Treatment - Part 2 of 3 Flashcards
A leading hypothesis as to why atypical antipsychotic medications are less likely than typical neuroleptic agents to cause EPS is based one which of the following properties of atypical antipsychotics?
RAPID DISSOCIATION FROM D2 RECEPTORS
35 y/o pt is started on a trial of clozapine for treatment-refractory schizoaffective disorder. During the initial medication titration, pt complains of sedation and orthostatic hypotension as well as flu-like symptoms, but seems symptomatically improved. However after a dose increase from 150 to 200mg, pt develops a fever to 102 degrees, tachycardia to 130bpm, and an acute metal status change. CXR, urine studies, and blood culture are unremarkable. A CBC reveals a WBC of 11.4, with an elevated eosinophil percent of 7%. Which known toxic risk of clozapine is the most likely Dx?
MYOCARDITIS
A 30yo w. 5yo hx of Schizophrenia, prior failed Haldol and Risperidone trial, despite adherent to meds continues to have severe psychotic symptoms. Med recommendation at this time is..
CLOZAPINE
30 yo on Clozapine for treatment resistant schizophrenia presenting with dyspnea, orthostatic hypotension and HR 130bpm. Elevated Eosinophil , EKG with non-specific T wave changes. Further most likely test to guide treatment
TROPONIN LEVEL
What lab finding is most typically associated with NMS?
INCREASED CREATINE KINASE LEVELS
Appropriate management of neuroleptic malignant syndrome:
HYDRATION AND COOLING
Antipsychotics are associated with what?
DYSTONIA, POIKILOTHERMY, LIPID SOLUBILITY, AND LOWER SEIZURE THRESHOLD
Which of the following effects is the basis for dantrolene’s efficacy in the treatment of neuroleptic malignant syndrome (aka nms)?
SKELETAL MUSCLE RELAXANT
32 y/o pt with hx of schizoaffective d/o stable on clozapine is admitted to internal medicine service for a severe GI viral infection. Pt is confused, slow, appears visibly ill and tired. Pt c/o stiffness and there is some rigidity to the movements. What should be recommended?
DISCONTINUE CLOZAPINE
Which antipsychotic has least effect on prolactin?
CLOZAPINE
A slow titration of Clozapine is required to decrease the risk of:
SEIZURES
Which neuroleptic has the weakest affinity for the dopamine D2-like receptor?
CLOZAPINE
Clozapine clearance decreased by
CIMETIDINE
Which med is contra-indicated with clozapine?
CARBAMAZEPINE
Schizophrenic on haldol 5mg presents to ED “unable to see.” Appears distressed, writhing and moaning. States “I’m unable to stop looking up.” What is the best treatment?
ADMINISTER BENZTROPINE 1MG IV NOW
What manifestations is the most common side effect of conventional antipsychotic meds?
AKATHISIA
What antipsychotic medication would be the best choice to avoid motor symptoms in Parkinson’s disease?
CLOZAPINE
What antipsychotic medication is helpful in treating Tourette’s?
HALOPERIDOL
Pt develops feelings of restlessness, an inability to relax, jitteriness, pacing, and rapid alternation of sitting and standing shortly after being started on a low dose of haloperidol. Addition of what medications would be most effective in managing these symptoms?
ATENOLOL
The therapeutic effect of 2nd generation antipsychotics on negative symptoms of schizophrenia is thought to be related to the induction of expression in what area of the brain?
PREFRONTAL CORTEX
Psych MD orders quetiapine 50 mg for an 82 y/o nursing home pt w/ dementia who has become severely agitated. Soon after, the psychiatrist receives a call from a family member who is concerned about the “black box” warnings associated with antipsychotics in the elderly. Which of the following is the most accurate information the psychiatrist could give the family member regarding the potential safety risks of this medication? (x2)
ATYPICAL ANTIPSYCHOTICS INCREASE MORTALITY; THIS MUST BE BALANCED AGAINST ANY POTENTIAL BENEFIT
Blockade of dopamine receptors in tuberoinfundibular tracts results in breast enlargement, galactorrhea, impotence, and amenorrhea. Mechanism is increase of:
PROLACTIN
Correlation of plasma drug concentration with the clinical effectiveness is best established for which antipsychotics?
CLOZAPINE AND HALOPERIDOL
Acutely psychotic pt started on risperdal 2 mg qhs. Increased to 3 mg BID over next few days. Pt becomes increasingly agitated, restless, unable to stop pacing. Most appropriate intervention?
ADD PROPRANOLOL 10 MG TID