F- Chapter 11: Antipsychotic Drugs Flashcards
(10 cards)
An adolescent male is newly diagnosed with schizo
phrenia. Which of the following antipsychotic agents
may have the best chance to improve his apathy and
blunted affect?
A. Chlorpromazine.
B. Fluphenazine.
C. Haloperidol.
D. Risperidone.
E. Thioridazine
D. Risperidone is the only antipsychotic on the list that has some reported benefit in improving the negative symptoms of schizophrenia. It is a second-generation antipsychotic, and the other drugs listed are first generation antipsychotic agents. All of the agents have the potential to diminish the hallucinations and delusional
thought processes (positive symptoms).
Which one of the following antipsychotics has been
shown to be a partial agonist at the dopamine D2
receptor?
A. Aripiprazole.
B. Clozapine.
C. Haloperidol.
D. Risperidone.
E. Thioridazine.
A. Aripiprazole is the agent that acts as a partial agonist at D2 receptors. Theoretically, the drug would enhance action at these receptors when there is a low concentration of dopamine and would block the actions of high concentrations of dopamine. All of the other drugs are only antagonistic at D2 receptors, with haloperidol being particularly potent.
A 21-year-old male has recently begun pimozide therapy for Tourette disorder. His parents bring him to the emergency department. They describe that he has been having “different-appearing tics” than before, such as prolonged contraction of the facial muscles. While being examined, he experiences opisthotonos (type of extrapyramidal spasm of the body in which the head and heels are bent backward and the body is bowed forward). Which of the following drugs would be beneficial in reducing these symptoms?
A. Benztropine.
B. Bromocriptine.
C. Lithium.
D. Prochlorperazine.
E. Risperidone.
A. The patient is experiencing EPS due to pimozide, and a muscarinic antagonist such as benztropine would be effective in reducing the symptoms. The other
drugs would have no effect or, in the case of prochlorperazine and risperidone, might increase the symptoms.
A 28-year-old woman with schizoaffective disorder
(combination of mood and psychotic symptoms)
reports difficulty falling asleep. Which of the following
would be most beneficial in this patient?
A. Lithium.
B. Chlorpromazine.
C. Haloperidol.
D. Paliperidone.
E. Ziprasidone.
D. Paliperidone is the only agent that is FDA approved for schizoaffective disorder. Chlorpromazine has significant sedative activity as well as antipsychotic
properties and is the drug most likely to alleviate this patient’s major complaint of insomnia. Although other antipsychotics may benefit this patient’s disorder, paliperidone has the indication for this disorder, and if the underlying disorder is improved, then the symptom of insomnia may also improve without risking other, unwanted adverse effects, such as the anticholinergic effects of chlorpromazine.
Which of the following antipsychotic agents is con
sidered to be the most potent and, thus, have the
highest risk of extrapyramidal symptoms?
A. Thioridazine.
B. Fluphenazine.
C. Quetiapine.
D. Chlorpromazine.
E. Clozapine
B. Among the older, conventional, or typical antipsychotics on this list, fluphenazine is the most potent and would thus be expected to have the highest incidence of EPS. The atypical antipsychotics listed (quetiapine and clozapine) could be considered low potency based on their common dosing and are considered to have the lowest risk for EPS
Which antipsychotic has the most sedative potential
and is sometimes questionably used as a hypnotic
agent in certain clinical settings?
A. Fluphenazine.
B. Thiothixene.
C. Quetiapine.
D. Haloperidol.
E. Iloperidone
C. Quetiapine has strong antihistaminergic effects causing sedation and is sometimes used at low doses as a sedative–hypnotic, even though this use is considered off-label. The other antipsychotic agents listed are weaker at blocking the histamine receptor and therefore are not as sedating
A 30-year-old male patient who is treated with halo
peridol for his diagnosis of schizophrenia is considered
to be well-managed symptomatically for his psychotic
symptoms. However, he is reporting restlessness, the
inability to sit still at the dinner table, and his family
notices that he is pacing up and down the hallway
frequently. Of the following, which is the best medication
to treat this antipsychotic-induced akathisia?
A. Benztropine.
B. Dantrolene.
C. Amoxapine.
D. Bromocriptine.
E. Propranolol.
E. Propranolol, a β-blocker, is considered the drug of choice for the management of antipsychotic-induced akathisia. Benztropine is more effective for pseudoparkinsonism and acute dystonias. Amoxapine is an antidepressant that has been associated with EPS. Bromocriptine is more effective for Parkinson-like symptoms, and dantrolene is a muscle relaxant that is best reserved for managing some symptoms of neuroleptic malignant syndrome
Which of the following antipsychotic agents is available
in a LAI formulation that may be useful for patients
with difficulty adhering to therapy?
A. Asenapine.
B. Chlorpromazine.
C. Clozapine.
D. Quetiapine.
E. Risperidone
E. Risperidone is available in a LAI formulation containing risperidone microspheres. The other agents listed do not have LAI formulations. Aripiprazole, fluphenazine, haloperidol, olanzapine, and paliperidone are other antipsychotics that are available in LAI formulations
Which of the following antipsychotic agents is most
associated with the possibility of a hematological
dyscrasia such as agranulocytosis in a patient being
treated for schizophrenia?
A. Chlorpromazine.
B. Buspirone.
C. Lithium.
D. Clozapine.
E. Asenapine
D. Clozapine is the only antipsychotic medication that has a black box warning and a risk of agranulocytosis in approximately 1% of the patients treated. This requires regular monitoring of white blood cell counts. Although other antipsychotics have case reports of blood dyscrasias, clozapine is considered to have the highest risk.
Which antipsychotic agent has been most associated
with significant QT interval prolongation and should
be used with caution in patients with preexisting
arrhythmias or patients taking other drugs associated
with QT prolongation?
A. Thioridazine.
B. Risperidone.
C. Asenapine.
D. Lurasidone.
E. Aripiprazole
A. Of the antipsychotic drugs listed, thioridazine has the highest risk for causing QT interval prolongation. Although this is a general warning for all antipsychotics, thioridazine has been issued a “black box warn
ing,” suggesting that it is associated with the greatest risk.
