disorder. Chlorpromazine
has significant sedative activity as well as antipsychotic
properties and is the drug most likely to alleviate this
patient’s major complaint of insomnia. Although other anti-
psychotics may benefit this patient’s disorder, paliperidone
has the indication for this disorder, and if the underlying dis-
order is improved, then the symptom of insomnia may also
improve without risking other, unwanted adverse effects,
such as the anticholinergic effects of chlorpromazine
11.5 Which of the following antipsychotic agents is con-
sidered to be the most potent and, thus, have the
highest risk of extrapyramidal symptoms?
A. Thioridazine.
B. Fluphenazine.
C. Quetiapine.
D. Chlorpromazine.
E. Clozapine.
Correct answer = B. Among the older, conventional, or
typical antipsychotics on this list, fluphenazine is the most
potent and would thus be expected to have the highest inci-
dence of EPS. The atypical antipsychotics listed (quetiapine
and clozapine) could be considered low potency based on
their common dosing and are considered to have the lowest
risk for EPS.
11.6 Which antipsychotic has the most sedative potential
and is sometimes questionably used as a hypnotic
agent in certain clinical settings?
A. Fluphenazine.
B. Thiothixene.
C. Quetiapine.
D. Haloperidol.
E. Iloperidone.
Correct answer = C. Quetiapine has strong antihistaminer-
gic effects causing sedation and is sometimes used at low
doses as a sedative–hypnotic, even though this use is con-
sidered off-label. The other antipsychotic agents listed are
weaker at blocking the histamine receptor and therefore are
not as sedating.
11.7 A 30-year-old male patient who is treated with halo-
peridol for his diagnosis of schizophrenia is considered
to be well-managed symptomatically for his psychotic
symptoms. However, he is reporting restlessness, the
inability to sit still at the dinner table, and his family
notices that he is pacing up and down the hallway
frequently. Of the following, which is the best medication
to treat this antipsychotic-induced akathisia?
A. Benztropine.
B. Dantrolene.
C. Amoxapine.
D. Bromocriptine.
E. Propranolol.
Correct answer = E. Propranolol, a β-blocker, is consid-
ered the drug of choice for the management of antipsy-
chotic-induced akathisia. Benztropine is more effective
for pseudoparkinsonism and acute dystonias. Amoxapine
is an antidepressant that has been associated with EPS.
Bromocriptine is more effective for Parkinson-like symp-
toms, and dantrolene is a muscle relaxant that is best
reserved for managing some symptoms of neuroleptic
malignant syndrome.
11.8 Which of the following antipsychotic agents is available
in a LAI formulation that may be useful for patients
with difficulty adhering to therapy?
A. Asenapine.
B. Chlorpromazine.
C. Clozapine.
D. Quetiapine.
E. Risperidone.
Correct answer = E. Risperidone is available in a LAI for-
mulation containing risperidone microspheres. The other
agents listed do not have LAI formulations. Aripiprazole,
fluphenazine, haloperidol, olanzapine, and paliperidone are
other antipsychotics that are available in LAI formulations
11.9 Which of the following antipsychotic agents is most
associated with the possibility of a hematological
dyscrasia such as agranulocytosis in a patient being
treated for schizophrenia?
A. Chlorpromazine.
B. Buspirone.
C. Lithium.
D. Clozapine.
E. Asenapine.
Correct answer = D. Clozapine is the only antipsychotic
medication that has a black box warning and a risk of
agranulocytosis in approximately 1% of the patients treated.
This requires regular monitoring of white blood cell counts.
Although other antipsychotics have case reports of blood
dyscrasias, clozapine is considered to have the highest risk.
11.10 Which antipsychotic agent has been most associated
with significant QT interval prolongation and should
be used with caution in patients with preexisting
arrhythmias or patients taking other drugs associated
with QT prolongation?
A. Thioridazine.
B. Risperidone.
C. Asenapine.
D. Lurasidone.
E. Aripiprazole
Correct answer = A. Of the antipsychotic drugs listed,
thioridazine has the highest risk for causing QT interval
prolongation. Although this is a general warning for all anti-
psychotics, thioridazine has been issued a “black box warn-
ing,” suggesting that it is associated with the greatest risk.
