Schizo/psychosis Flashcards
Select the correct chemical class for Haldol: Answer
A Phenothiazine B Butyrophenone C Synthetic pentasaccharide D Dopamine and 5HT3-partial agonist E NE and 5HT3-blocker
B
Butyrophenone
Incorrect
The butyrophenones haloperidol (Haldol) and droperidol (Inapsine) are among the agents with the highest QT-risk. They are dopamine-blockers.
Next
Byron Grey is a 34 year-old male diagnosed with schizophrenia. He presents to the clinic for routine follow-up and for his monthly injection of Invega Sustenna, which he has been taking for 11 months. His past medical history includes obesity, hypertension, hyperlipidemia and two suicide attempts. His medications include amlodipine 10 mg PO daily and atorvastatin 40 mg PO at HS. He smokes 1/2 pack of cigarettes per day. Which of the following medications can be given monthly or less frequently than monthly? (Select ALL that apply.)
Answer
A Rexulti B Risperdal Consta C Abilify Maintena D Invega Trinza E Haloperidol decanoate
C Abilify Maintena D Invega Trinza E Haloperidol decanoate
Incorrect
Rexulti is given daily and Risperdal Consta is administered every 2 weeks. Abilify Maintena and haloperidol decanoate are both given every month. Invega Trinza is given IM every 3 months. Patients must tolerate at least four months of Invega Sustenna before transitioning to Invega Trinza.
A 23 year-old male was picked up by the police for acting erratically and threatening patrons at a subway stop. He was placed into the acute lock-down ward of the psychiatric hospital and given an injection of haloperidol and lorazepam. He quickly developed a very painful sustained contraction of his neck and trunk. Choose the correct statements concerning this adverse drug reaction: (Select ALL that apply.)
Answer
A
He is likely experiencing a dystonic reaction due to lorazepam.
B
He is higher risk and should have received prophylaxis for this reaction.
C
He is experiencing a symptom due to the disease state (schizophrenia).
D
He is likely experiencing a dystonic reaction due to haloperidol.
E
He can be treated with a centrally-acting anticholinergic, such as diphenhydramine.
B
He is higher risk and should have received prophylaxis for this reaction.
D
He is likely experiencing a dystonic reaction due to haloperidol.
E
He can be treated with a centrally-acting anticholinergic, such as diphenhydramine.
Incorrect
Treatment for dystonic reactions is with centrally-acting anticholinergics (such as benztropine and diphenhydramine). These are administered by injection for fast relief, or can be given orally for prophylaxis during therapy initiation. Although any patient can experience this adverse event, the highest risk group for dystonic reactions is young males.
Doris Brass is a 72 year-old female caregiver for her husband Edward Brass, who is suffering from dementia. Recently, to Ms. Brass’s very sad surprise, her husband struck her while she was helping him eat. She asked the physician for help and he prescribed risperidone 1 mg BID. The pharmacist should inform Ms. Brass of the risk of using this medicine (and the mild, if any, benefit). The pharmacist should inform her that there may be a slightly increased risk of serious, possibly fatal, side effects when this medication is used in older adults with dementia primarily due to an increased risk of the following: (Select ALL that apply.)
Answer
A Myocardial infarction B Cerebrovascular accident C Renal failure D Decreased sodium bicarbonate, coma E Infection
A
Myocardial infarction
B
Cerebrovascular accident
E
Infection
Correct
All of the antipsychotics have a boxed warning for an increased risk of mortality in elderly patients with dementia-related psychosis, primarily due to an increased risk of cardiovascular disease or infections.
A female patient has been taking haloperidol 1 mg BID. Her family noticed an unusual “smacking” motion made with her lips and unusual eye movements. Choose the correct statements: (Select ALL that apply.)
Answer
A
This can be treated with an anticholinergic such as diphenhydramine.
B
The movement disorder can be successfully treated with a skeletal muscle relaxant.
C
If the haloperidol is not discontinued quickly there is a risk that the abnormal movement will become permanent.
D
The haloperidol should be discontinued; she will have to try an alternative antipsychotic.
E
This can be treated by lowering the dose of haloperidol.
C
If the haloperidol is not discontinued quickly there is a risk that the abnormal movement will become permanent.
D
The haloperidol should be discontinued; she will have to try an alternative antipsychotic.
Incorrect
On any antipsychotic the patient and/or caregivers should be instructed to contact the doctor about any movements that they cannot control in your face, tongue, or other body parts, as they may be signs of a serious condition called tardive dyskinesia. Tardive dyskinesia (TD) can be irreversible; the drug that is causing the problem should be discontinued as soon as a TD develops.
Brian McGough is a 24 year-old male who has failed trials with olanzapine and ziprasidone. The psychiatrist plans to initiate clozapine therapy and sends the patient to have a CBC drawn. The patient cannot be started on clozapine therapy if the absolute neutrophil count (ANC) is below:
Answer
A 500/mm^3 B 1,000/mm^3 C 1,500/mm^3 D 3,000/mm^3 E 4,500/mm^3
C
1,500/mm^3
Incorrect
Clozapine is the most effective agent for refractory schizophrenia (cases that do not respond to other treatments.) Unfortunately, agranulocytosis (loss of granulocytes, which are required to fight infection) limits the use of this medication, along with a risk of seizures. Do not initiate clozapine if the ANC is below 1,500. Therapy must be interrupted if the ANC drops to < 1,000 during treatment.
A pharmacist will counsel a patient beginning therapy with Saphris. Which of the following are correct counseling statements? (Select ALL that apply.)
Answer
A
Do not eat or drink for at least an hour after taking this medicine.
B
The medicine can make the tongue numb.
C
Place the tablet under the tongue and allow it to dissolve completely.
D
This medication can make the patient feel “wired” and may cause difficulty sleeping.
E
If the patient has any uncontrollable movements of the mouth, tongue, cheeks, jaw, or arms or legs, please contact a healthcare provider right away.
B
The medicine can make the tongue numb.
C
Place the tablet under the tongue and allow it to dissolve completely.
E
If the patient has any uncontrollable movements of the mouth, tongue, cheeks, jaw, or arms or legs, please contact a healthcare provider right away.
Correct
Do not eat or drink for ten minutes after taking this medicine. Saphris is sedating. It has about a 5% risk of EPS.
A 28 year-old female patient experienced high prolactin levels while using the atypical agent risperidone. She experienced decreased, irregular menstrual periods. She found this very bothersome and discontinued the drug. Which of the following agents would put her at repeated risk for the same adverse reaction?
Answer
A Paliperidone B Aripiprazole C Clozapine D Quetiapine E Asenapine
A
Paliperidone
Incorrect
Paliperidone is the active metabolite of risperidone. It is formulated in an OROS delivery, and is able to be dosed once daily. It has a similarly high risk of movement disorders, hyperprolactinemia and QT prolongations as risperidone. Elevated prolactin levels decrease menstrual period frequency in women and can cause infertility. Galactorrhea may be present. In men it can cause sexual dysfunction, and visual problems. With very high levels, gynecomastia can occur.
Ruby Reynolds has been diagnosed with schizophrenia and has been prescribed risperidone. Her heart rate becomes tachycardic and the physician wishes to use an agent with the lowest cardiovascular risk. Choose the agent on the patient’s formulary that is not considered to be among the higher risk options:
Answer
A Thioridazine B Paliperidone C Ziprasidone D Haloperidol E Lurasidone
E
Lurasidone
Correct
Thioridazine (Mellaril) and ziprasidone (Geodon) should be two of the antipsychotics that stick in your mind as “high QT risk.” Most have some QT risk.
