Schizophrenia/Psychosis Flashcards
A pt prescribed risperidone experienced weight gain and had trouble managing his diabetes. Which of the following antipsychotics has a lower risk of metabolic side effects?
a. Paliperidone
b. Olanzapine
c. Aripiprazole
d. Quetiapine
e. Clozapine
c
Of the 2nd gen (“atypical”) antipsychotics, aripiprazole, ziprasidone, and lurasidone have a lower risk of metabolic syndrome (weight gain, increased blood glucose, and increased lipids)
JK is a 72 y/o female with a variety of medical conditions. 2 years ago, her family reported that she was displaying paranoid delusions, including the belief that her daughter was trying to kill her by poisoning her food. The Dr prescribed risperidone, which has been helpful. At clinic today, JK is darting her tongue in and out and blinking in an involuntary manner. She’s displaying the following AE from the use of an antipsychotic:
a. Dystonic reaction
b. Tardive dyskinesia
c. Akathisia
d. Neuroleptic malignant syndrome
e. Sedation
b
-TD - involuntary movement of the tongue, lips, face, trunk, and extremities that occur in pts treated with long-term dopamine-blocking agents. If they occur the drug should be stopped. TDs can be irreversible
-Dystonic reaction - intermittent spasmodic or sustained involuntary contractions of muscles of the face, neck, trunk, pelvis, extremities, and even the larynx
-Akathisia - inability to remain still
-Neuroleptic malignant syndrome - life-threatening, neurological disorder that includes symptoms of high fever, sweating, unstable BP, stupor, muscle rigidity, and autonomic dysfunction
CF is a 74 y/o female who has a unilateral tremor in her right hand consistent with Parkinson disease. The Dr needs to choose an antipsychotic for CF. Which of the following agents has the lowest risk for movement disorders?
a. Paliperidone
b. Chlorpromazine
c. Lurasidone
d. Quetiapine
e. Risperidone
d
Of the 1st and 2nd gen antipsychotics, quetiapine has a lower risk of extrapyramidal side effects and is often a DOC for pts with psychosis and Parkinson disease.
DB is a 72 y/o male who’s suffering from dementia. Recently, DB struck his wife while she was helping him eat. The wife asked the Dr for help, and DB was prescribed risperidone 1 mg BID. The pharmacist is concerned about which safety issue if DB takes the med prescribed?
a. Lupus-like syndrome
b. Cerebrovascular accident
c. Renal failure
d. Bronchospasm
e. Gingival hyperplasia
b
All of the antipsychotics have a BBW for an increased risk of mortality in elderly pts with dementia-related psychosis, primarily d/t CV and infectious causes. Several antipsychotics also have warnings for an increased risk of stroke in pts with dementia.
Which of the following Rx drug classes may induce or exacerbate psychotic symptoms?
a. Systemic steroids
b. Finasteride or dutasteride
c. Sinemet
d. Mirapex
e. Adderall
a, c, d, e
Drugs that can cause psychotic symptoms:
Anticholinergics (centrally-acting, high doses)
Dextromethorphan
Dopamine or dopamine agonists (e.g., Requip, Mirapex, Sinemet)
Interferons
Stimulants
Systemic steroids (typically with lack of sleep - ICU psychosis)
Bath salts
Weed
Cocaine
LSD
Meth, ice, crystal
PCP
A 28 y/o female pt 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 AE?
a. Paliperidone
b. Aripiprazole
c. Clozapine
d. Quetiapine
e. Asenapine
a
Paliperidone is the active metabolite of risperidone.
RR is a 27 y/o female graduate student who’s seen mumbling to herself repeatedly in class. When confronted, it’s apparent that RR believes she’s talking to someone. Choose the response that best describes the symptom of schizophrenia displayed by this pt:
a. Delusion
b. Hallucination
c. Poor hygiene
d. Lack of emotion
e. Loss of interest in everyday activities
b
AB has been taking an atypical antipsychotic as an adjunctive agent to treat resistant depression. After beginning the antipsychotic, she began to have feelings of restlessness and an urge to move. She states she can’t keep her legs still. AB is displaying what AE from the use of an antipsychotic?
a. Dystonic reaction
b. Tardive dyskinesia
c. Akathisia
d. Neuroleptic malignant syndrome
e. Sedation
c
-TD - involuntary movement of the tongue, lips, face, trunk, and extremities that occur in pts treated with long-term dopamine-blocking agents. If they occur the drug should be stopped. TDs can be irreversible
-Dystonic reaction - intermittent spasmodic or sustained involuntary contractions of muscles of the face, neck, trunk, pelvis, extremities, and even the larynx
-Akathisia - inability to remain still
-Neuroleptic malignant syndrome - life-threatening, neurological disorder that includes symptoms of high fever, sweating, unstable BP, stupor, muscle rigidity, and autonomic dysfunction
Which of the following drugs requires prescribers, pharmacists, and pts to participate in a REMS program?
a. Clozapine
b. Aripiprazole
c. Quetiapine
d. Ziprasidone
e. Risperidone
a
The purpose of this registry is to prevent the use in pts who have a hx of drug-induced agranulocytosis and to detect neutropenia with scheduled monitoring of ANC values.
SJ has failed several trials of antipsychotics. He continues to respond to “voices” that constantly torment him. He has tried to commit suicide several times. His other med conditions include seizures (well-controlled since childhood), depression, anxiety, elevated cholesterol, and prediabetes. SJ’s healthcare provider would like to start clozapine. His WBC count is 5500 and his ANC is 1890. Choose the correct statements.
a. The pt should be counseled on the side effect of hypersalivation.
b. Clozapine could worsen the pt’s seizure disorder.
c. It’s reasonable to consider clozapine since the pt has failed several antipsychotics.
d. The pt’s ANC is appropriate to begin clozapine therapy.
e. Clozapine will have a positive effect on the pt’s cholesterol and prediabetes.
a, b, c, d
-Though clozapine (Clozaril) has ~5% risk of seizures, a trial is reasonable given this pt has failed several other antipsychotic treatments, and his seizures have been well-controlled since childhood.
-To start clozapine tx, baseline ANC must be >/= 1500 and should be discontinued if ANC < 1000.
Which antipsychotic has the lowest risk of extrapyramidal symptoms?
a. Quetiapine
b. Haloperidol
c. Risperidone
d. Thioridazine
e. Fluphenazine
a
Quetiapine has the lowest risk of extrapyramidal symptoms which makes it a preferred agent in Parkinson disease pts experiencing psychosis.
Select the correct chemical class for Haldol:
a. Phenothiazine
b. Butyrophenone
c. Synthetic pentasaccharide
d. Dopamine and 5HT3-partial agonist
e. NE and 5HT3-blocker
b
The butyrophenones haloperidol (Haldol) and droperidol (Inapsine) are among the agents with the highest QT-prolongation risk. They work mainly by blocking dopamine-2 receptors.
Haloperidol is available in which of the following formulations?
a. Oral tablet
b. Fast-acting injection
c. Two-week depot injection
d. Four-week depot injection
e. Orally disintegrating tablet
a, b, d
What is the rationale behind the production of several different forms of orally disintegrating tablets for schizophrenia?
a. Some pts with schizophrenia will “cheek” the med and spit it out later
b. Most pts with schizophrenia have dysphagia
c. Some pts with schizophrenia have mucositis; this form lowers the risk
d. Most pts with schizophrenia will not wish to receive injections
e. Some pts with schizophrenia have elevated blood glucose
a
A Dr has a pt who’s forgetful and doesn’t take her antipsychotic on a regular basis. The Dr wishes to use an atypical (“2nd gen”) agent that can be administered every 2 weeks. Which agent comes in a 2-week IM injection?
a. Paliperidone
b. Risperidone
c. Ziprasidone
d. Quetiapine
e. Aripiprazole
b
-Paliperidone has IM injections that can be given every month, every 3 months, or every 6 months
-Ziprasidone doesn’t have a long-acting injection available
-Quetiapine doesn’t come in an injection
-Aripiprazole IM injections can be given every month or every 4-8 weeks
