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DSM indications for antipsychotic medication
Antworten
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Disorders where PSYCHOSIS is defining feature (Schizophrenia, Psychotic D/O due to medical condition, Substance induced psychotic D/O, Delusional D/O, Brief psychotic D/O
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Disorders where psychosis is an associate feature (BAD, MDD w/ psychosis, Alzheimer's Disease - BBW)
Frage 2
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The following are positive symptoms of psychosis
Frage 3
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The following are negative symptoms of psychosis
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Delusions
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Loss of normal functions and feelings
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Hallucinations
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Not being able to experience pleasure
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Reduced emotional responsiveness and social drive
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Reduced speech, reduced grooming, limited eye contact
Frage 4
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Which of the following are pharmacological treatment for psychosis
Antworten
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typical antipsychotics
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atypical antipsychotics
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antidepressants
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adjunctive agents
Frage 5
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All antipsychotics have equal efficacy in equipotent doses, but individual vary in responses
Frage 6
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What should be assessed when deciding on which antipsychotic to prescribe
Frage 7
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1st break patients respond better than chronic patients, respond to lower doses of both typical and atypical antipsychotics than chronic patients
Frage 8
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Use of LAI leads to better outcomes
Frage 9
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What is the prime driver in lack of treatment adherence in schizophrenia
Frage 10
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Which of the following are cosidered intolerable SE
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Weight gain
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Decrease in libido
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Cardiometabolic
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Cognitive dysfunction
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EPS
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Sedation/sleepiness
Frage 11
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Cardiometabolic is a combination of metabolic dysfunctions mainly characterized by insulin resistance, impaired glucose tolerance, dyslipidemia, hypertension, and central adiposity
Frage 12
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EPS is dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness), parkinsonism (rigidity), bradykinesia (slowness of movement), tremor, and tardive dyskinesia (irregular, jerky movements).
Frage 13
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Dopamine systems in [blank_start]mesolimbic[blank_end] pathway may contribute to the 'positive symptoms'
Dopamine function in the [blank_start]mesocortical[blank_end] pathway may be responsible for the 'negative
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mesolimbic
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mesocortical
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mesolimbic
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mesocortical
Frage 14
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Dopamine Hypothesis of Schizophrenia/Psychosis attributes symptoms of schizophrenia (like psychoses) to a disturbed and hyperactive dopaminergic signal transduction
Frage 15
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Pro arguments for the Dopamine hypothesis of schizophrenia/psychosis
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Agents acting at alternative sites also produce psychos
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DA agents produce psychosis
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Antipsychotics are DA antagonists
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D2 receptor affinity correlates with antipsychotic potency
Frage 16
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Dysregulation in the following NT may cause psychosis/schizophrenia
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Serotonin
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NE
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Glutamate
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GABA
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Nicotinic Acetylcholine
Frage 17
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Which systeme modulate the dopamine system and thus are implicted in psychosis/schizophrenia
Antworten
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NE
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Glutatmate
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5HT
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Nicotinic Acetylcholine
Frage 18
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Which of the following are conventional D2 antagonists =FGA = typical antipsychotics
Frage 19
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Before prescribing an LAI, a PMHNP should first trial with the oral agent
Frage 20
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Typical LAI include
Antworten
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Fluphenazine decanoate
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Haloperidol deconate
Frage 21
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All typical antipsychotics are basically the same in that they block D2 receptors in the brain
Frage 22
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Typical antipsychotics block D2 receptors in the brain and can also block
Frage 23
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Which receptor makes antipsychotic an atypical antipsychotic
Frage 24
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Typical agents block all 4 DA pathways which drives the following SE
Antworten
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Production of negative symptoms
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Worsening of cognitive symptoms
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Unwanted EPS
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Prolactin levels rising
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Increase in appetite and weight gain
Frage 25
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5H2TA ANTAGONISM and D2 ANTAGONISM is the MOA for aytpical antipsychotics
Frage 26
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According to Stahl, "the pines, the dones, 2 pips and a rip" are how to identify atypical antipsychotics
Frage 27
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Which of the following are atypical antipsychotics
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DONE - Iloperidone, Lurasidone, Paliperidone, Siziprasidone
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PIP - Aripiprazole, Brexpipraxole
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PINE - Quetiapine, Asenapine, Olanzapine, Clozapine
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RIP - Risperadol
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Caripraprazine
Frage 28
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5HT2A binding of the PINES is [blank_start]more[blank_end] potent than D2
Frage 29
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5HT2A binding by DONES is [blank_start]more[blank_end] potent than D2
Frage 30
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5HT2A binding by Two Pips and a Rip is [blank_start]less[blank_end] potent than D2
Frage 31
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So the order of antagonism for receptor sites is:
Pine - Done - D2 -Rip/Pip
Frage 32
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What is the black box warning for atypical antipsychotics
Antworten
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Pregnancy
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Lactation
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Elderly with dementia
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Hepatotoxicity
Frage 33
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Atypical Antipsychotic class side effects include
Frage 34
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What is the biggest concern in the use of atypical antipsychotic ClozaPINE (Clozaril)
Antworten
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Cardiometabolic
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BP
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Agranulocytosis
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DRESS
Frage 35
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All SGA are 5HT-DA Antagonists
Frage 36
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ClozaPINE (Clozaril) is
Antworten
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Not first line
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For treatment resistent
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For highly aggressive
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For elderly
Frage 37
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How often should a patient on ClozaPINE (Clozaril) be monitored
Antworten
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Weekly blood tests for 6 months, every 2 weeks for the following six months
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Weekly blood tests for 6 months, monthly for the following six months
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Weekly blood tests for 6 months, every 2 weeks for the following year
Frage 38
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What is the main concern with OlazaPINE (Zyprexa)?
Frage 39
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Common Side effects of OlanzaPINE (Zyprexa)
Frage 40
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What interactions should a PMHNP watch with OlazaPINE (Zyprexa) which will raise the level of the drug?
Antworten
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Coumadin
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Carbamazepine
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Smoking
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Grapefruit juice
Frage 41
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The binding properties of QuetiaPINE (Seroquel) are due to metabolite
Frage 42
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QuetiaPINE causes prolactin elevation
Frage 43
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Which SE are common with QuetiaPINE (Seroquel)?
Frage 44
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QuetiaPINE (Seroquel) has strong antidepressant properties and is frequently used as an adjunct to address sleep issues
Frage 45
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What is contraindication/concern for QuetiaPINE (Seroquel)?
Frage 46
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AsenaPINE (Saphris) has the following indications
Frage 47
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What makes AsenaPINE (Saphris) MOA unique?
Frage 48
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Which are the common SE of AsenaPINE (Saphris)
Frage 49
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What is the CI/concern with AsenaPINE (Saphris)
Frage 50
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Which atypical antipsychotic can be used for autism irritability
Antworten
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PaliperiDONE (Invega)
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RisperiDONE (Risperdol)
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ZiprasiDONE
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LurasiDONE
Frage 51
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Which atypical antipsychotic can also be used as a mood stabilizer
Antworten
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Paliperdone
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Olanzepine
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Risperidone
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Asenapine
Frage 52
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Which atypical antipsychotic can increase prolactin levels even at low doses
Antworten
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Ziprasidone (Geodon)
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Larsidone (Latuda)
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Risperidone (Resperdol)
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Paliperidone (Invega)
Frage 53
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Risperidone (Risperdal) can [blank_start]lower[blank_end] plasma levels of carbamazepine
Risperidone (Risperdal) can [blank_start]increase[blank_end] plasma levels of Paroxetine & Fluoxetine
Antworten
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lower
-
increase
-
lower
-
increase
Frage 54
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What makes the administration of Paliperidone (Invega) unique
Frage 55
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What are the common side effects of PaliperiDONE?
Frage 56
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EPS is a common side effect of Paliperidone (Invega)
Frage 57
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Contraindications/Concerns for Paliperidone (Invega) include risk of
Frage 58
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Contraindications/Concerns for Paliperidone (Invega) include risk of
Frage 59
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Paliperidone (Invega) is metabolized by the liver
Frage 60
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Risperidone (Risperdal) is better tolerated than Paliperidone (Invega)
Frage 61
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What is the biggest concern/adverse effect to monitor with ZiprasiDONE (Geodon)
Antworten
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QTc elongation
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Cardiometabolic syndrome
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DRESS
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Priapism
Frage 62
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The following SE are common with Ziprasidone (Geodon)
Antworten
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Sedation
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Weight gain
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EPS
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Hah! Trick question
Frage 63
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Ziprasidone should not be taken with food
Frage 64
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The following AE should be monitored with Ziprasidone
Frage 65
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Iloperidone is indicated for [blank_start]schizophrenia[blank_end] while Luradidone is indicated for [blank_start]bipolar depression[blank_end]
Antworten
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schizophrenia
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bipolar depression
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schizophrenia
-
bipolar depression
Frage 66
Frage
Iloperidone (Fanapt) is a CYP450D6 inhibitor so will affect dosing with the following medications
Antworten
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Paxil
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Fluoxetine
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Duloxetine
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Quinidine
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Trazadone
Frage 67
Frage
Which medication lowers the risk of EPS
Antworten
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Lurasidone (Latuda)
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Iloperidone (Fanapt)
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Aripiprazole (Abilify)
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Cariprazine (Vraylar)
Frage 68
Frage
What are concerns, SE, AD or Iloperidone (Fanapt)
Frage 69
Frage
What reduces the metabolic risk in Larisidone and makes it less sedating?
Antworten
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CYP3A4 metabolism
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Lack of H1 binding
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Lower D2 inhibition
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Lack of H2A binding
Frage 70
Frage
Which drug is contraindicated with Rifampin?
Antworten
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Illoperidone (Fanapt)
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Lurasidone (Latuda)
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Aripipprazole
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Ziprasidone (Geodon)
Frage 71
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Lurasidone (Latuda) should be taken with food
Frage 72
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Aripiprazole interacts with other CYP450 inducers like Carbamazepine, Fluoxetine, Duloxetine
Frage 73
Frage
Which of the following is a third generation antipsychotic whose MOA is DA partial agonist?
Antworten
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Ziprasidone (Geodon)
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Cariprazine (Vraylar)
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Iloperidone (Fanapt)
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Aripiprazole (Abilify)
Frage 74
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Parkinson’s disease psychosis is a non-motor symptom of Parkinson’s disease that causes patients to experience hallucinations and/or delusions which is treated by the drug Nuplazid (pimavenserin)
Frage 75
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[blank_start]Aripiprazole[blank_end] is most sedating and weight gaining while [blank_start]clozapine[blank_end] has biggest risk of EPS
Antworten
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Aripiprazole
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Clozapine
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aripiprazole
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clozapine
Frage 76
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Prior to prescribing Atypical think about risk factors
1.Extrapyramidal Symptoms (EPS)
2.Cardiovascular Effects
3.Cost
4.Metabolic Effects
5.Weight Gain
6.Sexual Side Effects
7.Prolactin Elevation
8.Cholinergic Side Effects
9.Blood Dyscrasia
10.Sedation
Frage 77
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Which two SGA are NOT recommended as first line therapy
Antworten
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Lurasidone
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Olanzapine
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Quetiapine
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Clozapine
Frage 78
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The following are symptoms of NMS which is incraed with higher potency drugs
Antworten
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Fluctuation LOC/confusion
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Lead pipe rigidity
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Autonomic instability: hyperthermia, hypertension, tachycardia, tachypnea
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Diaphoresis
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Mutism
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Leukocytosis, increased CPK, AST, ALT, LDH & myoglobinuria
Frage 79
Frage
The following is the treatment for NMS
Antworten
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Discontinue neuroleptic
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Supportive care: hydration and temperature control
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Bromocriptine (DA agoninst used to restore lost DA tone
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Dantrolene (Direct acting skeletal muscle relaxant)
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Prayer and chocolate
Frage 80
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Which of the following are risk factors for QT Prolongation
Frage 81
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Normal QT <460 msec and as a PMHNP you should ask for an interpretation
Frage 82
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When do you screen for increase in prolactin levels
Frage 83
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How does the PMHNP treat increase levels of prolactin
Frage 84
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When is weight gain most important with atypical antipsychotics
Antworten
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First 4 weeks
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First 6 weeks
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First 8 weeks
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First 6 months
Frage 85
Frage
What drugs can be used to help manage weight gain due to atypical antipsychotics
Antworten
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Orlistat
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Toirmate
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Adjunct aripiprazole
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Metformin
Frage 86
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There is no need to titrate Clozapine when switching atypical antipsychotics
Frage 87
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Sialorrhea (drooling) is the second most common SE (80% of patients) of Clozapine. What interventions can be used to help manage the condition?
Frage 88
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Rick has a history of schizophrenia and has been very non-adherent in the past. He has been on several medications in the past, including aripiprazole (ineffective), haloperidol (EPS), quetiapine (sedation), risperidone (effective) and ziprasidone (ineffective). His PMHNP would like to start him on a long-acting injectable to help increase his adherence. Rick would receive the injection at his monthly doctor's appointment, immediately prior to his appointment. Given this information, which of the following medications would the best potential agent for Rick?
Antworten
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Zyprexa Relprev
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Aristada
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Risperdal Consta
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Invega Sustenna
Frage 89
Frage
Fred, your patient with Schizophrenia, is having an involuntary muscle contraction that pulls his head drastically to the left side. It is very uncomfortable. You know that medications to treat schizophrenia can cause side effects and given his presentation and discomfort, which side effect is he experiencing?
Antworten
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Dystonic reaction
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Tardive dyskinesia
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Akathisia
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Rabbit syndrome
Frage 90
Frage
A 34 y/o female with schizophrenia is not responding to a standard dose of an antipsychotic. Which of the following might you suspect?
Antworten
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Dopamine 1Ac receptor occupancy less than 60%
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Dopamine 1Ac receptor occupancy less than 100%
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Dopamine 2 receptor occupancy less than 60%
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Dopamine 2 receptor occupancy less than 100%
Frage 91
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Sally is a 32 year old female treated for schizoaffective disorder, bipolar type. She is treated with Invega (paliperidone) 12 mg po daily. Sally reports she has not had her menses in over 6 months and complains of galactorrhea. You know this is due to prolactin elevation through which dopamine pathway?
Antworten
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Mesolimbic
-
Mesocortical
-
Nigrostriatal
-
Tuberoinfundibular
Frage 92
Frage
Sammy is a 56 y/o patient who has been taking an atypical antipsychotic for six months. She has experienced a 22 lb weight gain since starting this agent. Which of the following pharmacologic properties most likely underlies this patient's weight change?
Antworten
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Serotonin 2A antagonism and serotonin 2C antagonism
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Serotonin 2C antagonism and histamine 1 antagonism
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Histamine 1 antagonism and dopamine 2 antagonism
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Dopamine 2 antagonism and serotonin 2A antagonism
Frage 93
Frage
Charles is a 34-year-old male treated for schizophrenia and has been stable on invega trinza 819 mg IM every three months. Charles has a long history of psychiatric hospitalizations and this is the first time since his diagnosis at age 22 that he has not hospitalized in over three years. Charles is presenting as a new patient to your clinic, and part of the initial evaluation you order laboratory studies that reveal the following:
Triglycerides 388 mg / dL, LDL 180 mg / dL, Hemoglobin A1C 8, WBC 8.8 cells / mcL, and Prolactin level 67 ng/ML. As the PMH NP treating Charles what is a reasonable next step?
Antworten
-
Start Charles on Rosuvastatin (Crestor) 20 mg po daily educate him about a low cholesterol diet and recheck his lipid panel in 3 months.
-
Start Charles on Metformin 500 mg po BID, re-check his A1C in 3 months and educate him on a low cholesterol diet
-
Start Charles on Aripiprazole (Abilify) 5 mg po daily, recheck his prolactin level in 3 months, and refer him to his primary care provider for a well man examination
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Refer Charles to his primary care provider and provide him a copy of all laboratory values to present at his medical visit
Frage 94
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Doris is a 44-year-old female treated for schizophrenia and has been stable on clozapine 300 mg po HS. The only side effect she has is sialorrhea, which she copes with by putting a towel on her pillow. At the day treatment center she has been part of a research study focused on tobacco cessation. Doris was smoking 2 ppd and is now down to less than 10 cigarettes a day. At her follow up visit, she presents sedated, confused, and her blood pressure is 80/60 mmHg, radial pulse 110. What is your appropriate next step?
Antworten
-
Order a clozapine level and lower her dose to 250 mg po HS due to suspicion of elevated levels related to smoking cessation and smoking being a CYP1AC inducer
-
Send her to the emergency room due to an acute mental status change and evaluation for neuroleptic malignant syndrome
-
Do not make any changes, now that she has decreased smoking her clozapine level will stabilized. Make a return visit in 2 weeks to assess her status
-
Order a clozapine level and based on the result make a dose adjustment as the CYP2C9 interaction between clozapine and smoking is no longer present and her level will stabilize
Frage 95
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Which of the following antipsychotic medication is least likely to cause orthostatic hypotension?
Frage 96
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A 24 year old man with schizophrenia was stable on aripiprazole. Two weeks ago he saw his PCP for night sweats, weight loss, fatigue and cough. He had a positive purified protein derivative (PPD) and chest X ray. He is starting on isonicotinylhydrazine (INH) and rifampicin today. You suspect a drug interaction, what is your next step?
Antworten
-
Increase the dose of aripiprazole
-
Decrease the dose of aripiprazole
-
Stop aripiprazole and start another medication
-
Do nothing and monitor the patient
Frage 97
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Mr. Smith is a 45 year old patient with schizophrenia recently discharged from the state psychiatric hospital. This is Mr. Smith's forth hospitalization in the last 9 months. He was discharged on Haldol 10 mg po daily and Divalproex Sodium 500 mg at HS. Due to his history of medication nonadherence, you talk about long acting injectable medication and he agrees. What is the most appropriate starting dose of haloperidol decanoate?
Antworten
-
25 mg IM every 4 weeks
-
50 mg IM every 4 weeks
-
100 mg IM every 4 weeks
-
300 mg IM every 4 weeks
Frage 98
Frage
Which of the following is cited as the most common reason persons with schizophrenia stop taking medications?
Frage 99
Frage
Which of the following statements best describes the difference between high and low potency antipsychotic medications?
Antworten
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Low potency antipsychotics are second generation and high potency antipsychotics are conventional
-
Low potency antipsychotics are typical antipsychotics and high potency antipsychotics are conventional
-
Low potency antipsychotics require lower doses and high potency antipsychotics are require higher doses
-
Low potency antipsychotics require higher doses and high potency antipsychotics require lower doses
Frage 100
Frage
Mr. Mac is taking haloperidol (Haldol) deaconate 100 mg IM every 4 weeks for the treatment of schizoaffective disorder. Knowing what you know about high and low potency antipsychotics, which side effects is he more likely to experience?
Antworten
-
More anticholengic, antihistaminic and low blood pressure
-
More extrapyramidal symptoms and prolactin elevation
-
More akathisia and Parkinsonism
-
More orthostatic hypotension and increase agitation
Frage 101
Frage
When an atypical antipsychotic is said to have lost it's atypicality, it is referring to which of the following?
Antworten
-
80% of dopamine blockade is occurring in the limbic region, treating the psychosis, and only 60% dopamine blockade in the striatum and the pituitary are blocked
-
80% or higher dopamine blockade in the limbic region, striatum and pituitary are blocked
-
Less than 60% dopamine blockade is occurring in the limbic region, striatum, and pituitary
-
Less than 60% dopamine blockade is occurring in the limbic region and more than 80% in the striatum and pituitary
Frage 102
Frage
What is unique properties does clozapine have, when compared to all other atypical antipsychotic medication?
Antworten
-
strong 5HT2A antagonism and low D2 receptor occupancy
-
strong 5HT2A agonist properties and high D2 occupancy
-
weak 5HT2A antagonism and low D2 receptor occupancy
-
weak 5HT2A agonist properties and high D2 occupancy