Schizophrenia

Question 1

Diagnosis of schizophrenia requires two or more of the following symptoms

Answer 1

Delusions, hallucinations, or disorganized speech over a period of 6 months

Question 2

___ is a neurotransmitter that slows the progression of schizophrenia

Answer 2

Nicotine. Dopamine is the other neurotransmitter that plays a role in schizophrenia

Question 3

In schizophrenia, the ___ region of the brain regulates emotions. ___ of this region produces symptoms of schizophrenia

Answer 3

Mesolimbic

Hyperactivity

Question 4

In schizophrenia, the ___ region of the brain regulates cognitive functioning. ___ of this region produces cognitive deficits

Answer 4

Mesocortical

Hypoactivity

Question 5

In schizophrenia, the ___ region of the brain regulates motor activity. ___ of this region produces tics and dyskinesia

Answer 5

Nigrostriatal

Hyperactivity

Question 6

In schizophrenia, the ___ region of the brain inhibits prolactin. ___ of this region increases prolactin and causes amenorrhea in females and gynecomastia in males

Answer 6

Tuberoinfundibular

Hypoactivity

Question 7

Be able to recognize the second generation (atypical) antipsychotics

Answer 7

Aripiprazole (Abilify)
Asenapine (Saphris)
Brexpiprazole (Rexulti)
Cariprazine (Vraylar)
Clozapine (Clozaril)
Iloperidone (Fanapt)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
Paliperidone (Invega)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
***You do not need to know brand names

Question 8

What are the maximum doses of aripiprazole, olanzapine, and quetiapine

Answer 8

Aripiprazole = 30mg
Olanzapine = 20mg
Quetiapine = 800mg

Question 9

Which 3 atypical antipsychotics are partial agonists

Answer 9

Aripiprazole
Brexpiprazole
Cariprazine

Question 10

All antipsychotics block ___ receptors

Answer 10

Dopamine

Question 11

Atypical antipsychotics block dopamine and ___ receptors

Answer 11

Serotonin

Question 12

Side effects (specifically extrapyramindal side effects) are generally more likely with high potency antipsychotics, such as ___ or ___

Answer 12

Haloperidol

Fluphenazine

Question 13

What medications are used to treat pseudoparkinsonism (“pill-rolling”, tremor, rigidity)?

Answer 13

Benztropine
Trihexyphenidyl
Diphenhydramine

Question 14

What medications are used to treat dystonias (twisting of the neck)?

Answer 14

Benztropine
Trihexyphenidyl
Diphenhydramine

Question 15

What medications are used to treat akathisia (restlessness)?

Answer 15

Propranolol

Lorazepam

Question 16

What medications are used to treat tardive dyskinesia (grimacing, worm-like movement of the tongue)?

Answer 16

Removal or reduction of offending agent
Valbenazine
Deutetrabenazine (If associated with Huntington’s Disease)

Question 17

Deutetrabenazine has a BBW of ___ and ___

Answer 17

Depression and suicide

Question 18

What two medications are VMAT 2 Inhibitors?

Answer 18

Valbenazine

Deutetrabenazine

Question 19

What are side effects of VMAT 2 Inhibitors and what medications are used to treat those side effects?

Answer 19

Neuroleptic Malignant Syndrome (NMS) -
Symptoms include hyperthermia, “cogwheeling”, rhabdomyolysis, diaphoresis
Treat with bromocriptine or dantroline (these increase dopamine)

Question 20

What is the BBW for antipsychotics?

Answer 20

Increased mortality in elderly

Question 21

What were the results of the CATIE trial?

Answer 21

Olanzapine is moderately more effective than other atypical antipsychotics and all conventional (1st generation) antipsychotics

Follow-up study showed clozapine to be superior to all other agents in “treatment-resistant schizophrenia”

Question 22

What is the first line treatment for schizophrenia?

Answer 22

Atypical antipsychotic

Question 23

What is the second line treatment for schizophrenia?

Answer 23

Switch to a different atypical antipsychotic or consider a conventional antipsychotic

Question 24

What is the third line treatment for schizophrenia?

Answer 24

Consider clozapine

Question 25

What is the fourth line treatment for schizophrenia?

Answer 25

Consider adding a second agent or ECT to existing clozapine regimen

Question 26

Which atypical antipsychotics cause the most weight gain?

Answer 26

CLOZAPINE, OLANZAPINE, paliperidone, quetiapine, risperidone

Question 27

What are the 3 major side effects of clozapine?

Answer 27

Weight gain, anticholinergic, orthostasis | May or may not cause extrapyramidal symptoms

Question 28

Which atypical antipsychotics cause the most EPS?

Answer 28

Asenapine, paliperidone, risperidone

Question 29

Which atypical antipsychotic may cause weight gain OR weight loss?

Answer 29

Ziprasidone

Question 30

Which atypical antipsychotics cause the most orthostasis?

Answer 30

CLOZAPINE, iloperidone, quetiapine

Question 31

Aripiprazole, brexpiprazole, and cariprazine can cause increased incidence of ___

Answer 31

Akathisia

Question 32

What three atypical antipsychotics have the greatest risk for sedation and metabolic effects?

Answer 32

Cariprazine, clozapine, and olanzapine

Question 33

Clozapine requires blood monitoring. What is the target drug concentration in order to reduce the risk of adverse effects?

Answer 33

350-400 mcg/mL

Question 34

A dose of clozapine > 600mg can cause ___

Answer 34

Seizures

Question 35

Sedation, coma, and death have been associated with injectable forms of ___

Answer 35

Olanzapine

Question 36

A common effect of quetiapine is ___

Answer 36

Sedation - due to anticholinergic properties | think "quiet nap"

Question 37

Ziprasidone has a BBW for ___

Answer 37

Cardiac abnormalities

Question 38

IM olanzapine CANNOT be given with IM ___

Answer 38

Lorazepam