Exam #02 - Antipsychotics Flashcards
Which of the following statements about schizophrenia are false:
A. Schizophrenics have significant cognitive impairment
B. Has an early onset (~23 y/o)
C. Suicide is the most frequent cause of death
D. A single gene has been implicated in the development of the disease
E. Worlwide incidence is 1.1%
(D)
No single gene has been implicated in the development of schizophrenia. There are (3) susceptibility genes involved in neurodevelopment: DISC-1, neuroregulin, and dysbindin. If a child has these susceptibility genes, they are primed to develop schizophrenia.
True or False - there is a higher likelihood of developing schizophrenia if your parents or relatives have schizophrenia?
True - schizophrenia is hereditary
What causes the early onset of schizophrenia?
DA surge in late adolescence + alterations in neuronal development (brain circuitry) correlates with first psychotic break associated with schizophrenia
[Neurodevelopmental Hypothesis]
All of the following represent anatomical differences seen in a schizophrenic brain compared to a normal brain, except a schizophrenic brain has…?
A. Enlarged ventricles B. Reduction in white matter C. Reduction in hippocampus D. Decrease in dendritic spines E. All of the above are true
(E) all the above are true
The decrease in hippocampus volume is a logical difference since this is the region associated with cognition/memory and schizophrenic patients have severe cognition/memory impairment
Which of the following symptoms of schizophrenia are associated with cognitive impairment:
A. memory B. thought disorganization C. plan and organize D. A & C E. All of the above
(D)
Problems with memory and ability to plan and organize are symptoms associated with schizophrenic cognitive impairment. Thought disorganization is a positive symptom, not a cognitive impairment
All of the following statements regarding schizophrenia are true, except:
A. Decreased ability to express emotion is a negative symptom
B. Most patients are impaired in all three symptom domains (positive, negative, cognitive)
C. Positive symptoms are a result of dopaminergic overactivity in mesolimbic pathway
D. Negative symptoms are a result of dopaminergic overactivity in mesocortical pathway
E. Cognitive impairment is a result of decreased activity in mesocortical pathway
(D)
Negative symptoms are a result of DECREASED dopaminergic activity in mesocortical pathway
Which of the following symptoms of schizophrenia are associated with positive symptoms:
A. Unusual thoughts and perceptions B. Delusions C. Thought disorganization D. Hallucinations E. All of the above
(E) all of the above are positive symptoms
True or False - currently, there are no effective treatment options for CIS (cognitive impairment symptoms)
True
True or False - a stabilized schizophrenic with positive/negative symptoms controlled, are able to function in society like a normal individual?
False - although their psychotic symptoms are controlled, they are still plagued by cognitive impairment and cannot do simple things like planning out their day, read a bus schedule, or hold a job
Which region of the brain is associated with hyperprolactinemia in patients given antipsychotics (D2 antagonists)?
Tuberoinfundibular pathway - DA released at this site regulates secretion of prolactin from anterior pituitary gland. Antipsychotics block DA in this pathway resulting in increase in blood prolactin levels which can lead to abnormal lactation (even in males)
Which of the following drugs would NOT produce hallucinations:
A. Amphetamine B. Cocaine C. L-DOPA D. Risperidone (Risperdal ®) E. All of these drugs would produce hallucinations
(D)
Risperidone (Risperdal ®) is an atypical antipsychotic used in the treatment of schizophrenia. It TREATS positive symptoms, which include hallucinations
Which of the following statements regarding NMDA receptor are false:
A. It is ionotropic
B. Activation requires glutamate and glycine
C. Agonist binding allows positive ion flow into cell
D. Ketamine would block NMDA receptor
E. None of the above
(E) all are true
True or False NMDA antagonists like Ketamine and PCP can precipitate psychotic symptoms?
True - NMDA antagonists increase DA in mesolimbic pathway and decrease DA in prefrontal cortex; the same pathology seen in schizophrenic patients.
[Glutamate Hypothesis of Schizophrenia]
Blocking glutamate and glycine agonist activity at the NMDA receptor with an NMDA antagonist results in psychotic symptoms
All of the following statements regarding schizophrenia are true, except:
A. glutamate (NMDA) hypofunction results in disinhibition of GABA
B. weight gain is a common AE seen in typical antipsychotic agents
C. core element of atypical antipsychotics is 5-HT2a antagonism
D. prolonged use of antipsychotic drugs increases the risk of tardive dyskinesia
E. decrease of DA in prefrontal cortex is associated with psychotic symptoms
(B)
weight gain is a common AE seen in ATYPICAL antipsychotic agents
Glutamate (NMDA) hypofunction results in disinhibition of GABA - body is not producing as much glutamate (excitatory) so it reacts by not producing as much GABA (inhibitory) to regulate the balance of excitatory and inhibitory control
Tardive dyskinesia is slow, jerky uncontrolled movements that come from prolonged use of antipsychotic use. EPS are more transient than tardive dyskinesia
Which of the following are NOT adverse effects associated with typical antipsychotics:
A. EPS
B. Hyperprolactinemia
C. Tardive dyskinesia
D. Dyslipidemia
(D)
Dyslipidemia is a common AE of ATYPICAL antipsychotics
All of the following are primarily D2 antagonists, except:
A. Chlorpromazine B. Haloperidol C. Clozapine D. Thioridazine E. Fluphenazine
(C) Clozapine is an ATYPICAL antipsychotic whose MOA is primarily 5-HT2A antagonism
Haloperidol is a typical antipsychotic and DA inverse agonist
Which of the following statements regarding atypical antipsychotics are false:
A. effective in positive symptoms B. increased metabolic dysfunction C. QTc prolongation D. no FDA blackbox warning E. little or no EPS
(D)
Both typical and atypical antipsychotics carry a black box warning that states increased risk of mortality in elderly patients when used for dementia related psychosis
Which of the following statements regarding atypical antipsychotics is false:
A. weight gain and dyslipidemia are common AE’s
B. has only 5HT2A antagonist effects
C. less endocrine effects than 1st generation antipsychotics
D. use caution in diabetes patients
E. Aripiprazole (Abilify ®) is one example
(B) Atypical antipsychotic agents have both D2 and 5HT2A antagonist effects (but primarily 5HT2A antagonism)
Give the trade name for the following generic drugs used to treat schizophrenia:
Risperidone Olanzapine Ziprasidone Clozapine Quetiapine Aripiprazole Paliperidone Asenapine
Risperidone (Risperdal ®) Olanzapine (Zyprexa ®) Ziprasidone (Geodon ®) Clozapine (Clozaril ®) Quetiapine (Seroquel ®) Aripiprazole (Abilify ®) Paliperidone (Intega ®) Asenapine (Saphris ®)
Which drug used to treat schizophrenia is the highest risk agent for QTc prolongation?
Ziprasidone (Geodon ®)
Which drug used to treat schizophrenia is the active metabolite of risperidone?
Paliperidone (Intega ®)
Which drug used to treat schizophrenia has a large 1st pass effect and therefore only available in sublingual form?
Asenapine (Saphris ®)
True or False - weight gain due to atypical antipsychotic use is primarily from H1 and 5HT2C antagonism
True
True or False - QTc prolongation due to atypical antipsychotic use is primarily from the small D2 antagonist effects?
False - it has nothing to do with D2 antagonist effects. It is primarily from BLOCKING CARDIAC CHANNEL
The correct order of drugs regarding D2 binding potency from least to most is:
A. Olanzapine, Quetiapine, Clozapine, Ziprasidone, Risperidone
B. Clozapine, Olanzapine, Quetiapine, Risperidone, Ziprasidone
C. Olanzapine, Clozapine, Quetipine, Ziprasidone, Risperidone
D. Clozapine, Quetiapine, Olanzapine, Ziprasidone, Risperidone
(D) - Clozapine has the least D2 binding potency (and therefore the least EPS) and Risperidone has the highest D2 binding potency (and therefore more EPS)
True or False - the optimal range of % occupancy of D2 receptors to delivery antipsychotic effects by antipsychotic drugs is 60-80%
True - above 80% you will start to see EPS
All of the following are options to manage EPS side effects of typical antipsychotics, except:
A. Lower antipsychotic dose B. Add Cogentin or Artane to treat the AE (EPS) C. Change to an atypical antipsychotic D. Add another typical antipsychotic E. None of the above
(D) - you would NOT want to add another typical antipsychotic. Patient is experiencing EPS from D2 antagonism and adding another D2 antagonist would make it worse
You can lower the dose but you’d still want to stay in the optimal range of 60-80% where antipsychotic effects are seen
Benzotropine (Cogentin ®) and Trihexyphenidyl (Artane ®) are anticholinergic drugs that are added to treat the AE (EPS)
Which of the following statements is FALSE:
A. Olanzapine is dosed once a day
B. Aripiprazole is a partial D2 agonist with 5HT2a antagonism
C. Zyprexa is associated with significant weight gain
D. Clozapine has the lowest D2 affinity relative to any other antipsychotic
E. Abilify has a higher risk of EPS and hyperprolactinemia than other antipsychotics
(E)
Aripiprazole (Abilify ®) has a LOWER risk of EPS and hyperprolactinemia because it is only a partial D2 antagonist
Olanzapine (Zyprexa ®) is dosed once a day and is associated with significant weight gain (as is Clozapine)
Which (2) antipsychotic drugs are implicated in significant weight gain liability?
- Clozapine
- Olanzapine
From binding to 5-HT2C and H1 antagonist
True or False - The partial agonist effects at 5HT1A receptors seen from Ziprasidone and Aripiprazole is thought to contribute to improvement in cognitive impairment
True
Which antipsychotic is an effective Tx for bipolar mania and can also be used as adjunctive therapy in patients with major depressive disorder?
Aripiprazole (Abilify ®)
True or False - Abilify’s MOA as an antipsychotic is unique in that it lowers dopaminergic neurotransmission in mesolimbic pathway and enhances dopaminergic activity in mesocortical pathway?
True - it addresses typical pathology of schizophrenia
Which of the following statements about Clozapine (Clozaril ®) is correct?
A. not used in patients experiencing 1st psychotic break (for refractory patients) B. causes increased salivation C. weight gain is a common AE D. can cause agranulocytosis E. all of the above
(E) all are correct
Which (3) antipsychotics have the greatest QTc prolongation liability?
In order from greatest liability to least
- Thioridazine
- Ziprasidone
- Risperidone
Which of the following antipsychotics would be most appropriate for a schizophrenic patient with considerable compliance problems?
A. Ziprasidone B. Fluphenazine decanoate C. Aripiprazole ER D. Quetiapine E. B and C
(E)
Fluphenazine decanoate (Prolixin ®) and Aripiprazole ER (Abilify Maintena ®) are both sustained release formulations for schizophrenic patients that don’t have the ability to take their medication
Ziprasidone and Quetiapine are just atypical antipsychotic drugs
This disease is characterized by alternating states of mania, depression, and mood moderation (euthymia)?
Bipolar disorder
All of the following statements about Lithium are true, except?
A. Lithium is an effective Tx for bipolar disorder
B. Lithium inhibits glycogen synthase kinase 3 (GSK-3)
C. Lithium causes increased appetite
D. Lithium modulates cellular signaling on inside of cell
E. Lithium inhibits inositol phophates (IP3)
(C) - lithium actually causes LOSS of appetite
All of the following are AE of lithium, except:
A. Sedation B. Dizziness C. Fine hand tremors D. Increased production of urine and excessive thirst E. constipation
(E) - lithium actually causes MILD DIARRHEA, not constipation
What is the only antipsychotic that can be used as monotherapy approved by the FDA for bipolar depression?
Quetiapine
What (2) drugs are effective treatment for both acute Tx and maintenance Tx of Bipolar disorder?
- Lithium
2. Valproate
