Therapeutics of antipsychotics

Question 1

T/F: Antipsychotics are used in schizophrenia for reduction in symptoms but do not eliminate the symptoms

Answer 1

True

Question 2

What are the three SGAs that have the greatest efficacy, what order is the efficacy

Answer 2

Clozapine, Olanzapine, Risperidone/ Clozapine Olanzapine, Risperidone

Question 3

T/F: There is no difference in efficacy between First generation antipsychotics and second generation antipsychotics

Answer 3

False: Clozapine, Olanzapine, and Risperidone have the highest amount of efficacy among all antipsychotics while first generation antispychotics have no difference in efficacy

Question 4

T/F: Patients should be put on clozapine before combination treatment

Answer 4

True

Question 5

What type of dosing should be done for a 1st episode compared to the chornically ill, partial responder who is tolerating

Answer 5

Lower than usual, titrate above usual dose range

Question 6

What type of antipsychotic agent should be chosen after the first episode (stage 1) , stage 2, stage 3

Answer 6

Atypical for a 6 week period, typical or atypical not tried in stage 1, clozapine

Question 7

Which AP is considered first line if the patient also has suicidal ideation

Answer 7

Clozapine

Question 8

What is the therapeutic trial for APs, initial symptom improvement, duration of treatment

Answer 8

4-12 weeks, 1-2 weeks, one year

Question 9

What is the most common side effects of SGAs, FGAs

Answer 9

Metabolic complications, Extrapyramidal side effects (EPS)

Question 10

What is the BBW for antispsychotic agents

Answer 10

Elderly patient with demntia-related psychosis treated with antipsychotic drugs are at an increased risk of death

Question 11

What is a rare but deadly risde effect of FGAs, symptoms

Answer 11

Neurpoleptic Malignant Syndrome/ muscle rigidity, hyperpyrexia (really high fever), altered consciousness

Question 12

What are the early onset types of EPS, Late onset

Answer 12

Akathisia, Dystonic reactions, Pseudoparkinsonism/ Tardive dyskinesia

Question 13

How is akathisia treated

Answer 13

Propanolol, short term BZDS (lorazepam), anticholinergic (benztropine or diphenhydramine)

Question 14

Which EPS symptoms is seen in 90% of patients within 4 days, which antispsychotics are more likely to cause this, treatment

Answer 14

Dystonic reactions, high dose or high potency typical antipsychotics, Stop offending agent or antichoinergic or BZD

Question 15

What are the treatment options for pseudoparkinsonism

Answer 15

Reduce dose, switch to another agent with lower D2 affinity or high M1 affinity, anticholiergic agents

Question 16

How is tardive dyskinesia treated, prevented

Answer 16

Reduce dose, stop, switch (may not get better)/ minimize daily dose, AIMS at baseline then 6 months then yearly

Question 17

Which antipsychotic is most known to cause QTc prolongation

Answer 17

Ziprasidone

Question 18

Which antipsychotic is wieght neutral, potentially loose weight

Answer 18

Ziprasidone, Molindone

Question 19

Which antipsychotics are associated with the most sedation

Answer 19

Chlopromazine, Clozapine, and quetiapine/ Olanzapine (moderate)

Question 20

Which antipsychotics are associated with the most EPS (strongest D2 affinity)

Answer 20

Haloperidol, perhenzazine

Question 21

What antipsychotics are associated with the most anticholinergic effect

Answer 21

Chlorpromazine, Clozapine

Question 22

Which antipsychotics are associated with orthostasis

Answer 22

Chorpromazine, Clozapine, iIloperidone

Question 23

What antispychotics are associated with the high increases in prolactin

Answer 23

Haloperidol, perphenzine, Risperidone/paliperidone

Question 24

Which antispychotic is has the least amount of side effects

Answer 24

Aripiprazole

Question 25

What must be done before a patient is given long-acting injectable agents

Answer 25

Must try PO before switching to long-acting to establish tolerability

Question 26

Which long acting injectable agents must be done every 2-4 weeks

Answer 26

Haloperidol, fluphenazine, risperidone, Olanzapine

Question 27

Which long-acting injectable is every 4 or 8 weeks, every 3 months

Answer 27

Arpiprazole, Paliperidone

Question 28

What is the low potency FGA, side effects

Answer 28

Chlopromazine, High sedation, high anticholinergics, high orthostasis

Question 29

What are the two high potency FGAs, side effects

Answer 29

Haloperidol and Fluphenazine/ High EPS and Increasing prolactin levels

Question 30

What are the recommended SGAs in stage 1

Answer 30

Aripirazole, olanzapine, quetiapine, risperidone, ziprasidone

Question 31

What are the indications for clozapine, what is the the therapeutic trial

Answer 31

treatment resistant schizophrenia and sucidal behabior associated with schizophrenia, 12 weeks

Question 32

What is the BBW for clozapine

Answer 32

Seizures, leukopenia/neutropenia/agranulocytosis, myocarditis/cardiomyopathy

Question 33

What are the common side effects of clozapine

Answer 33

Drowsiness, weight gain, tachycardia, orthostatic hypotension, constipation

Question 34

How does the REMS program for clozapine work

Answer 34

ANC must be AT LEAST 1000/uL for general population and must be AT LEAST 500/uL for patient with documented Benign Ethnic Neutropenia (BEN)/ weekly blood monitoring for 1st 6 months, then every 2qweeks for 6 months then even every 28 days if ANC is at goal

Question 35

Which antipsychotic is known for increased risk of hyperlipidemia and hyperglycemia

Answer 35

Olanzapine

Question 36

What are side effects of ziprasidone, what is special about its kinetics

Answer 36

moderate sedation, moderate EPS, nausea, akathisia/ must take with food (absoprtion 50% lower without food)

Question 37

Which is the FDA warning for using aripiprazole

Answer 37

Compulsive and excessive urge and behaviors

Question 38

What is the active metabolite of paliperidone, advantage

Answer 38

Paliperidone. not sifnificantly metabolized by CYPs

Question 39

What other antipsychotic has a warning of QTc prolongation and also has NE-alpha antagonism

Answer 39

Iloperidone

Question 40

Which antipsychotic is the only sublingual tablet, tip

Answer 40

Asenapine, avoid eating and drinking for 10 minutes after administration

Question 41

What are pharmcokinetic tips for lurasidone

Answer 41

Must take with food (weight neutral)

Question 42

Which antipsychotics are effected by smoking

Answer 42

Clozapine and Olanzapine

Question 43

Which APs have the most drug-drug interactions

Answer 43

Clozapine and Perphenazine

Question 44

Which typical APs have significant weight gain

Answer 44

Chlopromazine, thioridazine

Question 45

Which atypical APs have significant weight gain

Answer 45

Clozapine, Olanzapine, risperidone