Questão 1
Questão
DSM indications for antipsychotic medication
Responda
-
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)
Questão 2
Questão
The following are positive symptoms of psychosis
Questão 3
Questão
The following are negative symptoms of psychosis
Responda
-
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
Questão 4
Questão
Which of the following are pharmacological treatment for psychosis
Responda
-
typical antipsychotics
-
atypical antipsychotics
-
antidepressants
-
adjunctive agents
Questão 5
Questão
All antipsychotics have equal efficacy in equipotent doses, but individual vary in responses
Questão 6
Questão
What should be assessed when deciding on which antipsychotic to prescribe
Questão 7
Questão
1st break patients respond better than chronic patients, respond to lower doses of both typical and atypical antipsychotics than chronic patients
Questão 8
Questão
Use of LAI leads to better outcomes
Questão 9
Questão
What is the prime driver in lack of treatment adherence in schizophrenia
Questão 10
Questão
Which of the following are cosidered intolerable SE
Responda
-
Weight gain
-
Decrease in libido
-
Cardiometabolic
-
Cognitive dysfunction
-
EPS
-
Sedation/sleepiness
Questão 11
Questão
Cardiometabolic is a combination of metabolic dysfunctions mainly characterized by insulin resistance, impaired glucose tolerance, dyslipidemia, hypertension, and central adiposity
Questão 12
Questão
EPS is dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness), parkinsonism (rigidity), bradykinesia (slowness of movement), tremor, and tardive dyskinesia (irregular, jerky movements).
Questão 13
Questão
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
Responda
-
mesolimbic
-
mesocortical
-
mesolimbic
-
mesocortical
Questão 14
Questão
Dopamine Hypothesis of Schizophrenia/Psychosis attributes symptoms of schizophrenia (like psychoses) to a disturbed and hyperactive dopaminergic signal transduction
Questão 15
Questão
Pro arguments for the Dopamine hypothesis of schizophrenia/psychosis
Responda
-
Agents acting at alternative sites also produce psychos
-
DA agents produce psychosis
-
Antipsychotics are DA antagonists
-
D2 receptor affinity correlates with antipsychotic potency
Questão 16
Questão
Dysregulation in the following NT may cause psychosis/schizophrenia
Responda
-
Serotonin
-
NE
-
Glutamate
-
GABA
-
Nicotinic Acetylcholine
Questão 17
Questão
Which systeme modulate the dopamine system and thus are implicted in psychosis/schizophrenia
Responda
-
NE
-
Glutatmate
-
5HT
-
Nicotinic Acetylcholine
Questão 18
Questão
Which of the following are conventional D2 antagonists =FGA = typical antipsychotics
Questão 19
Questão
Before prescribing an LAI, a PMHNP should first trial with the oral agent
Questão 20
Questão
Typical LAI include
Responda
-
Fluphenazine decanoate
-
Haloperidol deconate
Questão 21
Questão
All typical antipsychotics are basically the same in that they block D2 receptors in the brain
Questão 22
Questão
Typical antipsychotics block D2 receptors in the brain and can also block
Questão 23
Questão
Which receptor makes antipsychotic an atypical antipsychotic
Questão 24
Questão
Typical agents block all 4 DA pathways which drives the following SE
Responda
-
Production of negative symptoms
-
Worsening of cognitive symptoms
-
Unwanted EPS
-
Prolactin levels rising
-
Increase in appetite and weight gain
Questão 25
Questão
5H2TA ANTAGONISM and D2 ANTAGONISM is the MOA for aytpical antipsychotics
Questão 26
Questão
According to Stahl, "the pines, the dones, 2 pips and a rip" are how to identify atypical antipsychotics
Questão 27
Questão
Which of the following are atypical antipsychotics
Responda
-
DONE - Iloperidone, Lurasidone, Paliperidone, Siziprasidone
-
PIP - Aripiprazole, Brexpipraxole
-
PINE - Quetiapine, Asenapine, Olanzapine, Clozapine
-
RIP - Risperadol
-
Caripraprazine
Questão 28
Questão
5HT2A binding of the PINES is [blank_start]more[blank_end] potent than D2
Questão 29
Questão
5HT2A binding by DONES is [blank_start]more[blank_end] potent than D2
Questão 30
Questão
5HT2A binding by Two Pips and a Rip is [blank_start]less[blank_end] potent than D2
Questão 31
Questão
So the order of antagonism for receptor sites is:
Pine - Done - D2 -Rip/Pip
Questão 32
Questão
What is the black box warning for atypical antipsychotics
Responda
-
Pregnancy
-
Lactation
-
Elderly with dementia
-
Hepatotoxicity
Questão 33
Questão
Atypical Antipsychotic class side effects include
Questão 34
Questão
What is the biggest concern in the use of atypical antipsychotic ClozaPINE (Clozaril)
Responda
-
Cardiometabolic
-
BP
-
Agranulocytosis
-
DRESS
Questão 35
Questão
All SGA are 5HT-DA Antagonists
Questão 36
Questão
ClozaPINE (Clozaril) is
Responda
-
Not first line
-
For treatment resistent
-
For highly aggressive
-
For elderly
Questão 37
Questão
How often should a patient on ClozaPINE (Clozaril) be monitored
Responda
-
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
Questão 38
Questão
What is the main concern with OlazaPINE (Zyprexa)?
Questão 39
Questão
Common Side effects of OlanzaPINE (Zyprexa)
Questão 40
Questão
What interactions should a PMHNP watch with OlazaPINE (Zyprexa) which will raise the level of the drug?
Responda
-
Coumadin
-
Carbamazepine
-
Smoking
-
Grapefruit juice
Questão 41
Questão
The binding properties of QuetiaPINE (Seroquel) are due to metabolite
Questão 42
Questão
QuetiaPINE causes prolactin elevation
Questão 43
Questão
Which SE are common with QuetiaPINE (Seroquel)?
Questão 44
Questão
QuetiaPINE (Seroquel) has strong antidepressant properties and is frequently used as an adjunct to address sleep issues
Questão 45
Questão
What is contraindication/concern for QuetiaPINE (Seroquel)?
Questão 46
Questão
AsenaPINE (Saphris) has the following indications
Questão 47
Questão
What makes AsenaPINE (Saphris) MOA unique?
Questão 48
Questão
Which are the common SE of AsenaPINE (Saphris)
Questão 49
Questão
What is the CI/concern with AsenaPINE (Saphris)
Questão 50
Questão
Which atypical antipsychotic can be used for autism irritability
Responda
-
PaliperiDONE (Invega)
-
RisperiDONE (Risperdol)
-
ZiprasiDONE
-
LurasiDONE
Questão 51
Questão
Which atypical antipsychotic can also be used as a mood stabilizer
Responda
-
Paliperdone
-
Olanzepine
-
Risperidone
-
Asenapine
Questão 52
Questão
Which atypical antipsychotic can increase prolactin levels even at low doses
Responda
-
Ziprasidone (Geodon)
-
Larsidone (Latuda)
-
Risperidone (Resperdol)
-
Paliperidone (Invega)
Questão 53
Questão
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
Responda
-
lower
-
increase
-
lower
-
increase
Questão 54
Questão
What makes the administration of Paliperidone (Invega) unique
Questão 55
Questão
What are the common side effects of PaliperiDONE?
Questão 56
Questão
EPS is a common side effect of Paliperidone (Invega)
Questão 57
Questão
Contraindications/Concerns for Paliperidone (Invega) include risk of
Questão 58
Questão
Contraindications/Concerns for Paliperidone (Invega) include risk of
Questão 59
Questão
Paliperidone (Invega) is metabolized by the liver
Questão 60
Questão
Risperidone (Risperdal) is better tolerated than Paliperidone (Invega)
Questão 61
Questão
What is the biggest concern/adverse effect to monitor with ZiprasiDONE (Geodon)
Responda
-
QTc elongation
-
Cardiometabolic syndrome
-
DRESS
-
Priapism
Questão 62
Questão
The following SE are common with Ziprasidone (Geodon)
Responda
-
Sedation
-
Weight gain
-
EPS
-
Hah! Trick question
Questão 63
Questão
Ziprasidone should not be taken with food
Questão 64
Questão
The following AE should be monitored with Ziprasidone
Questão 65
Questão
Iloperidone is indicated for [blank_start]schizophrenia[blank_end] while Luradidone is indicated for [blank_start]bipolar depression[blank_end]
Responda
-
schizophrenia
-
bipolar depression
-
schizophrenia
-
bipolar depression
Questão 66
Questão
Iloperidone (Fanapt) is a CYP450D6 inhibitor so will affect dosing with the following medications
Responda
-
Paxil
-
Fluoxetine
-
Duloxetine
-
Quinidine
-
Trazadone
Questão 67
Questão
Which medication lowers the risk of EPS
Responda
-
Lurasidone (Latuda)
-
Iloperidone (Fanapt)
-
Aripiprazole (Abilify)
-
Cariprazine (Vraylar)
Questão 68
Questão
What are concerns, SE, AD or Iloperidone (Fanapt)
Questão 69
Questão
What reduces the metabolic risk in Larisidone and makes it less sedating?
Responda
-
CYP3A4 metabolism
-
Lack of H1 binding
-
Lower D2 inhibition
-
Lack of H2A binding
Questão 70
Questão
Which drug is contraindicated with Rifampin?
Responda
-
Illoperidone (Fanapt)
-
Lurasidone (Latuda)
-
Aripipprazole
-
Ziprasidone (Geodon)
Questão 71
Questão
Lurasidone (Latuda) should be taken with food
Questão 72
Questão
Aripiprazole interacts with other CYP450 inducers like Carbamazepine, Fluoxetine, Duloxetine
Questão 73
Questão
Which of the following is a third generation antipsychotic whose MOA is DA partial agonist?
Responda
-
Ziprasidone (Geodon)
-
Cariprazine (Vraylar)
-
Iloperidone (Fanapt)
-
Aripiprazole (Abilify)
Questão 74
Questão
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)
Questão 75
Questão
[blank_start]Aripiprazole[blank_end] is most sedating and weight gaining while [blank_start]clozapine[blank_end] has biggest risk of EPS
Responda
-
Aripiprazole
-
Clozapine
-
aripiprazole
-
clozapine
Questão 76
Questão
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
Questão 77
Questão
Which two SGA are NOT recommended as first line therapy
Responda
-
Lurasidone
-
Olanzapine
-
Quetiapine
-
Clozapine
Questão 78
Questão
The following are symptoms of NMS which is incraed with higher potency drugs
Responda
-
Fluctuation LOC/confusion
-
Lead pipe rigidity
-
Autonomic instability: hyperthermia, hypertension, tachycardia, tachypnea
-
Diaphoresis
-
Mutism
-
Leukocytosis, increased CPK, AST, ALT, LDH & myoglobinuria
Questão 79
Questão
The following is the treatment for NMS
Responda
-
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
Questão 80
Questão
Which of the following are risk factors for QT Prolongation
Questão 81
Questão
Normal QT <460 msec and as a PMHNP you should ask for an interpretation
Questão 82
Questão
When do you screen for increase in prolactin levels
Questão 83
Questão
How does the PMHNP treat increase levels of prolactin
Questão 84
Questão
When is weight gain most important with atypical antipsychotics
Responda
-
First 4 weeks
-
First 6 weeks
-
First 8 weeks
-
First 6 months
Questão 85
Questão
What drugs can be used to help manage weight gain due to atypical antipsychotics
Responda
-
Orlistat
-
Toirmate
-
Adjunct aripiprazole
-
Metformin
Questão 86
Questão
There is no need to titrate Clozapine when switching atypical antipsychotics
Questão 87
Questão
Sialorrhea (drooling) is the second most common SE (80% of patients) of Clozapine. What interventions can be used to help manage the condition?
Questão 88
Questão
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?
Responda
-
Zyprexa Relprev
-
Aristada
-
Risperdal Consta
-
Invega Sustenna
Questão 89
Questão
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?
Responda
-
Dystonic reaction
-
Tardive dyskinesia
-
Akathisia
-
Rabbit syndrome
Questão 90
Questão
A 34 y/o female with schizophrenia is not responding to a standard dose of an antipsychotic. Which of the following might you suspect?
Responda
-
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%
Questão 91
Questão
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?
Responda
-
Mesolimbic
-
Mesocortical
-
Nigrostriatal
-
Tuberoinfundibular
Questão 92
Questão
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?
Responda
-
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
Questão 93
Questão
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?
Responda
-
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
Questão 94
Questão
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?
Responda
-
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
Questão 95
Questão
Which of the following antipsychotic medication is least likely to cause orthostatic hypotension?
Questão 96
Questão
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?
Responda
-
Increase the dose of aripiprazole
-
Decrease the dose of aripiprazole
-
Stop aripiprazole and start another medication
-
Do nothing and monitor the patient
Questão 97
Questão
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?
Responda
-
25 mg IM every 4 weeks
-
50 mg IM every 4 weeks
-
100 mg IM every 4 weeks
-
300 mg IM every 4 weeks
Questão 98
Questão
Which of the following is cited as the most common reason persons with schizophrenia stop taking medications?
Questão 99
Questão
Which of the following statements best describes the difference between high and low potency antipsychotic medications?
Responda
-
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
Questão 100
Questão
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?
Responda
-
More anticholengic, antihistaminic and low blood pressure
-
More extrapyramidal symptoms and prolactin elevation
-
More akathisia and Parkinsonism
-
More orthostatic hypotension and increase agitation
Questão 101
Questão
When an atypical antipsychotic is said to have lost it's atypicality, it is referring to which of the following?
Responda
-
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
Questão 102
Questão
What is unique properties does clozapine have, when compared to all other atypical antipsychotic medication?
Responda
-
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