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Antipsychotics

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Quiz on Antipsychotics , created by Melanie Grynsztejn on 05/02/2018.
Melanie Grynsztejn
Quiz by Melanie Grynsztejn, updated more than 1 year ago
Melanie Grynsztejn
Created by Melanie Grynsztejn over 6 years ago
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Resource summary

Question 1

Question
DSM indications for antipsychotic medication
Answer
  • 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
  • Disorders where psychosis is an associate feature (BAD, MDD w/ psychosis, Alzheimer's Disease - BBW)

Question 2

Question
The following are positive symptoms of psychosis
Answer
  • Delusions
  • Reduced emotional responsiveness
  • Hallucinations
  • Loss of normal functions and feelings

Question 3

Question
The following are negative symptoms of psychosis
Answer
  • Delusions
  • Loss of normal functions and feelings
  • Hallucinations
  • Not being able to experience pleasure
  • Reduced emotional responsiveness and social drive
  • Reduced speech, reduced grooming, limited eye contact

Question 4

Question
Which of the following are pharmacological treatment for psychosis
Answer
  • typical antipsychotics
  • atypical antipsychotics
  • antidepressants
  • adjunctive agents

Question 5

Question
All antipsychotics have equal efficacy in equipotent doses, but individual vary in responses
Answer
  • True
  • False

Question 6

Question
What should be assessed when deciding on which antipsychotic to prescribe
Answer
  • Past medical history
  • Past response
  • Adherence
  • Dose & route
  • Dislike of the current president

Question 7

Question
1st break patients respond better than chronic patients, respond to lower doses of both typical and atypical antipsychotics than chronic patients
Answer
  • True
  • False

Question 8

Question
Use of LAI leads to better outcomes
Answer
  • True
  • False

Question 9

Question
What is the prime driver in lack of treatment adherence in schizophrenia
Answer
  • Lack of insurance
  • Anosognosia - lack of insight
  • Side effects
  • SES

Question 10

Question
Which of the following are cosidered intolerable SE
Answer
  • Weight gain
  • Decrease in libido
  • Cardiometabolic
  • Cognitive dysfunction
  • EPS
  • Sedation/sleepiness

Question 11

Question
Cardiometabolic is a combination of metabolic dysfunctions mainly characterized by insulin resistance, impaired glucose tolerance, dyslipidemia, hypertension, and central adiposity
Answer
  • True
  • False

Question 12

Question
EPS is dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness), parkinsonism (rigidity), bradykinesia (slowness of movement), tremor, and tardive dyskinesia (irregular, jerky movements).
Answer
  • True
  • False

Question 13

Question
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
Answer
  • mesolimbic
  • mesocortical
  • mesolimbic
  • mesocortical

Question 14

Question
Dopamine Hypothesis of Schizophrenia/Psychosis attributes symptoms of schizophrenia (like psychoses) to a disturbed and hyperactive dopaminergic signal transduction
Answer
  • True
  • False

Question 15

Question
Pro arguments for the Dopamine hypothesis of schizophrenia/psychosis
Answer
  • Agents acting at alternative sites also produce psychos
  • DA agents produce psychosis
  • Antipsychotics are DA antagonists
  • D2 receptor affinity correlates with antipsychotic potency

Question 16

Question
Dysregulation in the following NT may cause psychosis/schizophrenia
Answer
  • Serotonin
  • NE
  • Glutamate
  • GABA
  • Nicotinic Acetylcholine

Question 17

Question
Which systeme modulate the dopamine system and thus are implicted in psychosis/schizophrenia
Answer
  • NE
  • Glutatmate
  • 5HT
  • Nicotinic Acetylcholine

Question 18

Question
Which of the following are conventional D2 antagonists =FGA = typical antipsychotics
Answer
  • Chlorpromazine -Thorazine
  • Fluphenazine - Prolixin
  • Haloperidol - Haldol
  • Melindone - Moban
  • Perphenazine - Trilafon
  • Pimozide - Orap
  • Thioridazine - Mellaril
  • Thiothixene - Navene
  • Trifluoperazine - Stelazine

Question 19

Question
Before prescribing an LAI, a PMHNP should first trial with the oral agent
Answer
  • True
  • False

Question 20

Question
Typical LAI include
Answer
  • Fluphenazine decanoate
  • Haloperidol deconate

Question 21

Question
All typical antipsychotics are basically the same in that they block D2 receptors in the brain
Answer
  • True
  • False

Question 22

Question
Typical antipsychotics block D2 receptors in the brain and can also block
Answer
  • Muscarinic cholinergic receptors
  • H1 receptors
  • A1 adrenergic receptors
  • Sigma

Question 23

Question
Which receptor makes antipsychotic an atypical antipsychotic
Answer
  • 5H2TA
  • 5H1TC
  • 5H2TB
  • 5H3TA

Question 24

Question
Typical agents block all 4 DA pathways which drives the following SE
Answer
  • Production of negative symptoms
  • Worsening of cognitive symptoms
  • Unwanted EPS
  • Prolactin levels rising
  • Increase in appetite and weight gain

Question 25

Question
5H2TA ANTAGONISM and D2 ANTAGONISM is the MOA for aytpical antipsychotics
Answer
  • True
  • False

Question 26

Question
According to Stahl, "the pines, the dones, 2 pips and a rip" are how to identify atypical antipsychotics
Answer
  • True
  • False

Question 27

Question
Which of the following are atypical antipsychotics
Answer
  • DONE - Iloperidone, Lurasidone, Paliperidone, Siziprasidone
  • PIP - Aripiprazole, Brexpipraxole
  • PINE - Quetiapine, Asenapine, Olanzapine, Clozapine
  • RIP - Risperadol
  • Caripraprazine

Question 28

Question
5HT2A binding of the PINES is [blank_start]more[blank_end] potent than D2
Answer
  • more
  • less

Question 29

Question
5HT2A binding by DONES is [blank_start]more[blank_end] potent than D2
Answer
  • more
  • less

Question 30

Question
5HT2A binding by Two Pips and a Rip is [blank_start]less[blank_end] potent than D2
Answer
  • more
  • less

Question 31

Question
So the order of antagonism for receptor sites is: Pine - Done - D2 -Rip/Pip
Answer
  • True
  • False

Question 32

Question
What is the black box warning for atypical antipsychotics
Answer
  • Pregnancy
  • Lactation
  • Elderly with dementia
  • Hepatotoxicity

Question 33

Question
Atypical Antipsychotic class side effects include
Answer
  • BBW Elderly patients with dementia
  • NMS
  • Hepatotoxicity
  • Hyperprolactinemia
  • Metabolic changes
  • Dyslipidemia
  • Weight gain
  • Tardive dykinesia
  • Orthostatic hypotension
  • Seizures

Question 34

Question
What is the biggest concern in the use of atypical antipsychotic ClozaPINE (Clozaril)
Answer
  • Cardiometabolic
  • BP
  • Agranulocytosis
  • DRESS

Question 35

Question
All SGA are 5HT-DA Antagonists
Answer
  • True
  • False

Question 36

Question
ClozaPINE (Clozaril) is
Answer
  • Not first line
  • For treatment resistent
  • For highly aggressive
  • For elderly

Question 37

Question
How often should a patient on ClozaPINE (Clozaril) be monitored
Answer
  • Weekly blood tests for 6 months, every 2 weeks for the following six months
  • Weekly blood tests for 6 months, monthly for the following six months
  • Weekly blood tests for 6 months, every 2 weeks for the following year

Question 38

Question
What is the main concern with OlazaPINE (Zyprexa)?
Answer
  • EPS
  • Agranulocytosis
  • Cardiometabolic
  • Increase effect of BP medication

Question 39

Question
Common Side effects of OlanzaPINE (Zyprexa)
Answer
  • Sedation
  • Weight gain
  • EPS

Question 40

Question
What interactions should a PMHNP watch with OlazaPINE (Zyprexa) which will raise the level of the drug?
Answer
  • Coumadin
  • Carbamazepine
  • Smoking
  • Grapefruit juice

Question 41

Question
The binding properties of QuetiaPINE (Seroquel) are due to metabolite
Answer
  • True
  • False

Question 42

Question
QuetiaPINE causes prolactin elevation
Answer
  • True
  • False

Question 43

Question
Which SE are common with QuetiaPINE (Seroquel)?
Answer
  • Sedation
  • Weight gain
  • EPS

Question 44

Question
QuetiaPINE (Seroquel) has strong antidepressant properties and is frequently used as an adjunct to address sleep issues
Answer
  • True
  • False

Question 45

Question
What is contraindication/concern for QuetiaPINE (Seroquel)?
Answer
  • Agranulocytosis
  • Cardiometabolic
  • Cataracts
  • Increase effects of BP medication

Question 46

Question
AsenaPINE (Saphris) has the following indications
Answer
  • Schizophrenia
  • BAD
  • MDD

Question 47

Question
What makes AsenaPINE (Saphris) MOA unique?
Answer
  • Cannot be crushed or split
  • Absorbed on tongue
  • Lack of H1 binding
  • Binds to a metabolite

Question 48

Question
Which are the common SE of AsenaPINE (Saphris)
Answer
  • Sedation
  • Weight gain
  • EPS

Question 49

Question
What is the CI/concern with AsenaPINE (Saphris)
Answer
  • Agranulocytosis
  • Cardiometabolic risk
  • Increase effects of BP medication
  • DRESS

Question 50

Question
Which atypical antipsychotic can be used for autism irritability
Answer
  • PaliperiDONE (Invega)
  • RisperiDONE (Risperdol)
  • ZiprasiDONE
  • LurasiDONE

Question 51

Question
Which atypical antipsychotic can also be used as a mood stabilizer
Answer
  • Paliperdone
  • Olanzepine
  • Risperidone
  • Asenapine

Question 52

Question
Which atypical antipsychotic can increase prolactin levels even at low doses
Answer
  • Ziprasidone (Geodon)
  • Larsidone (Latuda)
  • Risperidone (Resperdol)
  • Paliperidone (Invega)

Question 53

Question
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
Answer
  • lower
  • increase
  • lower
  • increase

Question 54

Question
What makes the administration of Paliperidone (Invega) unique
Answer
  • Melts on the tongue
  • Can't be chewed or divided
  • Available only by IM

Question 55

Question
What are the common side effects of PaliperiDONE?
Answer
  • Sedation
  • Weight
  • EPS

Question 56

Question
EPS is a common side effect of Paliperidone (Invega)
Answer
  • True
  • False

Question 57

Question
Contraindications/Concerns for Paliperidone (Invega) include risk of
Answer
  • Agranulocytosis
  • Cardiometabolic syndrome
  • Cataracts
  • Increase the effect of BP medication

Question 58

Question
Contraindications/Concerns for Paliperidone (Invega) include risk of
Answer
  • Cardiometabolic risk
  • Cataracts
  • Increase effect of antihypertensive medications
  • QTc interval

Question 59

Question
Paliperidone (Invega) is metabolized by the liver
Answer
  • True
  • False

Question 60

Question
Risperidone (Risperdal) is better tolerated than Paliperidone (Invega)
Answer
  • True
  • False

Question 61

Question
What is the biggest concern/adverse effect to monitor with ZiprasiDONE (Geodon)
Answer
  • QTc elongation
  • Cardiometabolic syndrome
  • DRESS
  • Priapism

Question 62

Question
The following SE are common with Ziprasidone (Geodon)
Answer
  • Sedation
  • Weight gain
  • EPS
  • Hah! Trick question

Question 63

Question
Ziprasidone should not be taken with food
Answer
  • True
  • False

Question 64

Question
The following AE should be monitored with Ziprasidone
Answer
  • Cardiometabolic syndrome
  • DRESS
  • QTc
  • Enhance antihypertensive medication
  • Cataracts

Question 65

Question
Iloperidone is indicated for [blank_start]schizophrenia[blank_end] while Luradidone is indicated for [blank_start]bipolar depression[blank_end]
Answer
  • schizophrenia
  • bipolar depression
  • schizophrenia
  • bipolar depression

Question 66

Question
Iloperidone (Fanapt) is a CYP450D6 inhibitor so will affect dosing with the following medications
Answer
  • Paxil
  • Fluoxetine
  • Duloxetine
  • Quinidine
  • Trazadone

Question 67

Question
Which medication lowers the risk of EPS
Answer
  • Lurasidone (Latuda)
  • Iloperidone (Fanapt)
  • Aripiprazole (Abilify)
  • Cariprazine (Vraylar)

Question 68

Question
What are concerns, SE, AD or Iloperidone (Fanapt)
Answer
  • Risk of QTc elongatoni
  • Enhancement of antihypertensive medications
  • DRESS
  • EPS

Question 69

Question
What reduces the metabolic risk in Larisidone and makes it less sedating?
Answer
  • CYP3A4 metabolism
  • Lack of H1 binding
  • Lower D2 inhibition
  • Lack of H2A binding

Question 70

Question
Which drug is contraindicated with Rifampin?
Answer
  • Illoperidone (Fanapt)
  • Lurasidone (Latuda)
  • Aripipprazole
  • Ziprasidone (Geodon)

Question 71

Question
Lurasidone (Latuda) should be taken with food
Answer
  • True
  • False

Question 72

Question
Aripiprazole interacts with other CYP450 inducers like Carbamazepine, Fluoxetine, Duloxetine
Answer
  • True
  • False

Question 73

Question
Which of the following is a third generation antipsychotic whose MOA is DA partial agonist?
Answer
  • Ziprasidone (Geodon)
  • Cariprazine (Vraylar)
  • Iloperidone (Fanapt)
  • Aripiprazole (Abilify)

Question 74

Question
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)
Answer
  • True
  • False

Question 75

Question
[blank_start]Aripiprazole[blank_end] is most sedating and weight gaining while [blank_start]clozapine[blank_end] has biggest risk of EPS
Answer
  • Aripiprazole
  • Clozapine
  • aripiprazole
  • clozapine

Question 76

Question
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
Answer
  • True
  • False

Question 77

Question
Which two SGA are NOT recommended as first line therapy
Answer
  • Lurasidone
  • Olanzapine
  • Quetiapine
  • Clozapine

Question 78

Question
The following are symptoms of NMS which is incraed with higher potency drugs
Answer
  • Fluctuation LOC/confusion
  • Lead pipe rigidity
  • Autonomic instability: hyperthermia, hypertension, tachycardia, tachypnea
  • Diaphoresis
  • Mutism
  • Leukocytosis, increased CPK, AST, ALT, LDH & myoglobinuria

Question 79

Question
The following is the treatment for NMS
Answer
  • Discontinue neuroleptic
  • Supportive care: hydration and temperature control
  • Bromocriptine (DA agoninst used to restore lost DA tone
  • Dantrolene (Direct acting skeletal muscle relaxant)
  • Prayer and chocolate

Question 80

Question
Which of the following are risk factors for QT Prolongation
Answer
  • Medications - quinidine, thioridazine, TCA
  • Cardiac disease
  • Electrolyte imbalances
  • Hyperthyroidism
  • Hypothyroidism
  • Substance abuse

Question 81

Question
Normal QT <460 msec and as a PMHNP you should ask for an interpretation
Answer
  • True
  • False

Question 82

Question
When do you screen for increase in prolactin levels
Answer
  • Patient is symptomatic
  • Risperidone
  • Women of childbearing age
  • Paliperidone

Question 83

Question
How does the PMHNP treat increase levels of prolactin
Answer
  • Lower the dose
  • Switch to a prolactin-sparing agent
  • Augment with Aripiprazole
  • Augment with Risperidone

Question 84

Question
When is weight gain most important with atypical antipsychotics
Answer
  • First 4 weeks
  • First 6 weeks
  • First 8 weeks
  • First 6 months

Question 85

Question
What drugs can be used to help manage weight gain due to atypical antipsychotics
Answer
  • Orlistat
  • Toirmate
  • Adjunct aripiprazole
  • Metformin

Question 86

Question
There is no need to titrate Clozapine when switching atypical antipsychotics
Answer
  • True
  • False

Question 87

Question
Sialorrhea (drooling) is the second most common SE (80% of patients) of Clozapine. What interventions can be used to help manage the condition?
Answer
  • Use lowest dose possible
  • Dose medication HS
  • Treat with clonidine or a M1 selective antagonist
  • Walk around with a drool handkerchief

Question 88

Question
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?
Answer
  • Zyprexa Relprev
  • Aristada
  • Risperdal Consta
  • Invega Sustenna

Question 89

Question
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?
Answer
  • Dystonic reaction
  • Tardive dyskinesia
  • Akathisia
  • Rabbit syndrome

Question 90

Question
A 34 y/o female with schizophrenia is not responding to a standard dose of an antipsychotic. Which of the following might you suspect?
Answer
  • Dopamine 1Ac receptor occupancy less than 60%
  • Dopamine 1Ac receptor occupancy less than 100%
  • Dopamine 2 receptor occupancy less than 60%
  • Dopamine 2 receptor occupancy less than 100%

Question 91

Question
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?
Answer
  • Mesolimbic
  • Mesocortical
  • Nigrostriatal
  • Tuberoinfundibular

Question 92

Question
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?
Answer
  • Serotonin 2A antagonism and serotonin 2C antagonism
  • Serotonin 2C antagonism and histamine 1 antagonism
  • Histamine 1 antagonism and dopamine 2 antagonism
  • Dopamine 2 antagonism and serotonin 2A antagonism

Question 93

Question
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?
Answer
  • 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
  • Refer Charles to his primary care provider and provide him a copy of all laboratory values to present at his medical visit

Question 94

Question
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?
Answer
  • 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

Question 95

Question
Which of the following antipsychotic medication is least likely to cause orthostatic hypotension?
Answer
  • luphenazine (Prolixin)
  • clozapine (Clozaril)
  • chlorpromazine (Thorazine)
  • quetiapine (Seroquel)

Question 96

Question
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?
Answer
  • Increase the dose of aripiprazole
  • Decrease the dose of aripiprazole
  • Stop aripiprazole and start another medication
  • Do nothing and monitor the patient

Question 97

Question
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?
Answer
  • 25 mg IM every 4 weeks
  • 50 mg IM every 4 weeks
  • 100 mg IM every 4 weeks
  • 300 mg IM every 4 weeks

Question 98

Question
Which of the following is cited as the most common reason persons with schizophrenia stop taking medications?
Answer
  • Cardiometabolic Side Effects
  • Anosognosia
  • Positive Symptoms
  • Negative Symptoms

Question 99

Question
Which of the following statements best describes the difference between high and low potency antipsychotic medications?
Answer
  • 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

Question 100

Question
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?
Answer
  • More anticholengic, antihistaminic and low blood pressure
  • More extrapyramidal symptoms and prolactin elevation
  • More akathisia and Parkinsonism
  • More orthostatic hypotension and increase agitation

Question 101

Question
When an atypical antipsychotic is said to have lost it's atypicality, it is referring to which of the following?
Answer
  • 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

Question 102

Question
What is unique properties does clozapine have, when compared to all other atypical antipsychotic medication?
Answer
  • 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
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