Antipsych Flashcards
60y/o on 6mg risperidone, 50mg sertraline. Slowed thinking, drooling, cog-wheeling, masked facies. Mood/paranoia improved on meds. What to do? (5x)
DECREASE DOSE OF THE ANTIPSYCHOTIC
How do antipsychotic meds elevate prolactin (PRL)? (5x)
PROLACTIN IS UNDER TONIC INHIBITORY CONTROL BY DOPAMINE
25 y/o pt hospitalized for an acute psychotic break, begins to complain of thickened speech. Physical exam reveals eyes deviated to the upper right, grimacing, and posturing of the arms. The only meds taken were haldol and clonazepam. The most helpful treatment at this point would be: (3x)
DIPHENHYDRAMINE
25 y/o pt receives haldol and develops laryngospasm: Tx? (2x)
BENZTROPINE
Superior efficacy for atypical antipsychotics over typical antipsychotics in the treatment of psychosis has been consistently demonstrated in what medications? (x2)
CLOZAPINE
Periodically assess neuroleptic side effects using? (it also shows pt’s awareness of side effects) (2x)
AIMS
After an injection with haldol, a patient appears tremulous, dystonic, confused, and has a fever of 38.8 degrees C. Which of the following would be an essential part of the diagnostic workup for this patient? (2x)
CSF EVALUATION
Which med reduces the acute sx of neuroleptic induced akathisia? (2x)
BETA BLOCKERS (PROPRANOLOL, ATENOLOL)
A patient has a seizure secondary to a supratherapeutic level of clozapine. What changes in a patient’s life could account for this finding? (2x)
SMOKING CESSATION
What did the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) demonstrate about effectiveness of 2nd gen. antipsychotics for tx of schizophrenia? (2x)
SECOND GEN. ANTIPSYCHOTICS WERE NO MORE EFFECTIVE THAN FIRST GENERATIONS
These symptoms make a diagnosis of NMS more likely than other neurological and general medical conditions: (x2)
FEVER AND SEVERE MUSCLE RIGIDITY
55 y/o psychiatrically hospitalized pt with chronic schizophrenia stabilized on Clozapine. Two weeks after d/c pt p/w impending signs of psychotic relapse. Assuming pt adherence to meds and negative serum/urine tox screens, what is most likely explanation for relapse (x2)?
RESUMPTION OF HEAVY SMOKING
Elderly w/ VH and cognitive decline -> bradykinesia, rigidity, and multiple falls. What to avoid?
HALOPERIDOL
Finish “epidemic” with clozapine in 1975
AGRANULOCYTOSIS
mech for Qtc prolongation with neuroleptics
K CHANNEL BLOCKED
Med most helpful in tx of antipsychotic induced drooling?
GLYCOPYRROLATE
psychotropic with mod-severe renal impairment?
PALIPERIDONE
How does abilify reverse neuroleptic induced hyperprolactinemia?
PARTIAL D2 AGONIST
A 75 yo with baseline dementia admitted for new onset confusion, disoriented to time and place, work up negative, started on Haldol. After 3 days pt is much improved and minimally somnolence but still disoriented, what is the next pharmacological treatment approach
D/C HALDOL
Which med has increased risk of hyperglycemia and DM?
OLANZAPINE
What drug is most appropriate in emergency treatment of anticholinergic toxicity?
HALOPERIDOL
Which antipsychotic med is assoc with decreased psychotic sxs, decreased substance use, and increased abstinence in pts with schizophrenia and addictive d/o?
CLOZAPINE
36 y/o F pt w/ schizophrenia has been treated w/ olanzapine is discovered prolactin level : 354ng/ml (normal:3-30).The first action is:
ORDER A PREGNANCY TEST
Previous dual antipsychotic failure. Tolerating Clozapine 200mg for a month. What should be next step in medication management?
CONTINUE CLOZAPINE BY ITSELF
Which antipsychotic med has the largest number of studies supporting its use for Tx of explosiveness and reactive anger in youth?
RISPERIDONE
Antipsychotic drug adrenergic effect causing orthostatic hypotension
?1-BLOCKADE
Which atypical antipsychotic causes least weight gain?
ZIPRASIDONE
What hematological finding necessitates immediate dc of clozaril?
WBC 2000-3000, GRANULOCYTES 1000-1500
With the use of 2nd gen antipsychotics, alpha receptor antagonism is associated with what side effects?
TACHYCARDIA
Mechanism by which risperidone cause very little EPS despite binding w/ high affinity to a dopaminergic D2 receptor
SEROTONERGIC 5HT2 ANTAGONISM
What is a major side effect of clozapine?
SEIZURES
Most common side effect with clozapine tx is:
SEDATION
Antipsychotic associated with development of cataracts:
QUETIAPINE
Recent schizophrenic med adjustment, now with fever, diaphoresis, stiffness, tachycardia, confusion. Dx?
NEUROLEPTIC MALIGNANT SYNDROME
A patient who is prescribed a high-dose of fluphenazine develops a fever of 103 F, tachycardia and AMS. Which test is most likely to be helpful?
CREATINE KINASE
IV Haldol related torsades de pointes is associated with what?
LOW MAGNESIUM LEVELS
Which of the following would be of most concern after initiating treatment with IV haldol for an 82 y/o pt with delirium?
PROLONGED QTC INTERVAL
A leading hypothesis as to why atypical antipsychotic medications are less likely than typical neuroleptic agents to cause EPS is based one which of the following properties of atypical antipsychotics?
RAPID DISSOCIATION FROM D2 RECEPTORS
35 y/o pt is started on a trial of clozapine for treatment-refractory schizoaffective disorder. During the initial medication titration, pt complains of sedation and orthostatic hypotension as well as flu-like symptoms, but seems symptomatically improved. However after a dose increase from 150 to 200mg, pt develops a fever to 102 degrees, tachycardia to 130bpm, and an acute metal status change. CXR, urine studies, and blood culture are unremarkable. A CBC reveals a WBC of 11.4, with an elevated eosinophil percent of 7%. Which known toxic risk of clozapine is the most likely Dx?
MYOCARDITIS
A 30yo w. 5yo hx of Schizophrenia, prior failed Haldol and Risperidone trial, despite adherent to meds continues to have severe psychotic symptoms. Med recommendation at this time is..
CLOZAPINE
30 yo on Clozapine for treatment resistant schizophrenia presenting with dyspnea, orthostatic hypotension and HR 130bpm. Elevated Eosinophil , EKG with non-specific T wave changes. Further most likely test to guide treatment
TROPONIN LEVEL
What lab finding is most typically associated with NMS?
INCREASED CREATINE KINASE LEVELS
Appropriate management of neuroleptic malignant syndrome:
HYDRATION AND COOLING
Antipsychotics are associated with what?
DYSTONIA, POIKILOTHERMY, LIPID SOLUBILITY, AND LOWER SEIZURE THRESHOLD
Which of the following effects is the basis for dantrolene’s efficacy in the treatment of neuroleptic malignant syndrome (aka nms)?
SKELETAL MUSCLE RELAXANT
32 y/o pt with hx of schizoaffective d/o stable on clozapine is admitted to internal medicine service for a severe GI viral infection. Pt is confused, slow, appears visibly ill and tired. Pt c/o stiffness and there is some rigidity to the movements. What should be recommended?
DISCONTINUE CLOZAPINE
Which antipsychotic has least effect on prolactin?
CLOZAPINE
A slow titration of Clozapine is required to decrease the risk of:
SEIZURES
Which neuroleptic has the weakest affinity for the dopamine D2-like receptor?
CLOZAPINE
Clozapine clearance decreased by
CIMETIDINE
Which med is contra-indicated with clozapine?
CARBAMAZEPINE
Schizophrenic on haldol 5mg presents to ED “unable to see.” Appears distressed, writhing and moaning. States “I’m unable to stop looking up.” What is the best treatment?
ADMINISTER BENZTROPINE 1MG IV NOW
What manifestations is the most common side effect of conventional antipsychotic meds?
AKATHISIA
What antipsychotic medication would be the best choice to avoid motor symptoms in Parkinson’s disease?
CLOZAPINE
What antipsychotic medication is helpful in treating Tourette’s?
HALOPERIDOL
Pt develops feelings of restlessness, an inability to relax, jitteriness, pacing, and rapid alternation of sitting and standing shortly after being started on a low dose of haloperidol. Addition of what medications would be most effective in managing these symptoms?
ATENOLOL
The therapeutic effect of 2nd generation antipsychotics on negative symptoms of schizophrenia is thought to be related to the induction of expression in what area of the brain?
PREFRONTAL CORTEX
Psych MD orders quetiapine 50 mg for an 82 y/o nursing home pt w/ dementia who has become severely agitated. Soon after, the psychiatrist receives a call from a family member who is concerned about the “black box” warnings associated with antipsychotics in the elderly. Which of the following is the most accurate information the psychiatrist could give the family member regarding the potential safety risks of this medication? (x2)
ATYPICAL ANTIPSYCHOTICS INCREASE MORTALITY; THIS MUST BE BALANCED AGAINST ANY POTENTIAL BENEFIT
Blockade of dopamine receptors in tuberoinfundibular tracts results in breast enlargement, galactorrhea, impotence, and amenorrhea. Mechanism is increase of:
PROLACTIN
Correlation of plasma drug concentration with the clinical effectiveness is best established for which antipsychotics?
CLOZAPINE AND HALOPERIDOL
Acutely psychotic pt started on risperdal 2 mg qhs. Increased to 3 mg BID over next few days. Pt becomes increasingly agitated, restless, unable to stop pacing. Most appropriate intervention?
ADD PROPRANOLOL 10 MG TID
Psychotic pt given haldol, acute laryngospasm. In addition to intubation, give:
COGENTIN
Schizophrenic OD’d on antipsychotics, has EPS and urinary retention. Tx?
AMANTADINE
Pts over 65 y/o are less likely to tolerate higher doses of antipsychotics due to:
DECREASED HEPATIC METABOLISM
25 y/o pt is brought to the ED with a sudden onset of severe spasms of the neck and eyes deviated up and to the right. The pt has had a viral illness with nausea and vomiting and was given prochlorperazine yesterday. Which of the following meds would be most appropriate to prescribe for this patient?
DIPHENHYDRAMINE
A neonate has transient hyperreflexia, irritability, and tremors followed by a period of depressed interactive behavior and poor response to environmental stimuli. What did the childs mother use?
OLANZAPINE
In the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, which medication was the most effective due to its low rate of discontinuation, high reduction in psychopathology, and longest time to discontinuation of treatment
OLANZAPINE
Patient started on clozapine for treatment-resistant schizophrenia has initial ANC of 2200/mm3. How frequently should you get a CBC with diff?
WEEKLY
greatest risk factor for developing akathisia? Male sex, younger age, rapid dose escalation, lower potency agents, positive symptoms
RAPID DOSE ESCALATION
Quetiapine is known to develop diabetes, if starting metformin, this is an example of what kind of prevention? (primary, secondary, tertiary or quaternary?)
TERTIARY
