Antipsychotics (Segars)

Question 1

Specific indication Clozapine

Answer 1

recurrent suicidal behavior

Question 2

specific indication Pimavanserin

Answer 2

hallucinations/delusions associated with parkinsons disease psychosis

Question 3

Dopamine pathway responsible for positive symptoms of schizophrenia

Answer 3

overactivity of the mesolimbic pathway

Question 4

dopamine pathway responsible for the negative and cognitive symptoms of schizophrenia

Answer 4

mesocortical pathway dysfunction

Question 5

positive symptoms of schizophrenia (5)

Answer 5

• hallucinations
• delusions
• disorganized speech/thinking
• agitation
• abnormal motor behavior

Question 6

negative symptoms of schizophrenia (5)

Answer 6

• apathy
• avolition
• alogia
• cognitive deficits (working memory)
• social withdrawal

Question 7

primary difference between first generation and second generation antipsychotics

Answer 7

reduced movement disorder side effects in second generation agents

Question 8

receptors blocked by first generation antipsychotics (4)

Answer 8

1) primarily D2 post-synaptic receptors
2) Muscarinic
3) H1 receptors
4) alpha-1 receptors

Question 9

first generation anti-psychotics low potency agents (2)

Answer 9

1) thioridazine

2) chlorpromazine

Question 10

first generation anti-psychotics high potency agents (2)

Answer 10

1) fluphenazine

2) haloperidol

Question 11

first generation anti-psychotics low potency agent side effects

Answer 11

more sedation, hypotension and seizure-threshold reduction

Question 12

first generation anti-psychotics high potency agent side effects

Answer 12

more movement (EPS) and endocrine effects (prolactin)

Question 13

treatments for extrapyramidal symptoms (EPS) (2)

Answer 13

1) anticholinergic agents (benztropine and trihexyphenidyl)

2) antihistamine agents (diphenhydramine)

Question 14

treatments for tardive dyskinesia

Answer 14

selective vesicular monoamine transporter 2 (VMAT2) inhibitors:

1) valbenazine
2) deutetrabenazine

Question 15

suffix of VMAT2 inhibitors

Answer 15

• benazine

Question 16

Second generation antipsychotics MOA (general)

Answer 16

stronger 5HT-2A receptor blockers than D2 receptor blockers

Question 17

Suffix second generation antipsychotics that are 5HT-2A/DA receptor antagonists

Answer 17

• idone

Question 18

Suffix second generation antipsychotics that are partial DA/5HT-1A receptor agonists

Answer 18

• piprazole

Question 19

Suffix second generation antipsychotics that are multi-acting receptor-target agents

Answer 19

• apine

Question 20

second generation antipsychotic that is an inverse serotonin agonist/antagonist

Answer 20

Pimavanserin (for parkinsons psychosis)

Question 21

MOA Cariprazine (2)

Answer 21

1) 5HT-2A/DA receptor antagonist

2) partial DA/5HT-1A receptor agonist

Question 22

Main side effects second generation antipsychotics

Answer 22

metabolic effects/weight gain

Question 23

What second generation antipsychotic causes agranulocytosis rarely? How is this monitored?

Answer 23

Clozapine; monitor WBC and enroll in REMS program

Question 24

What is a rare side effect of Olanzapine

Answer 24

drug reaction with eosinophilia and systemic symptoms (DRESS)

Question 25

treatment for neuroleptic malignant syndrome

Answer 25

Dantrolene

Question 26

What should be monitored for patients taking second generation antipsychotics

Answer 26

• serum glucose
• lipids
• weight
• blood pressure
• waist circumference

Question 27

what is critical to treatment of psychotic disorders?

Answer 27

ADHERENCE

Question 28

How can treatment non-adherence be managed?

Answer 28

Long-Acting Injectable Agents (LAIAs)

Question 29

First generation LAIAs (2)

Answer 29

1) haloperidol decanoate

2) fluphenazine decanoate

Question 30

Second generation LAIAs (4)

Answer 30

1) Risperidone
2) Olanzapine
3) Aripiprazole lauroxil
4) Paliperidone palmitate
(ROAP)