Anti-Psychotics

Question 1

What is an additional indication for clozapine?

Answer 1

Recurrent suicidal behavior

Question 2

What is the indication for Pimavanserin?

Answer 2

Hallucinations/delusions associated with parkinson’s disease psychosis

Question 3

What are the 2 broad categories that FGA’s are divided into?

Answer 3

Low and high potency (based on D2 receptor potency/receptor occupancy)

Question 4

What are low potency FGA?

Answer 4

More sedation, hypotension, tachycardia and ECG changes; seen with chlorpromazine and thioridazine (associated with Torsade’s de pointes and sudden death)

Question 5

What are high potency FGA?

Answer 5

More movement (EPS) and endocrine effects (prolactin); seen with fluphenazine and haloperidol

Question 6

What is dystonia?

Answer 6

Sustained contraction that can develop within hours-days

Question 7

What can be used to tx dystonia?

Answer 7

Anticholinergics such as Benzotropine, Diphenhydramine and Trihexyphenidyl

Question 8

What is akathisia?

Answer 8

Constant movements that can develop within days-weeks of treatment

Question 9

What can be used to tx akathisia?

Answer 9

Beta blocker (propranolol), benzodiazepine (lorazepam) or anticholingergic (benztropine)

Question 10

What is parkinsonism?

Answer 10

Tremor, rigidity and bradykinesia that can develop within weeks to months of tx

Question 11

What can be used to tx parkinsonism?

Answer 11

Anticholinergic agent (benztropine) and dopamine enhancer (amantadine)

Question 12

What is tardive dyskinesia?

Answer 12

Repetitive, uncontrollable movements that can occur within 6 months of tx

Question 13

What can be used to tx tardive dyskinesia?

Answer 13

Selective vesicular monoamine transporter 2 (VMAT2) inhibitors such as Valbenazine or Deutetrabenazine

Question 14

Which monitoring scale can be used to assess for general sx?

Answer 14

Glasgow Antipsychotic Side effect Scale (GASS)

Question 15

Which screening tool is used to monitor for movement disorder such as TD?

Answer 15

Abnormal involuntary movement scale (AIMS)

Question 16

Which screening tool can be used to monitor for EPS sx?

Answer 16

Extrapyramidal sx rating scale (ESRS)

Question 17

Which screening tool can be used to monitor for akathisia?

Answer 17

Barnes akathisia rating scale (BARS)

Question 18

What is a rare but severe side effect that can be seen in all anti-psychotics?

Answer 18

Neuroleptic malignant syndrome (NMS)

Question 19

What is neuroleptic malignant syndrome (NMS)?

Answer 19

Rare but potentially fatal severe Parkinson’s like movement disorder with wide spread muscle contraction

Question 20

What can be used to tx NMS?

Answer 20

Dantrolene which acts on the ryanodine receptor (also diazepam used as indirect tx)

Question 21

Which generation is more commonly utilized as first line inital therapy?

Answer 21

SGA’s

Question 22

What can be used to treat acute agitation in schizophrenia pts?

Answer 22

Injectable IR versions of Haloperidol, Ziprasidone, Olanzapine or Aripiprazole; ODT or SL versions also available

Question 23

What is used to tx multi-drug resistant dz?

Answer 23

Clozapine

Question 24

What can be used to tx psychotic pts with suicidal thoughts/behaviors?

Answer 24

Clozapine

Question 25

How is non-adherence managed?

Answer 25

With long acting injectable agents (LAIA’s)

Question 26

What are the LAIA’s that can be used in a non-compliant pt?

Answer 26

Risperidone, Olanzapine, Aripiprazole lauroxil and Paliperidone palmitate (ROAP)

Question 27

Which SGA’s have the lowest amount of side effects?

Answer 27

Aripiprazole, Lumateperone, Brexipiprazole, Iloperidone, and Zipraseridone

Question 28

Which SGA’s have the highest number of side effects?

Answer 28

Clozapine and olanzapine

Question 29

Which SGA’s have the highest risk for weight gain?

Answer 29

Clozapine and olanzapine

Question 30

Which SGA’s have the lowest risk for weight gain?

Answer 30

Aripiprazole, Brexipiprazole, Lumateperone, Lurasidone, Ziprasidone

Question 31

Which SGA’s have the lowest risk for hyperglycemia?

Answer 31

Aripiprazole, Brexipiprazole, Cariprazine, Lumateperone, Paliperidone, Ziprasidone

Question 32

Which SGA’s have the greatest riks for hyperglycemia and HLD?

Answer 32

Clozapine and olanzapine

Question 33

Which SGA’s have the lowest risk for HLD?

Answer 33

Aripiprazole, Cariprazine, Iloperidone, Lumateperone, Ziprasidone

Question 34

Which SGA’s have the lowest risk of EPS sx?

Answer 34

Clozapine, Iloperidone, Lumateperone, Quetiapine, Ziprasidone

Question 35

Which SGA’s have the greatest risk for prolactin elevation?

Answer 35

Paliperidone and Risperidone

Question 36

Which SGA’s have the lowest risk for sedation?

Answer 36

Aripiprazole, Lumateperone, Paliperidone

Question 37

Which SGA’s have the greatest risk for sedation?

Answer 37

Cariprazine, Clozapine, Olanzapine, Quetiapine

Question 38

Which SGA’s have the highest risk of anticholinergic side effects?

Answer 38

Cariprazine and Clozapine

Question 39

Which SGA’s have the greatest risk of causing orthostatic hypotension?

Answer 39

Cariprazine, Clozapine, and Iloperidone

Question 40

Which SGA has the greatest risk of causing QTc prolongation?

Answer 40

Ziprasidone

Question 41

Which SGA’s have the lowest risk of causing QTc prolongation?

Answer 41

Aripiprazole, Brexipiprazole, Lumateperone, Lurasidone