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Chapter 17 - Cypress College

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					Haveles: Applied Pharmacology for the Dental Hygienist, 6th Edition

Chapter 17: Psychotherapeutic Agents

MULTIPLE CHOICE

1. Which of the following psychiatric disorders involves a loss of the perception of reality?

a. Bipolar affective disorder
b. Schizophrenia
c. Panic disorder
d. Obsessive-compulsive disorder

ANS: b
Schizophrenia is derived from the word meaning “splitting” and, in context, refers to patients
splitting from reality. The patient’s ability to function in society is impaired as a result of altered
thinking.

REF: pp. 223-224

2. The following symptoms are “negative” (passive) symptoms of psychoses except for one. Which
one is the exception?

a. Flat affect
b. Vocalization of feelings of superhuman strength
c. Abstract thinking difficult
d. Social withdrawal
e. Thought and speech impaired

ANS: b
Vocalization of feelings of superhuman strength is considered a “positive” or active symptom of
psychoses because it represents some action. The negative symptoms represent one form of
withdrawal or other (i.e., the inability to do or feel something rather than an ability to do or feel
something untoward).

REF: p. 224

3. The type of depression that seems to be unrelated to external events is called __________
depression.

a. Involutional
b. Unipolar
c. Manic
d. Exogenous
e. Reactive

ANS: a
Endogenous (involutional) depression seems to be unrelated to external events, whereas exogenous
(reactive) depression appears to be related to specific external events. The condition in patients who
exhibit only depression is termed unipolar depression. Manic depression is an oxymoron, given that
the two terms are opposite one another.
REF: p. 224

4. As a group, the atypical antipsychotics produce __________ nausea and __________
anticholinergic and sedative effects compared with conventional antipsychotics.

a. Increased, more
b. Increased, fewer
c. Decreased; more
d. Decreased; fewer

ANS: b
The atypical antipsychotics produce increased nausea and fewer anticholinergic and sedative
effects than conventional antipsychotics. Many patients are now being treated with the newer
“atypical” antipsychotics.

REF: p. 225

5. Which of the following agents is classified as an antipsychotic?

a. Celexa
b. Cephalexin
c. Zyprexa
d. Lexapro
e. Bextra

ANS: c
Correct: Zyprexa is the trade name for olanzapine, a newer atypical antipsychotic.
Incorrect Answers: Celexa is the trade name for the antidepressant citalopram, and Lexapro is the
trade name for its S-isomer. Cephalexin is a cephalosporin antibiotic, and Bextra is the trade name
for valdecoxib, the cyclooxygenase-2 (COX-2) selective nonsteroidal antiinflammatory drug.

REF: p. 225

6. In general, lower potency antipsychotic agents will have more: (1) sedation, (2) peripheral side
effects, (3) autonomic effects, (4) extrapyramidal effects

a. 1, 2, 3, 4
b. 1, 2, 3
c. 2, 3, 4
d. 1, 2
e. 3, 4

ANS: b
Lower potency antipsychotic agents such as chlorpromazine have more sedation, more peripheral
side effects, and more autonomic effects. Higher potency agents such as haloperidol have more
extrapyramidal effects and less sedation.

REF: p. 225

7. Conventional antipsychotics would have little effect on which of the following symptoms of
psychosis?
a. Delusions
b. Unwanted thoughts
c. Flat affect
d. Agitation
e. Disorganized behavior

ANS: c
Correct: Conventional antipsychotics are active against the positive effects of psychosis but have
little effect on the negative effects. Negative symptoms of psychosis include flat affect,
unemotional, apathetic, passivity, abstract thinking difficult, lacking spontaneity and goals,
impaired thought and speech, lack of pleasure, and social withdrawal.
Incorrect choices: Positive symptoms of psychosis include hallucinations, delusions, unwanted
thoughts, disorganized behavior, agitation, and distorted speech and communication.

REF: pp. 224, 226

8. Conventional antipsychotics are primarily __________ antagonists.

a. Acetylcholine
b. Norepinephrine
c. Dopamine
d. Serotonin (5-hydroxytryptamine)

ANS: c
Correct: Conventional antipsychotics are primarily dopamine antagonists.
Incorrect choices: Atypical antipsychotic agents have action at more than one receptor, for
example, the dopamine, serotonin, and norepinephrine receptors. This results in the improved
efficacy of these agents.

REF: p. 226

9. Tardive dyskinesia is typically seen in men older than age 40 who have been taking large doses
of phenothiazine for 6 months or longer. The onset is gradual and the symptoms are exacerbated on
drug withdrawal.

a. Both statements are true.
b. Both statements are false.
c. The first statement is true, the second statement is false.
d. The first statement is false; the statement second is true.

ANS: d
Tardive dyskinesia is typically seen in female patients who are more than 40 years of age and have
been taking large doses of the phenothiazine for a minimum of 6 months to 2 years or as long as 20
years. The onset is gradual and the movements are coordinated and rhythmic. This effect is
exacerbated by drug withdrawal.

REF: p. 226

10. Extrapyramidal reactions caused by phenothiazines:

a. Can be treated with anticholinergic agents
b. Are disorders of muscle control
c. Include akathisia
d. All of the above

ANS: d
The severity and prevalence of extrapyramidal reactions depends on the balance between
acetylcholine and dopamine. Too much dopamine blockade will lead to these side effects. An
anticholinergic can partially restore the balance between dopamine and acetylcholine action in
specific brain regions associated with muscle control, such as the corpus striatum. Akathisia is an
extrapyramidal reaction characterized by increased compulsive motor activity.

REF: pp. 226-227

11. Patients taking conventional antipsychotics can experience severe intermittent
temporomandibular joint (TMJ) pain. This pain is a consequence of:

a. Hyperalgesia produced by ?-adrenergic blockade
b. Anticholinergic side effects
c. Dislocation of the mandible
d. Extrapyramidal side effects

ANS: d
Correct: The extrapyramidal side effects of conventional antipsychotics can cause severe
intermittent pain in the region of the TMJ. This pain is produced by a spasm of the muscles of
mastication.
Incorrect Answers: ?-Adrenergic blockade does not produce hyperalgesia, pain is not caused by
anticholinergic side effects, and dislocation of the mandible is a possible consequence of a dental
practitioner attempting to force open the mouth of a patient who is experiencing a spasm of the
muscles of mastication.

REF: p. 227

12. Phenothiazines cause hypotension by blocking which receptor?

a. ?-Adrenergic
b. ?-Adrenergic
c. Dopamine
d. Acetylcholine

ANS: a
Phenothiazines, conventional antipsychotics, cause hypotension by blocking ?-adrenergic receptors.

REF: p. 227

13. Which of the following atypical antipsychotics is associated with agranulocytosis?

a. Aripiprazole
b. Clozapine
c. Quetiapine
d. Risperidone
e. Ziprasidone

ANS: b
Clozapine should be tried only after several trials of other agents have failed because it produces a
potentially life-threatening agranulocytosis. With the release of newer atypical antipsychotic
agents, use of this agent has decreased.

REF: p. 227

14. Epinephrine should not be used to treat vasomotor collapse in patients taking conventional
antipsychotics because the conventional antipsychotics are:

a. ?-Adrenergic stimulators
b. ?-Adrenergic blockers
c. ?-Adrenergic stimulators
d. ?-Adrenergic blockers

ANS: b
Because the conventional antipsychotics are ?-adrenergic blockers, epinephrine should not be used
to treat vasomotor collapse because it could cause a further decrease in blood pressure. This occurs
as a result of the predominant ?-agonist activity of epinephrine in the presence of the conventional
antipsychotics (?-blockers).

REF: p. 227

15. Conventional antipsychotic therapy must often be combined with anti-Parkinson medication of
the __________ type to control excessive extrapyramidal stimulation.

a. Adrenergic
b. Antiadrenergic
c. Cholinergic
d. Anticholinergic

ANS: d
To control excessive extrapyramidal stimulation, conventional antipsychotic therapy must often be
combined with anti-Parkinson medication of the anticholinergic type, for example, benztropine.
This combination is likely to exacerbate antimuscarinic peripheral effects such as xerostomia,
urinary retention, constipation, blurred vision, and inhibition of sweating.

REF: p. 227

16. Which antipsychotic is available as a long-acting injectable for schizophrenic patients who fail
to take their oral medication?

a. Chlorpromazine
b. Loxapine
c. Thioridazine
d. Fluphenazine
e. Quetiapine

ANS: d
Correct: Fluphenazine and haloperidol are two antipsychotic agents available in a long-acting
injectable form. They are administered intramuscularly as decanoate salts and require dosing every
3 to 4 weeks.
Incorrect Answers: Loxapine, thioridazine, and quetiapine are offered as oral forms only.
Chlorpromazine is available as an injectable, but this preparation has a significantly lower duration
of action.

REF: p. 227




17. Which of the following choices is recommended to counteract the anticholinergic effects of
conventional antipsychotics?

a. Caffeine-containing beverages
b. Alcohol-containing mouth rinses
c. Sugarless products or artificial saliva
d. Sugar-containing candy

ANS: c
Correct: Conventional antipsychotics are additive with other agents with atropine-like effects. Use
of sugarless products or artificial saliva should be encouraged.
Incorrect choices: Patients should be encouraged to stay away from caffeine-containing beverages
because they can exacerbate dry mouth. They should also avoid alcohol-containing mouth rinses
because alcohol can also exacerbate dry mouth. Patients may use sugar-containing candy to
counteract xerostomia. Use of sugarless products is recommended.

REF: p. 228

18. Which of the following are anticholinergic effects that may be associated with tricyclic
antidepressants?

a. Xerostomia
b. Bradycardia
c. Urination
d. Both a and b
e. Both b and c

ANS: a
Tricyclic antidepressants possess distinct anticholinergic effects resulting in xerostomia, blurred
vision, tachycardia, constipation, and urinary retention. Some tolerance can develop with continued
use.

REF: p. 230

19. Which of the following side effects is the most serious peripheral side effect associated with the
use of tricyclic antidepressants?

a. Orthostatic hypotension
b. Cardiac toxicity
c. Urination
d. Bradycardia

ANS: b
Correct: The most serious peripheral side effect associated with the tricyclic antidepressants is
cardiac toxicity. Myocardial infarction and congestive heart failure have occurred during the course
of treatment.
Incorrect choices: Orthostatic hypotension is associated with antipsychotics. Tricyclic
antidepressants are associated with anticholinergic effects such as xerostomia, tachycardia,
constipation, and urinary retention. Arrhythmias and episodes of tachycardia can be caused by the
antimuscarinic effects of the tricyclic antidepressants.

REF: p. 230

20. Of the tricyclic antidepressants listed, which one is most sedating?

a. Imipramine
b. Nortriptyline
c. Protriptyline
d. Desipramine
e. Amitriptyline

ANS: e
Of the tricyclic antidepressants listed, amitriptyline is generally the most sedating, with
desipramine being the least sedating. When sedation is desired, amitriptyline is used. When less
sedation is needed, nortriptyline or protriptyline can be tried.

REF: pp. 229-231

21. Which agent is used to treat nocturnal enuresis?

a. Olanzapine
b. Fluoxetine
c. Metoclopramide
d. Imipramine

ANS: d
Correct: Imipramine is effective in juvenile bed wetting, likely because of its anticholinergic
actions.
Incorrect Answers: Olanzapine, fluoxetine, and metoclopramide are not effective for nocturnal
enuresis.

REF: p. 231

22. Which of the following tricyclic antidepressants is used for the treatment of obsessive-
compulsive disorder?

a. Amitriptyline
b. Clomipramine
c. Doxepin
d. Nortriptyline

ANS: b
Correct: Clomipramine is used only in the treatment of obsessive-compulsive disorder. Patients
with obsessive-compulsive disorder repeatedly perform certain rituals such as hand washing.
Incorrect choices: Amitriptyline is used when sedation is desired. Doxepin is used when an
antianxiety effect is desired. Nortriptyline or protriptyline can be tried when less sedation is needed.

REF: p. 231

23. Which of the following types of dental medicaments must be administered with caution to
patients taking tricyclic antidepressants?

a. Fluoride
b. Antibiotics
c. Anesthetics
d. Analgesics

ANS: c
Vasoconstricting drugs in local anesthetic solution must be administered with caution to patients
taking tricyclic antidepressants. They may potentiate vasopressor response to epinephrine. The
cardiac dose (0.04 mg) can be safely administered to patients who do not have preexisting
arrhythmias.

REF: p. 231

24. Which of the following are adverse reactions associated with selective serotonin reuptake
inhibitors (SSRIs)?

a. Central nervous system (CNS) depression
b. Nausea and diarrhea in approximately 15% to 30% of patients
c. Xerostomia in 10% to 15% of the population
d. Both a and b
e. Both b and c

ANS: e
SSRIs are associated with nausea and diarrhea in approximately 15% to 30% of patients. Oral side
effects include xerostomia in 10% to 15% of the population, taste changes, aphthous stomatitis,
glossitis, and (rarely) increased salivation, salivary gland enlargement, and tongue discoloration or
edema.
Incorrect choices: SSRIs tend to produce CNS stimulation rather than CNS depression.

REF: p. 231

25. Which antidepressant is least likely to cause xerostomia?

a. Bupropion
b. Sertraline
c. Chlorpromazine
d. Amitriptyline
e. Trazodone

ANS: b
Correct: Sertraline, as with other SSRIs, produces a lower incidence of xerostomia than other
classes of antidepressants, probably because their anticholinergic activity is significantly weaker.
Incorrect Answers: Bupropion, trazodone, and especially amitriptyline have a greater
anticholinergic action and incidence of xerostomia. Chlorpromazine is not an antidepressant.
REF: p. 231

26. Bupropion is reserved for patients who are not responsive to other agents because of a potential
for:

a. Cardiac arrhythmias
b. Seizures
c. Retinopathy
d. Glaucoma

ANS: b
Because of its seizure potential, bupropion is reserved for patients who are not responsive to other
agents. Approximately 0.4% of patients treated with bupropion have experienced seizures. This
incidence may be four times greater than with tricyclic antidepressants and as much as 10 times
greater with tricyclic antidepressants at higher doses.

REF: p. 231

27. Which antidepressant drug carries a “black box” warning regarding its potential to cause life-
threatening liver failure?

a. Imipramine
b. Bupropion
c. Nefazodone
d. Mirtazapine
e. Venlafaxine

ANS: c
Correct: Of the antidepressant drugs, nefazodone has the potential to cause fatal hepatic
dysfunction.

REF: p. 232


28. Interaction of monoamine oxidase inhibitors (MAOIs) with many drugs such as amphetamines,
and with foods such as wines, cheese, and fish, can precipitate:

a. Hair loss
b. Hypertensive crisis
c. Gout
d. Dysgeusia

ANS: b
MAOIs interaction with many drugs and foods can precipitate a hypertensive crisis and even death.
Patients taking MAOIs have detailed food prohibitions because of this chance of food-drug
interactions.

REF: p. 232

29. Which of the following medications is used to treat bipolar depression?
a. Haloperidol
b. Lithium
c. Clozapine
d. paroxetine

ANS: b
Correct: Lithium is used in the treatment of bipolar depression, which is characterized by cyclic
recurrence of mania alternating with depression.
Incorrect choices: Haloperidol is a high-potency conventional antipsychotic. Clozapine is an
atypical antidepressant. Paroxetine is an SSRI.

REF: p. 232

30. Patients undergoing lithium therapy should be observed for signs of overdose toxicity,
including:

a. Hyperpyrexia
b. Constipation
c. Muscle rigidity and fasciculations
d. Loquacious speech

ANS: c
Correct: Overdose toxicity may be exhibited by CNS symptoms, including muscle rigidity,
hyperactive deep reflexes, excessive tremor, and muscle fasciculations.
Incorrect choices: Side effects of treatment with lithium include polyuria, fine hand tremor, thirst,
and in more severe cases, slurred speech, ataxia, nausea, vomiting, and diarrhea.

REF: p. 232

31. Which of the following categories of medications has recently been approved for the treatment
of bipolar disorder?

a. High-potency conventional antipsychotics
b. Atypical antipsychotics
c. SSRIs
d. MAOIs

ANS: b
All of the atypical antipsychotics have been approved for the treatment of bipolar disorder, as well
as for the acute treatment of bipolar disorder. Olanzapine and aripiprazole are approved for relapse
prevention of bipolar disorder.

REF: p. 232

TRUE/FALSE

32. Atypical antipsychotics have fewer side effects than conventional antipsychotics.

ANS: True
As with conventional antipsychotics, the atypical antipsychotics are effective against the positive
effects associated with psychoses. Unlike conventional antipsychotics, however, the atypical
antipsychotics are effective against the negative effects.
REF: p. 226

33. Force should be exerted to open the patient’s mouth if muscle spasm is present as a result of
tardive dyskinesia.

ANS: False
Forces should not be exerted to open the patient’s mouth for dental treatment because dislocations
of the mandible can occur.

REF: p. 227

34. Conventional antipsychotics may be used as a chemical restraint in nursing homes.

ANS: False
Use of these agents as chemical restraints in nursing homes is unethical.

REF: p. 228

35. The chemoreceptor trigger zone (CTZ) is a site of action for prochlorperazine and
promethazine.

ANS: True
Correct: Prochlorperazine and promethazine are both phenothiazines. They are antiemetic
compounds by virtue of their ability to depress the CTZ.

REF: p. 228

36. SSRIs tend to produce CNS stimulation rather than CNS depression.

ANS: True
SSRIs do not have the sedative actions found within many tricyclic antidepressants. As a class, they
tend to be less sedating, although sedation is sometimes seen with some members of this class (e.g.,
sertraline).

REF: p. 231

				
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