Antipsychotics

Question 1

Not only was this drug the first antipsychotic, it was the first psychotropic medication of any kind

Answer 1

chlorpromazine (Thorazine)

Question 2

Typical antipsychotics are divided into these two categories which also correlates to their D2 receptor’s binding affinity

Answer 2

high potency & low potency

Question 3

This typical antipsychotic is available PO, IM, & IV; is commonly used to treat agitated patients in hospitals/ER’s; & can be used to treat Tourette’s syndromes

Answer 3

haloperidol (Haldol)

Question 4

Name 3 anticholinergic medications commonly used to counter EPS side effects:

Answer 4

trihexyphenidyl (artane), benztropine (cogentin), & diphenhydramine (Benadryl)

Question 5

When used in their long acting injectable form, these 2 FGA’s are given IM every 2-4 weeks to treat patients with chronic schizophrenia

Answer 5

haloperidol (Haldol) & fluphenazine (Prolixin)

Question 6

This type of typical antipsychotic is anti-cholinergic, anti-histaminic, & an α1 adrenergic antagonist

Answer 6

low potency antipsychotics Chlorpromazine (thorazine)

Question 7

While prochlorperazine (Compazine) is a D2 blocker it is more commonly used for this than its antipsychotic properties

Answer 7

antiemetic properties

Question 8

This antipsychotic can also be used to treat intractable hiccups

Answer 8

chlorpromazine (Thorazine)

Question 9

This typical antipsychotic has the greatest risk of any antipsychotic for dose dependent QTc prolongation, torsades de pointes, and cardiotoxicity

Answer 9

thioridazine (Mellaril)

Question 10

Even though its the most efficacious antipsychotic, its side effect profile prevents this drug from consideration for first line use

Answer 10

Clozapine (Clozaril)

Question 11

This atypical antipsychotic is used to treat psychosis in Lewy Body Dementia & Parkinson’s Disease due to its low likelihood of EPS

Answer 11

quetiapine (Seroquel)

Question 12

These 2 atypical antipsychotics are available in a long acting injectable form & have the highest risk among atypicals of causing prolactin elevation

Answer 12

risperidone (Risperdal) & paliperidone (Invega)

Question 13

These two atypicals are most likely to cause side effects of significant sedation and the metabolic syndrome

Answer 13

olanzapine (Zyprexa) and clozapine (Clozaril)

Question 14

Of all the SGA’s, this medication has the highest risk of causing QTc prolongation

Answer 14

ziprasidone (Geodon)

Question 15

This SGA is a partial dopamine agonist & commonly has the side effect akathisia

Answer 15

aripiprazole (Abilify)

Question 16

This atypical antipsychotic is FDA approved for adjunct treatment of major depression

Answer 16

aripiprazole (Abilify)

Question 17

Due to the risk of seizure induction, slow dose titration must be done for this atypical antipsychotic

Answer 17

clozapine (Clozaril)

Question 18

Name the most metabolically “neutral” antipsychotics

Answer 18

Lurasidone (latuda), asenapine (saphris), ziprasidone (geodone), aripiprazole (abilify)

Question 19

More common with typical antipsychotics, this side effect is characterized by repetitive, involuntary, purposeless movements

Answer 19

Tardive Dyskinesia

Question 20

For a patient taking Clozapine (Clozaril) this is done when the WBC is < 2,000 or the absolute neutrophil count is < 1,000

Answer 20

abrupt stop (abrupt stop → rebound psychosis; do gradual taper when possible)

Question 21

Due to the risk of metabolic syndrome, patients on atypical antipsychotics should have their weight, waist circumference and these 2 labs monitored regularly

Answer 21

glucose & lipids

Question 22

Clozapine (clozaril), Quetiapine (seroquel), Iloperidone (fanapt), Risperidone (risperdal) Paliperidone (invega) ——————————————– All may cause dose dependent orthostatic hypotension due to this

Answer 22

α1 adrenergic antagonism (undesirable in elderly pts & pts at risk for falls)

Question 23

There is a blackbox warning for the use of antipsychotics in elderly dementia patients due to increased risk of this

Answer 23

sudden death (cardiovascular cause)

Question 24

This atypical antipsychotic may cause dry mouth due to its anticholinergic properties, but ironically it may also cause excess salivation

Answer 24

clozapine (Clozaril)

Question 25

SGA’s work primary by blocking these 2 receptors

Answer 25

D2 & 5HT2A receptor

Question 26

The positive symptoms of schizophrenia are due to hyperactivity of what dopamine tract?

Answer 26

The Mesolimbic Pathway

Question 27

Excess blockade of this dopamine tract may cause infertility, galactorrhea, & osteopenia

Answer 27

The Tubuloinfundibular Pathway

Question 28

When switching to aripiprazole (abilify) from a different antipsychotic, before the other antipsychotic has washed out, the aripiprazole (abilify)—at least in theory— initially does this at the D2 receptors

Answer 28

acts as a dopamine agonist (When switching to abilify, need to switch slowly or have a washout period)

Question 29

The percentage of D2 occupancy necessary for the antipsychotic effect is this

Answer 29

60%

Question 30

This percentage of occupancy at D2 is believed to be associated with elevated prolactin and/or EPS

Answer 30

~80%

Question 31

While NMS is uncommon to rare (incident rate 0.02-3%), its cause is this

Answer 31

dopamine antagonism

Question 32

Hypoactivity of this dopamine tract is believed to be associated with the development of negative symptoms

Answer 32

The mesocortical pathway

Question 33

The SGA with the unique mechanism of action of partial dopamine agonism is this

Answer 33

aripiprazole (Abilify)

Question 34

Which antiemetic medications are D2 blockers and may cause EPS or TD

Answer 34

Prochlorperazine (Compazine) Metoclopramide (Reglan) Droperidol (Inapsine) Promethazine (Phenergan)

Question 35

About 75% of pts with schizophrenia do this unhealthy activity which also induces an increased metabolic rate of antipsychotic medications

Answer 35

cigarette smoking

Question 36

While not diagnostic for NMS (it may be normal if there is not clearly well developed rigidity), this lab’s degree of abnormality correlates with the disease severity & prognosis

Answer 36

creatine kinase

Question 37

Antipsychotics approved for the treatment of bipolar depression are olanzapine/fluoxetine (symbyax), lurasidone (latuda), and this

Answer 37

quetiapine (Seroquel)

Question 38

This atypical has a significant risk of causing hyperprolactinemia, is the active metabolite of risperidone (Risperdal), and needs to be taken with food

Answer 38

paliperidone (Invega)

Question 39

The 4 SGA’s that are available in long acting injectable preparations are:

Answer 39

risperidone (Risperidal Consta) olanzapine (Zyprexa Relprevv) paliperidone (Invega Sustenna) aripiprazole (Abilify Maintena)

Question 40

Antipsychotic side effects of sedation & weight gain are likely due to antagonist activity at this receptor

Answer 40

Histamine (H1)

Question 41

This demographic is at the greatest risk for dystonia from antipsychotics

Answer 41

young males

Question 42

While muscular rigidity, hyperthermia, & autonomic stability are all common symptoms of NMS, most often this symptom presents first

Answer 42

mental status changes

Question 43

The picture showsa pt experiencing this EPS side effect

Answer 43

Dystonia

Question 44

The antipsychotic side effect seen in this patient is this

Answer 44

oculogyric crisis

Question 45

The picture shows a patient with this D2 blocking medication side effect

Answer 45

gynecomasitia (From hyperprolactinemia)