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Antipsychotics

10. Self-assessment questions

Question 1

Antipsychotics are licensed for a wide variety of conditions. Which of the following are licensed indications for some antipsychotics:

  1. Tourette syndrome
  2. Hiccoughs
  3. Nausea and vomiting
  4. Attention deficit hyperactivity disorder
  5. Personality disorder

Choose your answers as follows:

  • If 1, 2 and 3 are correct
  • If 2 and 4 are correct
  • If only 5 is correct
  • If 1, 2, 3 and 5 are correct
  • If all are correct

Feedback on the responses is given at the end of the module

Question 2

Which of the following antipsychotics are usually considered ‘atypical’ or ‘second-generation’ antipsychotics?

  1. Paliperidone
  2. Aripiprazole
  3. Clozapine
  4. Sulpiride
  5. Amisulpride

Choose your answers as follows:

  • If 1, 2 and 3 are correct
  • If 2 and 4 are correct
  • If only 5 is correct
  • If 1, 2, 3 and 5 are correct
  • If all are correct

Feedback on the responses is given at the end of the module

Question 3

Antipsychotics can affect various physiological systems in addition to their intended target of action. Which of the following physiological systems is NOT thought to be directly affected by antipsychotics? Select the single best answer.

  1. Bone marrow
  2. Spinal cord motor fibres
  3. Extrapyramidal motor system
  4. Hypothalamic temperature regulation
  5. Pituitary hormone secretion

Feedback on the responses is given at the end of the module

Question 4

All of the following are considered extrapyramidal side effects of antipsychotics, EXCEPT (select the single best answer):

  1. Tardive dyskinesia
  2. Acute dystonia
  3. Akathisia
  4. Catatonia
  5. Parkinsonism

Feedback on the responses is given at the end of the module

Question 5

Which of the following is NOT a typical feature of neuroleptic malignant syndrome? Select the single best answer.

  1. Hyperthermia
  2. Muscular rigidity
  3. Myoclonus
  4. Laboratory report of high concentration of creatine kinase
  5. Autonomic instability

Feedback on the responses is given at the end of the module

Question 6

An 18-year-old is admitted to A&E having been detained by the police. He was running down a motorway naked screaming about his ‘mind being controlled by the Apple Corporation’. The admitting A&E doctor prescribed haloperidol 10 mg by intramuscular injection. You are asked to review the patient two hours later and find him grimacing and lying in a contorted position on the bed. The most likely explanation for this is:

  1. Parkinsonism
  2. Psychomotor retardation
  3. Catatonia
  4. Dystonia
  5. Tardive dyskinesia

Feedback on the responses is given at the end of the module

Question 7

Which of the following may be appropriate treatment options for the above scenario:

  1. Intramuscular benzodiazepine eg lorazepam
  2. Oral antimuscarinic eg orphenadrine
  3. Oral dopamine agonist eg bromocriptine
  4. Intramuscular antimuscarinic eg procyclidine
  5. Intramuscular serotonin antagonist eg ondansetron

Choose your answers as follows:

  • If 1, 2 and 3 are correct
  • If 2 and 4 are correct
  • If only 5 is correct
  • If 1, 2, 3 and 5 are correct
  • If all are correct

Feedback on the responses is given at the end of the module

Question 8

A patient was started on an antipsychotic two weeks ago, in line with current guidelines. On medication review she complains of nausea (but no vomiting). Which of the following could be appropriate management (select the single best answer):

  • Halving the antipsychotic dose
  • Reassurance that nausea is likely to improve with time
  • Metoclopramide by mouth
  • Prochlorperazine by mouth
  • Discontinuing antipsychotic treatment

Feedback on the responses is given at the end of the module

Question 9

A 21-year-old lady with schizophrenia is prescribed risperidone. Her condition responds well to treatment with clear improvement in symptoms. However, her blood tests reveal persistent and marked elevation of circulating prolactin. On medication review, you discuss with the clinical team switching to an alternative antipsychotic. Which of these alternative antipsychotics might be appropriate option in this case?

  1. Haloperidol
  2. Quetiapine
  3. Clozapine
  4. Aripiprazole
  5. Amisulpride

Choose your answers as follows:

  • If 1, 2 and 3 are correct
  • If 2 and 4 are correct
  • If only 5 is correct
  • If 1, 2, 3 and 5 are correct
  • If all are correct

Feedback on the responses is given at the end of the module

Question 10

Which of the following can increase the risk of clinically significant arrhythmia associated with antipsychotic-induced QT-interval prolongation?

  1. Other medicines
  2. Hypokalaemia
  3. Congenital QT interval prolongation
  4. Family history of sudden cardiac death
  5. Congestive cardiac failure

Choose your answers as follows:

  • If 1, 2 and 3 are correct
  • If 2 and 4 are correct
  • If only 5 is correct
  • If 1, 2, 3 and 5 are correct
  • If all are correct

Feedback on the responses is given at the end of the module

Question 11

Which of the following cardiovascular disorders are associated with antipsychotic use?

  1. Cardiomyopathy
  2. Cerebrovascular accident
  3. Myocarditis
  4. Tetralogy of Fallot
  5. Short QTc syndrome

Choose your answers as follows:

  • If 1, 2 and 3 are correct
  • If 2 and 4 are correct
  • If only 5 is correct
  • If 1, 2, 3 and 5 are correct
  • If all are correct

Feedback on the responses is given at the end of the module

Question 12

Which one of the following is NOT a valid means of improving adherence to antipsychotic treatment? Select the single best answer.

  • Use of sublingual or liquid formulations
  • Using antipsychotic blood level monitoring as the basis for discussing adherence with the patient
  • Use of pill organiser/reminder device eg Dosett box
  • Use of prolonged-action antipsychotic injection
  • Frank disclosure of adverse effects

Feedback on the responses is given at the end of the module

Question 13

Which of the following adverse effects of antipsychotics is NOT likely to be related to hyperprolactinaemia? Select the single best answer.

  • Hyperglycaemia
  • Osteoporosis
  • Erectile dysfunction
  • Amenorrhoea
  • Breast pain

Feedback on the responses is given at the end of the module

Question 14

A 24-year-old man with schizophrenia is treated with clozapine. At a routine appointment he reports improvement in his condition. He asks if you might prescribe something for his sore throat and fever because he feels he might have got the flu. Which of the following possible effects must you particularly consider? Select the single best answer.

  • Leucocytosis
  • Myocarditis
  • Neuroleptic malignant syndrome
  • Agranulocytosis
  • Non-Hodgkin’s lymphoma

Feedback on the responses is given at the end of the module

Question 15

All of the following medicines can increase the hypotensive effects of antipsychotics, EXCEPT (select the single best answer):

  • Calcium-channel blockers
  • ACE inhibitors
  • Opioids
  • Pseudoephedrine
  • Beta-blockers

Feedback on the responses is given at the end of the module

Question 16

At a routine appointment, a 31-year-old lady on antipsychotic therapy for schizoaffective disorder says that she would like to start a family in the next year or so. All of the following may be useful to a discussion of risk and benefit, EXCEPT (select the single best answer):

  • Antipsychotics may reduce fertility
  • Antipsychotics can cross the placenta and enter fetal circulation
  • Antipsychotics should always be discontinued before attempting pregnancy, to prevent teratogenic effects in the first trimester
  • If an antipsychotic is taken in the third trimester of pregnancy, the neonate may display extrapyramidal effects and other antipsychotic-associated adverse effects
  • She should specifically discuss her antipsychotic regimen with the doctor before attempting to conceive

Feedback on the responses is given at the end of the module

Question 17

You are asked to see a 19-year-old man admitted with a suspected first episode of psychosis and extreme agitation. The ward staff are having considerable difficulty managing his agitation and are concerned that he may become a threat to himself or others. Which of the following would NOT be appropriate for the patient’s initial management? Select the single best answer.

  • Attempts at de-escalation, including transfer to a low-stimulus environment
  • Attempting physical examination of the patient
  • Lorazepam 1–2 mg by mouth
  • Lorazepam 1–2 mg by intramuscular injection
  • Haloperidol 10 mg by intramuscular injection

Feedback on the responses is given at the end of the module

Question 18

Which of the following concerns has particularly led to the recommendation that antipsychotics (except in limited circumstances) are best avoided for the management of behavioural disorders in the elderly with dementia? Select the single best answer.

  • Acute dystonia
  • Drug-induced parkinsonism
  • Inability to regulate body temperature
  • Stroke
  • Postural hypotension

Feedback on the responses is given at the end of the module

Question 19

Which of the following is NOT thought to alter clozapine metabolism (select the single best answer):

  • Coffee
  • Nicotine replacement gum
  • Tea
  • Cigarettes
  • None of the above

Feedback on the responses is given at the end of the module

Question 20

Intramuscular injections of prolonged-release antipsychotics, also called ‘depot antipsychotics’, help promote adherence to treatment and reduce relapse risk. In which of the following situations should a prolonged-release antipsychotic NOT be used? Select the single best answer.

  • Simultaneous use of oral ‘first-generation’ antipsychotic therapy with a depot ‘first-generation’ antipsychotic
  • Continuing depot antipsychotic therapy during pregnancy
  • Depot antipsychotic therapy during childhood
  • Depot antipsychotic therapy in individuals aged over 65 years
  • Depot antipsychotic therapy in the presence of cardiovascular, renal or liver disease

Feedback on the responses is given at the end of the module