Antipsychotics Jeopardy

Question 1

Not only was this drug the first antipsychotic, it was the first psychotropic medication of any kind.

Answer 1

Chlorpromazine (Thorazine)

Question 2

Typical antipsychotics are divided into these two categories which also correlates to their D2 receptor’s binding affinity

Answer 2

High potency and low potency

Question 3

This typical antipsychotic is available PO, IM, and IV, is commonly used to treat agitated patients in hospitals/ER’s, and can be used to treat Tourette’s syndrome.

Answer 3

Haloperidol (Haldol)

Question 4

Three anticholinergic meds commonly used to counter extrapyramidal side-effects (EPS) are: trihexyphenidyl (Artane), benztropine (Cogentin), & this medication

Answer 4

Diphenhydramine (Benadryl)

Question 5

When used in their long-acting injectable form, these 2 FGA’s are given IM every 2-4 weeks to treat pts w/ chronic schizophrenia.

Answer 5

• Haloperidol (Haldol)

- Fluphenazine (Prolixin)

Question 6

This type of typical antipsychotic is anti-cholinergic, anti-histaminic, & an α1 adrenergic antagonist.

Answer 6

Low potency antipsychotic

- Chlorpromazine (thorazine)

Question 7

While prochlorperazine (Compazine) is a D2 blocker, it is more commonly used for this than its antipsychotic properties.

Answer 7

Antiemetic properties

Question 8

This antipsychotic can also be used to treat intractable hiccups.

Answer 8

Chlorpromazine (Thorazine)

Question 9

This typical antipsychotic has the greatest risk of any antipsychotic for dose dependent QTc prolongation, torsades de pointes, and cardiotoxicity

Answer 9

Thioridazine (Mellaril)

Question 10

Even though its the most efficacious antipsychotic, its side effect profile prevents this drug from consideration for first line use.

Answer 10

Clozapine (Clozaril)

Question 11

This atypical antipsychotic is used to treat psychosis in Lewy Body Dementia & Parkinson’s Disease due to its low likelihood of EPS.

Answer 11

Quetiapine (Seroquel)

Question 12

These 2 atypicals are available in a long acting injectable form and have the highest risk among atypicals of causing prolactin elevation.

Answer 12

• Risperidone (Risperdal)

- Paliperidone (Invega)

Question 13

These two atypicals are most likely to cause side effects of significant sedation and the metabolic syndrome.

Answer 13

• Olanzapine (Zyprexa)

- Clozapine (Clozaril)

Question 14

Of all the SGA’s, this med has the highest risk of causing

QTc prolongation.

Answer 14

Ziprasidone (Geodon)

Question 15

This SGA is a partial dopamine agonist & commonly has the side effect akathisia.

Answer 15

Aripiprazole (Abilify)

Question 16

This atypical is FDA approved for adjunct treatment of MDD.

Answer 16

Aripiprazole (Abilify)

Question 17

Due to the risk of seizure induction, slow dose titration must be done for this atypical antipsychotic.

Answer 17

Clozapine (Clozaril)

Question 18

Lurasidone (Latuda), asenapine (Saphris) & these two SGA’s are the most metabolically “neutral”.

Answer 18

• Ziprasidone (Geodon)

- Aripiprazole (Abilify)

Question 19

More common with typical antipsychotics, this side effect is characterized by repetitive, involuntary, purposeless
movements.

Answer 19

Tardive dyskinesia

Question 20

For a pt taking Clozapine (Clozaril), this is done when the WBC is <2,000 or the ANC is <1,000.

Answer 20

Abrupt stop
(abrupt stop → rebound psychosis; do gradual taper when possible)

Question 21

Due to the risk of metabolic syndrome, pts on atypicals should have their weight, waist circumference, and these 2 labs monitored regularly.

Answer 21

• Glucose

- Lipids

Question 22

The picture shows a pt experiencing this EPS side

effect. (Neck tilted towards shoulder)

Answer 22

Dystonia

Question 23

Clozapine (Clozaril), quetiapine (Seroquel), iloperidone (Fanapt), risperidone (Risperdal) paliperidone (Invega)

may all cause dose dependent orthostatic hypotension due to this.

Answer 23

α1 adrenergic antagonism

- Undesirable in elderly pts & pts at risk for falls

Question 24

There is a blackbox warning for the use of antipsychotics in elderly dementia patients due to increased risk of this.

Answer 24

Sudden death (CV cause)

Question 25

The antipsychotic side effect seen in this pt is this (eyes looking upward and towards midline, asymmetrically)

Answer 25

Oculogyric crisis

Question 26

What is the MoA behind gynecomastia in pts taking D2-receptor blockers?

Answer 26

Hyperprolactinemia

Question 27

This atypical may cause dry mouth due to its anticholinergic properties, but ironically it may also cause excess salivation.

Answer 27

Clozapine (Clozaril)

Question 28

SGA’s work primary by blocking these 2 receptors.

Answer 28

D2 receptor | 5HT2A receptor

Question 29

The positive sx of schizophrenia are due to hyperactivity of what dopamine tract?

Answer 29

Mesolimbic pathway

Question 30

Excess blockade of this dopamine tract may cause infertility, galactorrhea, and osteopenia.

Answer 30

Tubuloinfundibular pathway

Question 31

When switching to aripiprazole (Abilify) from a different antipsychotic, before the other antipsychotic has washed out, the aripiprazole (abilify)—at least in theory— initially does this at the D2 receptors.

Answer 31

Act as a dopamine agonist - When switching to abilify, need to switch slowly or have a washout period

Question 32

The % of D2 occupancy necessary for the antipsychotic effect is this.

Answer 32

60%

Question 33

This % of occupancy at D2 is believed to be associated with elevated prolactin and/or EPS.

Answer 33

80%

Question 34

While NMS is uncommon to rare (incident rate 0.02-3%), its | cause is this.

Answer 34

Dopamine antagonism

Question 35

Hypoactivity of this dopamine tract is believed to be a/w the development of negative sx.

Answer 35

Mesocortical pathway

Question 36

The SGA with the unique MoA of partial dopamine agonism is this.

Answer 36

Aripiprazole (Abilify)

Question 37

Prochlorperazine (Compazine) Metoclopramide (Reglan) Droperidol (Inapsine) Promethazine (Phenergan) This antiemetic medication(s) is/are a D2 blocker(s) and may cause EPS or tardive dyskinesia (TD).

Answer 37

All

Question 38

About 75% of pts with schizophrenia do this unhealthy activity which also induces increased metabolism of antipsychotic meds.

Answer 38

Cigarette smoking

Question 39

While not diagnostic for NMS (it may be nl if there is not clearly well developed rigidity), this lab's degree of abnormality correlates with the disease severity and prognosis.

Answer 39

Creatine kinase

Question 40

Antipsychotics approved for the treatment of bipolar depression are olanzapine/fluoxetine (Symbyax), lurasidone (Latuda), and this.

Answer 40

Quetiapine (Seroquel)

Question 41

This atypical has a significant risk of causing hyperprolactinemia, is the active metabolite of risperidone (Risperdal), and needs to be taken with food.

Answer 41

Paliperidone (Invega)

Question 42

The 4 SGA’s that are available in long acting injectable preparations are: risperidone (Risperidal Consta), olanzapine (Zyprexa Relprevv), and these two meds.

Answer 42

- Paliperidone (Invega Sustenna) | - Aripiprazole (Abilify Maintena)

Question 43

Antipsychotic side effects of sedation and weight gain are likely due to antagonist activity at this receptor.

Answer 43

Histamine (H1)

Question 44

Young or Elderly Males or Females This demographic is at the greatest risk for dystonia from antipsychotics.

Answer 44

Young males

Question 45

While muscular rigidity, hyperthermia, and autonomic instability are all common sx of NMS, most often this symptom presents first.

Answer 45

Mental status changes