Quiz
Antipsychotics
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Questions in this quiz (102)
1DSM indications for antipsychotic medication
- ADisorders 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
- BDisorders where psychosis is an associate feature (BAD, MDD w/ psychosis, Alzheimer's Disease - BBW)
2The following are positive symptoms of psychosis
- ADelusions
- BReduced emotional responsiveness
- CHallucinations
- DLoss of normal functions and feelings
3The following are negative symptoms of psychosis
- ADelusions
- BLoss of normal functions and feelings
- CHallucinations
- DNot being able to experience pleasure
- EReduced emotional responsiveness and social drive
- FReduced speech, reduced grooming, limited eye contact
4Which of the following are pharmacological treatment for psychosis
- Atypical antipsychotics
- Batypical antipsychotics
- Cantidepressants
- Dadjunctive agents
5All antipsychotics have equal efficacy in equipotent doses, but individual vary in responses
- ATrue
- BFalse
6What should be assessed when deciding on which antipsychotic to prescribe
- APast medical history
- BPast response
- CAdherence
- DDose & route
- EDislike of the current president
71st break patients respond better than chronic patients, respond to lower doses of both typical and atypical antipsychotics than chronic patients
- ATrue
- BFalse
8Use of LAI leads to better outcomes
- ATrue
- BFalse
9What is the prime driver in lack of treatment adherence in schizophrenia
- ALack of insurance
- BAnosognosia - lack of insight
- CSide effects
- DSES
10Which of the following are cosidered intolerable SE
- AWeight gain
- BDecrease in libido
- CCardiometabolic
- DCognitive dysfunction
- EEPS
- FSedation/sleepiness
11Cardiometabolic is a combination of metabolic dysfunctions mainly characterized by insulin resistance, impaired glucose tolerance, dyslipidemia, hypertension, and central adiposity
- ATrue
- BFalse
12EPS is dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness), parkinsonism (rigidity), bradykinesia (slowness of movement), tremor, and tardive dyskinesia (irregular, jerky movements).
- ATrue
- BFalse
13Dopamine 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- Amesolimbic
- Bmesocortical
- Cmesolimbic
- Dmesocortical
14Dopamine Hypothesis of Schizophrenia/Psychosis attributes symptoms of schizophrenia (like psychoses) to a disturbed and hyperactive dopaminergic signal transduction
- ATrue
- BFalse
15Pro arguments for the Dopamine hypothesis of schizophrenia/psychosis
- AAgents acting at alternative sites also produce psychos
- BDA agents produce psychosis
- CAntipsychotics are DA antagonists
- DD2 receptor affinity correlates with antipsychotic potency
16Dysregulation in the following NT may cause psychosis/schizophrenia
- ASerotonin
- BNE
- CGlutamate
- DGABA
- ENicotinic Acetylcholine
17Which systeme modulate the dopamine system and thus are implicted in psychosis/schizophrenia
- ANE
- BGlutatmate
- C5HT
- DNicotinic Acetylcholine
18Which of the following are conventional D2 antagonists =FGA = typical antipsychotics
- AChlorpromazine -Thorazine
- BFluphenazine - Prolixin
- CHaloperidol - Haldol
- DMelindone - Moban
- EPerphenazine - Trilafon
- FPimozide - Orap
- GThioridazine - Mellaril
- HThiothixene - Navene
- ITrifluoperazine - Stelazine
19Before prescribing an LAI, a PMHNP should first trial with the oral agent
- ATrue
- BFalse
20Typical LAI include
- AFluphenazine decanoate
- BHaloperidol deconate
21All typical antipsychotics are basically the same in that they block D2 receptors in the brain
- ATrue
- BFalse
22Typical antipsychotics block D2 receptors in the brain and can also block
- AMuscarinic cholinergic receptors
- BH1 receptors
- CA1 adrenergic receptors
- DSigma
23Which receptor makes antipsychotic an atypical antipsychotic
- A5H2TA
- B5H1TC
- C5H2TB
- D5H3TA
24Typical agents block all 4 DA pathways which drives the following SE
- AProduction of negative symptoms
- BWorsening of cognitive symptoms
- CUnwanted EPS
- DProlactin levels rising
- EIncrease in appetite and weight gain
255H2TA ANTAGONISM and D2 ANTAGONISM is the MOA for aytpical antipsychotics
- ATrue
- BFalse
26According to Stahl, "the pines, the dones, 2 pips and a rip" are how to identify atypical antipsychotics
- ATrue
- BFalse
27Which of the following are atypical antipsychotics
- ADONE - Iloperidone, Lurasidone, Paliperidone, Siziprasidone
- BPIP - Aripiprazole, Brexpipraxole
- CPINE - Quetiapine, Asenapine, Olanzapine, Clozapine
- DRIP - Risperadol
- ECaripraprazine
285HT2A binding of the PINES is [blank_start]more[blank_end] potent than D2
- Amore
- Bless
295HT2A binding by DONES is [blank_start]more[blank_end] potent than D2
- Amore
- Bless
305HT2A binding by Two Pips and a Rip is [blank_start]less[blank_end] potent than D2
- Amore
- Bless
31So the order of antagonism for receptor sites is:
Pine - Done - D2 -Rip/Pip- ATrue
- BFalse
32What is the black box warning for atypical antipsychotics
- APregnancy
- BLactation
- CElderly with dementia
- DHepatotoxicity
33Atypical Antipsychotic class side effects include
- ABBW Elderly patients with dementia
- BNMS
- CHepatotoxicity
- DHyperprolactinemia
- EMetabolic changes
- FDyslipidemia
- GWeight gain
- HTardive dykinesia
- IOrthostatic hypotension
- JSeizures
34What is the biggest concern in the use of atypical antipsychotic ClozaPINE (Clozaril)
- ACardiometabolic
- BBP
- CAgranulocytosis
- DDRESS
35All SGA are 5HT-DA Antagonists
- ATrue
- BFalse
36ClozaPINE (Clozaril) is
- ANot first line
- BFor treatment resistent
- CFor highly aggressive
- DFor elderly
37How often should a patient on ClozaPINE (Clozaril) be monitored
- AWeekly blood tests for 6 months, every 2 weeks for the following six months
- BWeekly blood tests for 6 months, monthly for the following six months
- CWeekly blood tests for 6 months, every 2 weeks for the following year
38What is the main concern with OlazaPINE (Zyprexa)?
- AEPS
- BAgranulocytosis
- CCardiometabolic
- DIncrease effect of BP medication
39Common Side effects of OlanzaPINE (Zyprexa)
- ASedation
- BWeight gain
- CEPS
40What interactions should a PMHNP watch with OlazaPINE (Zyprexa) which will raise the level of the drug?
- ACoumadin
- BCarbamazepine
- CSmoking
- DGrapefruit juice
41The binding properties of QuetiaPINE (Seroquel) are due to metabolite
- ATrue
- BFalse
42QuetiaPINE causes prolactin elevation
- ATrue
- BFalse
43Which SE are common with QuetiaPINE (Seroquel)?
- ASedation
- BWeight gain
- CEPS
44QuetiaPINE (Seroquel) has strong antidepressant properties and is frequently used as an adjunct to address sleep issues
- ATrue
- BFalse
45What is contraindication/concern for QuetiaPINE (Seroquel)?
- AAgranulocytosis
- BCardiometabolic
- CCataracts
- DIncrease effects of BP medication
46AsenaPINE (Saphris) has the following indications
- ASchizophrenia
- BBAD
- CMDD
47What makes AsenaPINE (Saphris) MOA unique?
- ACannot be crushed or split
- BAbsorbed on tongue
- CLack of H1 binding
- DBinds to a metabolite
48Which are the common SE of AsenaPINE (Saphris)
- ASedation
- BWeight gain
- CEPS
49What is the CI/concern with AsenaPINE (Saphris)
- AAgranulocytosis
- BCardiometabolic risk
- CIncrease effects of BP medication
- DDRESS
50Which atypical antipsychotic can be used for autism irritability
- APaliperiDONE (Invega)
- BRisperiDONE (Risperdol)
- CZiprasiDONE
- DLurasiDONE
51Which atypical antipsychotic can also be used as a mood stabilizer
- APaliperdone
- BOlanzepine
- CRisperidone
- DAsenapine
52Which atypical antipsychotic can increase prolactin levels even at low doses
- AZiprasidone (Geodon)
- BLarsidone (Latuda)
- CRisperidone (Resperdol)
- DPaliperidone (Invega)
53Risperidone (Risperdal) can [blank_start]lower[blank_end] plasma levels of carbamazepine
Risperidone (Risperdal) can [blank_start]increase[blank_end] plasma levels of Paroxetine & Fluoxetine- Alower
- Bincrease
- Clower
- Dincrease
54What makes the administration of Paliperidone (Invega) unique
- AMelts on the tongue
- BCan't be chewed or divided
- CAvailable only by IM
55What are the common side effects of PaliperiDONE?
- ASedation
- BWeight
- CEPS
56EPS is a common side effect of Paliperidone (Invega)
- ATrue
- BFalse
57Contraindications/Concerns for Paliperidone (Invega) include risk of
- AAgranulocytosis
- BCardiometabolic syndrome
- CCataracts
- DIncrease the effect of BP medication
58Contraindications/Concerns for Paliperidone (Invega) include risk of
- ACardiometabolic risk
- BCataracts
- CIncrease effect of antihypertensive medications
- DQTc interval
59Paliperidone (Invega) is metabolized by the liver
- ATrue
- BFalse
60Risperidone (Risperdal) is better tolerated than Paliperidone (Invega)
- ATrue
- BFalse
61What is the biggest concern/adverse effect to monitor with ZiprasiDONE (Geodon)
- AQTc elongation
- BCardiometabolic syndrome
- CDRESS
- DPriapism
62The following SE are common with Ziprasidone (Geodon)
- ASedation
- BWeight gain
- CEPS
- DHah! Trick question
63Ziprasidone should not be taken with food
- ATrue
- BFalse
64The following AE should be monitored with Ziprasidone
- ACardiometabolic syndrome
- BDRESS
- CQTc
- DEnhance antihypertensive medication
- ECataracts
65Iloperidone is indicated for [blank_start]schizophrenia[blank_end] while Luradidone is indicated for [blank_start]bipolar depression[blank_end]
- Aschizophrenia
- Bbipolar depression
- Cschizophrenia
- Dbipolar depression
66Iloperidone (Fanapt) is a CYP450D6 inhibitor so will affect dosing with the following medications
- APaxil
- BFluoxetine
- CDuloxetine
- DQuinidine
- ETrazadone
67Which medication lowers the risk of EPS
- ALurasidone (Latuda)
- BIloperidone (Fanapt)
- CAripiprazole (Abilify)
- DCariprazine (Vraylar)
68What are concerns, SE, AD or Iloperidone (Fanapt)
- ARisk of QTc elongatoni
- BEnhancement of antihypertensive medications
- CDRESS
- DEPS
69What reduces the metabolic risk in Larisidone and makes it less sedating?
- ACYP3A4 metabolism
- BLack of H1 binding
- CLower D2 inhibition
- DLack of H2A binding
70Which drug is contraindicated with Rifampin?
- AIlloperidone (Fanapt)
- BLurasidone (Latuda)
- CAripipprazole
- DZiprasidone (Geodon)
71Lurasidone (Latuda) should be taken with food
- ATrue
- BFalse
72Aripiprazole interacts with other CYP450 inducers like Carbamazepine, Fluoxetine, Duloxetine
- ATrue
- BFalse
73Which of the following is a third generation antipsychotic whose MOA is DA partial agonist?
- AZiprasidone (Geodon)
- BCariprazine (Vraylar)
- CIloperidone (Fanapt)
- DAripiprazole (Abilify)
74Parkinson’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)
- ATrue
- BFalse
75[blank_start]Aripiprazole[blank_end] is most sedating and weight gaining while [blank_start]clozapine[blank_end] has biggest risk of EPS
- AAripiprazole
- BClozapine
- Caripiprazole
- Dclozapine
76Prior 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- ATrue
- BFalse
77Which two SGA are NOT recommended as first line therapy
- ALurasidone
- BOlanzapine
- CQuetiapine
- DClozapine
78The following are symptoms of NMS which is incraed with higher potency drugs
- AFluctuation LOC/confusion
- BLead pipe rigidity
- CAutonomic instability: hyperthermia, hypertension, tachycardia, tachypnea
- DDiaphoresis
- EMutism
- FLeukocytosis, increased CPK, AST, ALT, LDH & myoglobinuria
79The following is the treatment for NMS
- ADiscontinue neuroleptic
- BSupportive care: hydration and temperature control
- CBromocriptine (DA agoninst used to restore lost DA tone
- DDantrolene (Direct acting skeletal muscle relaxant)
- EPrayer and chocolate
80Which of the following are risk factors for QT Prolongation
- AMedications - quinidine, thioridazine, TCA
- BCardiac disease
- CElectrolyte imbalances
- DHyperthyroidism
- EHypothyroidism
- FSubstance abuse
81Normal QT <460 msec and as a PMHNP you should ask for an interpretation
- ATrue
- BFalse
82When do you screen for increase in prolactin levels
- APatient is symptomatic
- BRisperidone
- CWomen of childbearing age
- DPaliperidone
83How does the PMHNP treat increase levels of prolactin
- ALower the dose
- BSwitch to a prolactin-sparing agent
- CAugment with Aripiprazole
- DAugment with Risperidone
84When is weight gain most important with atypical antipsychotics
- AFirst 4 weeks
- BFirst 6 weeks
- CFirst 8 weeks
- DFirst 6 months
85What drugs can be used to help manage weight gain due to atypical antipsychotics
- AOrlistat
- BToirmate
- CAdjunct aripiprazole
- DMetformin
86There is no need to titrate Clozapine when switching atypical antipsychotics
- ATrue
- BFalse
87Sialorrhea (drooling) is the second most common SE (80% of patients) of Clozapine. What interventions can be used to help manage the condition?
- AUse lowest dose possible
- BDose medication HS
- CTreat with clonidine or a M1 selective antagonist
- DWalk around with a drool handkerchief
88Rick 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?
- AZyprexa Relprev
- BAristada
- CRisperdal Consta
- DInvega Sustenna
89Fred, 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?
- ADystonic reaction
- BTardive dyskinesia
- CAkathisia
- DRabbit syndrome
90A 34 y/o female with schizophrenia is not responding to a standard dose of an antipsychotic. Which of the following might you suspect?
- ADopamine 1Ac receptor occupancy less than 60%
- BDopamine 1Ac receptor occupancy less than 100%
- CDopamine 2 receptor occupancy less than 60%
- DDopamine 2 receptor occupancy less than 100%
91Sally 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?
- AMesolimbic
- BMesocortical
- CNigrostriatal
- DTuberoinfundibular
92Sammy 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?
- ASerotonin 2A antagonism and serotonin 2C antagonism
- BSerotonin 2C antagonism and histamine 1 antagonism
- CHistamine 1 antagonism and dopamine 2 antagonism
- DDopamine 2 antagonism and serotonin 2A antagonism
93Charles 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?- AStart Charles on Rosuvastatin (Crestor) 20 mg po daily educate him about a low cholesterol diet and recheck his lipid panel in 3 months.
- BStart Charles on Metformin 500 mg po BID, re-check his A1C in 3 months and educate him on a low cholesterol diet
- CStart 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
- DRefer Charles to his primary care provider and provide him a copy of all laboratory values to present at his medical visit
94Doris 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?
- AOrder 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
- BSend her to the emergency room due to an acute mental status change and evaluation for neuroleptic malignant syndrome
- CDo 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
- DOrder 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
95Which of the following antipsychotic medication is least likely to cause orthostatic hypotension?
- Aluphenazine (Prolixin)
- Bclozapine (Clozaril)
- Cchlorpromazine (Thorazine)
- Dquetiapine (Seroquel)
96A 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?
- AIncrease the dose of aripiprazole
- BDecrease the dose of aripiprazole
- CStop aripiprazole and start another medication
- DDo nothing and monitor the patient
97Mr. 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?
- A25 mg IM every 4 weeks
- B50 mg IM every 4 weeks
- C100 mg IM every 4 weeks
- D300 mg IM every 4 weeks
98Which of the following is cited as the most common reason persons with schizophrenia stop taking medications?
- ACardiometabolic Side Effects
- BAnosognosia
- CPositive Symptoms
- DNegative Symptoms
99Which of the following statements best describes the difference between high and low potency antipsychotic medications?
- ALow potency antipsychotics are second generation and high potency antipsychotics are conventional
- BLow potency antipsychotics are typical antipsychotics and high potency antipsychotics are conventional
- CLow potency antipsychotics require lower doses and high potency antipsychotics are require higher doses
- DLow potency antipsychotics require higher doses and high potency antipsychotics require lower doses
100Mr. 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?
- AMore anticholengic, antihistaminic and low blood pressure
- BMore extrapyramidal symptoms and prolactin elevation
- CMore akathisia and Parkinsonism
- DMore orthostatic hypotension and increase agitation
101When an atypical antipsychotic is said to have lost it's atypicality, it is referring to which of the following?
- A80% 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
- B80% or higher dopamine blockade in the limbic region, striatum and pituitary are blocked
- CLess than 60% dopamine blockade is occurring in the limbic region, striatum, and pituitary
- DLess than 60% dopamine blockade is occurring in the limbic region and more than 80% in the striatum and pituitary
102What is unique properties does clozapine have, when compared to all other atypical antipsychotic medication?
- Astrong 5HT2A antagonism and low D2 receptor occupancy
- Bstrong 5HT2A agonist properties and high D2 occupancy
- Cweak 5HT2A antagonism and low D2 receptor occupancy
- Dweak 5HT2A agonist properties and high D2 occupancy
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- Quiz on Antipsychotics , created by Melanie Grynsztejn on 05/02/2018.
- Author
- Melanie Grynsztejn
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- English
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