Pregunta 1
Pregunta
DSM indications for antipsychotic medication
Respuesta
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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)
Pregunta 2
Pregunta
The following are positive symptoms of psychosis
Pregunta 3
Pregunta
The following are negative symptoms of psychosis
Respuesta
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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
Pregunta 4
Pregunta
Which of the following are pharmacological treatment for psychosis
Respuesta
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typical antipsychotics
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atypical antipsychotics
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antidepressants
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adjunctive agents
Pregunta 5
Pregunta
All antipsychotics have equal efficacy in equipotent doses, but individual vary in responses
Pregunta 6
Pregunta
What should be assessed when deciding on which antipsychotic to prescribe
Pregunta 7
Pregunta
1st break patients respond better than chronic patients, respond to lower doses of both typical and atypical antipsychotics than chronic patients
Pregunta 8
Pregunta
Use of LAI leads to better outcomes
Pregunta 9
Pregunta
What is the prime driver in lack of treatment adherence in schizophrenia
Pregunta 10
Pregunta
Which of the following are cosidered intolerable SE
Respuesta
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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
Pregunta 11
Pregunta
Cardiometabolic is a combination of metabolic dysfunctions mainly characterized by insulin resistance, impaired glucose tolerance, dyslipidemia, hypertension, and central adiposity
Pregunta 12
Pregunta
EPS is dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness), parkinsonism (rigidity), bradykinesia (slowness of movement), tremor, and tardive dyskinesia (irregular, jerky movements).
Pregunta 13
Pregunta
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
Respuesta
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mesolimbic
-
mesocortical
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mesolimbic
-
mesocortical
Pregunta 14
Pregunta
Dopamine Hypothesis of Schizophrenia/Psychosis attributes symptoms of schizophrenia (like psychoses) to a disturbed and hyperactive dopaminergic signal transduction
Pregunta 15
Pregunta
Pro arguments for the Dopamine hypothesis of schizophrenia/psychosis
Respuesta
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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
Pregunta 16
Pregunta
Dysregulation in the following NT may cause psychosis/schizophrenia
Respuesta
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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
Pregunta 17
Pregunta
Which systeme modulate the dopamine system and thus are implicted in psychosis/schizophrenia
Respuesta
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NE
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Glutatmate
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5HT
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Nicotinic Acetylcholine
Pregunta 18
Pregunta
Which of the following are conventional D2 antagonists =FGA = typical antipsychotics
Pregunta 19
Pregunta
Before prescribing an LAI, a PMHNP should first trial with the oral agent
Pregunta 20
Pregunta
Typical LAI include
Respuesta
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Fluphenazine decanoate
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Haloperidol deconate
Pregunta 21
Pregunta
All typical antipsychotics are basically the same in that they block D2 receptors in the brain
Pregunta 22
Pregunta
Typical antipsychotics block D2 receptors in the brain and can also block
Pregunta 23
Pregunta
Which receptor makes antipsychotic an atypical antipsychotic
Pregunta 24
Pregunta
Typical agents block all 4 DA pathways which drives the following SE
Respuesta
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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
Pregunta 25
Pregunta
5H2TA ANTAGONISM and D2 ANTAGONISM is the MOA for aytpical antipsychotics
Pregunta 26
Pregunta
According to Stahl, "the pines, the dones, 2 pips and a rip" are how to identify atypical antipsychotics
Pregunta 27
Pregunta
Which of the following are atypical antipsychotics
Respuesta
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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
Pregunta 28
Pregunta
5HT2A binding of the PINES is [blank_start]more[blank_end] potent than D2
Pregunta 29
Pregunta
5HT2A binding by DONES is [blank_start]more[blank_end] potent than D2
Pregunta 30
Pregunta
5HT2A binding by Two Pips and a Rip is [blank_start]less[blank_end] potent than D2
Pregunta 31
Pregunta
So the order of antagonism for receptor sites is:
Pine - Done - D2 -Rip/Pip
Pregunta 32
Pregunta
What is the black box warning for atypical antipsychotics
Respuesta
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Pregnancy
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Lactation
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Elderly with dementia
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Hepatotoxicity
Pregunta 33
Pregunta
Atypical Antipsychotic class side effects include
Pregunta 34
Pregunta
What is the biggest concern in the use of atypical antipsychotic ClozaPINE (Clozaril)
Respuesta
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Cardiometabolic
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BP
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Agranulocytosis
-
DRESS
Pregunta 35
Pregunta
All SGA are 5HT-DA Antagonists
Pregunta 36
Pregunta
ClozaPINE (Clozaril) is
Respuesta
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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
Pregunta 37
Pregunta
How often should a patient on ClozaPINE (Clozaril) be monitored
Respuesta
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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
Pregunta 38
Pregunta
What is the main concern with OlazaPINE (Zyprexa)?
Pregunta 39
Pregunta
Common Side effects of OlanzaPINE (Zyprexa)
Pregunta 40
Pregunta
What interactions should a PMHNP watch with OlazaPINE (Zyprexa) which will raise the level of the drug?
Respuesta
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Coumadin
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Carbamazepine
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Smoking
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Grapefruit juice
Pregunta 41
Pregunta
The binding properties of QuetiaPINE (Seroquel) are due to metabolite
Pregunta 42
Pregunta
QuetiaPINE causes prolactin elevation
Pregunta 43
Pregunta
Which SE are common with QuetiaPINE (Seroquel)?
Pregunta 44
Pregunta
QuetiaPINE (Seroquel) has strong antidepressant properties and is frequently used as an adjunct to address sleep issues
Pregunta 45
Pregunta
What is contraindication/concern for QuetiaPINE (Seroquel)?
Pregunta 46
Pregunta
AsenaPINE (Saphris) has the following indications
Pregunta 47
Pregunta
What makes AsenaPINE (Saphris) MOA unique?
Pregunta 48
Pregunta
Which are the common SE of AsenaPINE (Saphris)
Pregunta 49
Pregunta
What is the CI/concern with AsenaPINE (Saphris)
Pregunta 50
Pregunta
Which atypical antipsychotic can be used for autism irritability
Respuesta
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PaliperiDONE (Invega)
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RisperiDONE (Risperdol)
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ZiprasiDONE
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LurasiDONE
Pregunta 51
Pregunta
Which atypical antipsychotic can also be used as a mood stabilizer
Respuesta
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Paliperdone
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Olanzepine
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Risperidone
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Asenapine
Pregunta 52
Pregunta
Which atypical antipsychotic can increase prolactin levels even at low doses
Respuesta
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Ziprasidone (Geodon)
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Larsidone (Latuda)
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Risperidone (Resperdol)
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Paliperidone (Invega)
Pregunta 53
Pregunta
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
Respuesta
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lower
-
increase
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lower
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increase
Pregunta 54
Pregunta
What makes the administration of Paliperidone (Invega) unique
Pregunta 55
Pregunta
What are the common side effects of PaliperiDONE?
Pregunta 56
Pregunta
EPS is a common side effect of Paliperidone (Invega)
Pregunta 57
Pregunta
Contraindications/Concerns for Paliperidone (Invega) include risk of
Pregunta 58
Pregunta
Contraindications/Concerns for Paliperidone (Invega) include risk of
Pregunta 59
Pregunta
Paliperidone (Invega) is metabolized by the liver
Pregunta 60
Pregunta
Risperidone (Risperdal) is better tolerated than Paliperidone (Invega)
Pregunta 61
Pregunta
What is the biggest concern/adverse effect to monitor with ZiprasiDONE (Geodon)
Respuesta
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QTc elongation
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Cardiometabolic syndrome
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DRESS
-
Priapism
Pregunta 62
Pregunta
The following SE are common with Ziprasidone (Geodon)
Respuesta
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Sedation
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Weight gain
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EPS
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Hah! Trick question
Pregunta 63
Pregunta
Ziprasidone should not be taken with food
Pregunta 64
Pregunta
The following AE should be monitored with Ziprasidone
Pregunta 65
Pregunta
Iloperidone is indicated for [blank_start]schizophrenia[blank_end] while Luradidone is indicated for [blank_start]bipolar depression[blank_end]
Respuesta
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schizophrenia
-
bipolar depression
-
schizophrenia
-
bipolar depression
Pregunta 66
Pregunta
Iloperidone (Fanapt) is a CYP450D6 inhibitor so will affect dosing with the following medications
Respuesta
-
Paxil
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Fluoxetine
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Duloxetine
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Quinidine
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Trazadone
Pregunta 67
Pregunta
Which medication lowers the risk of EPS
Respuesta
-
Lurasidone (Latuda)
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Iloperidone (Fanapt)
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Aripiprazole (Abilify)
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Cariprazine (Vraylar)
Pregunta 68
Pregunta
What are concerns, SE, AD or Iloperidone (Fanapt)
Pregunta 69
Pregunta
What reduces the metabolic risk in Larisidone and makes it less sedating?
Respuesta
-
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
Pregunta 70
Pregunta
Which drug is contraindicated with Rifampin?
Respuesta
-
Illoperidone (Fanapt)
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Lurasidone (Latuda)
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Aripipprazole
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Ziprasidone (Geodon)
Pregunta 71
Pregunta
Lurasidone (Latuda) should be taken with food
Pregunta 72
Pregunta
Aripiprazole interacts with other CYP450 inducers like Carbamazepine, Fluoxetine, Duloxetine
Pregunta 73
Pregunta
Which of the following is a third generation antipsychotic whose MOA is DA partial agonist?
Respuesta
-
Ziprasidone (Geodon)
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Cariprazine (Vraylar)
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Iloperidone (Fanapt)
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Aripiprazole (Abilify)
Pregunta 74
Pregunta
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)
Pregunta 75
Pregunta
[blank_start]Aripiprazole[blank_end] is most sedating and weight gaining while [blank_start]clozapine[blank_end] has biggest risk of EPS
Respuesta
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Aripiprazole
-
Clozapine
-
aripiprazole
-
clozapine
Pregunta 76
Pregunta
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
Pregunta 77
Pregunta
Which two SGA are NOT recommended as first line therapy
Respuesta
-
Lurasidone
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Olanzapine
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Quetiapine
-
Clozapine
Pregunta 78
Pregunta
The following are symptoms of NMS which is incraed with higher potency drugs
Respuesta
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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
Pregunta 79
Pregunta
The following is the treatment for NMS
Respuesta
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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
Pregunta 80
Pregunta
Which of the following are risk factors for QT Prolongation
Pregunta 81
Pregunta
Normal QT <460 msec and as a PMHNP you should ask for an interpretation
Pregunta 82
Pregunta
When do you screen for increase in prolactin levels
Pregunta 83
Pregunta
How does the PMHNP treat increase levels of prolactin
Pregunta 84
Pregunta
When is weight gain most important with atypical antipsychotics
Respuesta
-
First 4 weeks
-
First 6 weeks
-
First 8 weeks
-
First 6 months
Pregunta 85
Pregunta
What drugs can be used to help manage weight gain due to atypical antipsychotics
Respuesta
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Orlistat
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Toirmate
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Adjunct aripiprazole
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Metformin
Pregunta 86
Pregunta
There is no need to titrate Clozapine when switching atypical antipsychotics
Pregunta 87
Pregunta
Sialorrhea (drooling) is the second most common SE (80% of patients) of Clozapine. What interventions can be used to help manage the condition?
Pregunta 88
Pregunta
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?
Respuesta
-
Zyprexa Relprev
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Aristada
-
Risperdal Consta
-
Invega Sustenna
Pregunta 89
Pregunta
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?
Respuesta
-
Dystonic reaction
-
Tardive dyskinesia
-
Akathisia
-
Rabbit syndrome
Pregunta 90
Pregunta
A 34 y/o female with schizophrenia is not responding to a standard dose of an antipsychotic. Which of the following might you suspect?
Respuesta
-
Dopamine 1Ac receptor occupancy less than 60%
-
Dopamine 1Ac receptor occupancy less than 100%
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Dopamine 2 receptor occupancy less than 60%
-
Dopamine 2 receptor occupancy less than 100%
Pregunta 91
Pregunta
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?
Respuesta
-
Mesolimbic
-
Mesocortical
-
Nigrostriatal
-
Tuberoinfundibular
Pregunta 92
Pregunta
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?
Respuesta
-
Serotonin 2A antagonism and serotonin 2C antagonism
-
Serotonin 2C antagonism and histamine 1 antagonism
-
Histamine 1 antagonism and dopamine 2 antagonism
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Dopamine 2 antagonism and serotonin 2A antagonism
Pregunta 93
Pregunta
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?
Respuesta
-
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
Pregunta 94
Pregunta
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?
Respuesta
-
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
Pregunta 95
Pregunta
Which of the following antipsychotic medication is least likely to cause orthostatic hypotension?
Pregunta 96
Pregunta
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?
Respuesta
-
Increase the dose of aripiprazole
-
Decrease the dose of aripiprazole
-
Stop aripiprazole and start another medication
-
Do nothing and monitor the patient
Pregunta 97
Pregunta
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?
Respuesta
-
25 mg IM every 4 weeks
-
50 mg IM every 4 weeks
-
100 mg IM every 4 weeks
-
300 mg IM every 4 weeks
Pregunta 98
Pregunta
Which of the following is cited as the most common reason persons with schizophrenia stop taking medications?
Pregunta 99
Pregunta
Which of the following statements best describes the difference between high and low potency antipsychotic medications?
Respuesta
-
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
Pregunta 100
Pregunta
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?
Respuesta
-
More anticholengic, antihistaminic and low blood pressure
-
More extrapyramidal symptoms and prolactin elevation
-
More akathisia and Parkinsonism
-
More orthostatic hypotension and increase agitation
Pregunta 101
Pregunta
When an atypical antipsychotic is said to have lost it's atypicality, it is referring to which of the following?
Respuesta
-
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
Pregunta 102
Pregunta
What is unique properties does clozapine have, when compared to all other atypical antipsychotic medication?
Respuesta
-
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