Antipsychotic Drugs Overview

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What are the two major categories of antipsychotic drugs?

Typical and atypical (correct)

Dopaminergic and non-dopaminergic

Neuroleptic and major tranquilizers

Conventional and atypical

What is the theory that overstimulation of dopamine (D) receptors is at the heart of schizophrenia called?

The serotonin hypothesis

The GABA hypothesis

The glutamate hypothesis

The dopamine hypothesis (correct)

Which class of antipsychotic drugs includes the drug chlorpromazine (Thorazine)?

Benzisoxazoles

Quinolinones

Thienobenzodiazepines

Phenothiazines (correct)

What is the primary effect of typical antipsychotics in reducing the positive symptoms of schizophrenia?

Reducing dopamine receptor stimulation Signup and view all the answers

Which class of antipsychotics includes the drug asenapine?

Dibenzo-oxepino pyrroles Signup and view all the answers

What was the first antipsychotic drug used to treat psychosis, according to the passage?

Chlorpromazine (Thorazine) Signup and view all the answers

Which side effect of typical antipsychotics is characterized by involuntary, painful movements?

Rigidity Signup and view all the answers

What is the term used to describe the side effect characterized by restlessness?

Akathisia Signup and view all the answers

Which drug interaction poses the most serious risk of CNS depression when combined with antipsychotics?

CNS depressants Signup and view all the answers

Among the listed side effects, which one may be irreversible if it occurs?

Tardive dyskinesia Signup and view all the answers

What is a common symptom of pseudoparkinsonism associated with typical antipsychotics?

Shuffling gait Signup and view all the answers

Which side effect of typical antipsychotics is related to difficulty speaking and swallowing?

Tardive dyskinesia Signup and view all the answers

Which of the following is NOT a characteristic of the newer atypical antipsychotic agents?

Increased risk of metabolic syndrome Signup and view all the answers

According to the passage, what should practitioners do after 3 months of prescribing an atypical antipsychotic?

Check BMI quarterly and order laboratory work-ups annually Signup and view all the answers

What is the primary mechanism of action by which atypical antipsychotics reduce the negative symptoms of schizophrenia?

Blocking serotonin receptors in the cortex, which increases dopamine release Signup and view all the answers

Which of the following is a true statement about the pharmacokinetics of atypical antipsychotics?

They have a wide range of half-lives, with clozapine having a shorter half-life than olanzapine Signup and view all the answers

Which of the following is a contraindication for the use of atypical antipsychotics?

All of the above Signup and view all the answers

Which of the following adverse effects is LEAST likely to occur with the use of atypical antipsychotics compared to typical antipsychotics?

Weight gain Signup and view all the answers

What is the primary reason why clozapine is reserved for the treatment of severe schizophrenia refractory to other antipsychotics?

Clozapine has a higher risk of potentially fatal agranulocytosis Signup and view all the answers

Which of the following atypical antipsychotics is associated with the highest incidence of weight gain and sedation?

Olanzapine Signup and view all the answers

What is the primary reason why atypical antipsychotics should be prescribed cautiously in the presence of hepatic or renal disease?

They are primarily metabolized in the liver and excreted through the renal system Signup and view all the answers

Which of the following is a true statement about the onset of action and time to steady state for atypical antipsychotics?

Onset of action is within a few days to a few weeks, and steady state is reached within a few days Signup and view all the answers

According to the current hypothesis, what is thought to contribute to the positive symptoms of schizophrenia?

Overactivity of D2 receptors in certain brain regions Signup and view all the answers

What are typical antipsychotics less effective in treating?

Negative symptoms of schizophrenia Signup and view all the answers

At approximately what percentage of D2 receptor occupancy do extrapyramidal symptoms become more prominent?

78% Signup and view all the answers

Which of the following is a typical antipsychotic from the phenothiazine group?

Chlorpromazine Signup and view all the answers

What is a life-threatening adverse reaction associated with typical antipsychotics?

Neuroleptic malignant syndrome (NMS) Signup and view all the answers

Which of the following statements about the pharmacokinetics of typical antipsychotics is true?

They are rapidly absorbed and distributed widely to adipose tissue. Signup and view all the answers

What percentage of D2 receptor blockade is associated with clinical effectiveness of typical antipsychotics?

60% to 70% Signup and view all the answers

Which of the following is a precaution or contraindication for the use of typical antipsychotics?

Narrow-angle glaucoma Signup and view all the answers

Which of the following statements about the FDA Black Box Warning for typical antipsychotics is true?

It warns about increased mortality in older adult patients with dementia-related psychosis. Signup and view all the answers

Which of the following statements about high-potency typical antipsychotics is true?

They have a higher risk of causing extrapyramidal symptoms. Signup and view all the answers

Which atypical antipsychotic drug is known to address both the positive and negative symptoms of schizophrenia?

Aripiprazole Signup and view all the answers

What is the maximum daily dose recommended for Thioridazine in adults with psychosis?

800 mg Signup and view all the answers

In which age group should the Abnormal Involuntary Movement Scale (AIMS) be rated more frequently according to the instructions?

Males under 25 years and females over 70 years Signup and view all the answers

What is the usual optimal dose range for Thiothixene in adults with severe psychosis?

12-30 mg/day Signup and view all the answers

Which antipsychotic drug is specifically used for the treatment of motor and phonic tics in patients with Tourette’s syndrome?

Pimozide Signup and view all the answers

What is the appropriate initial dose of Loxapine for adults and children over 12 years with acute severe agitation?

10 mg bid Signup and view all the answers

Which of the following antipsychotic drugs should undergo genotyping for CYP2D6 if doses exceed 4 mg/day?

Pimozide Signup and view all the answers

What is the maximum recommended dose of Pimozide per day in children and adults?

$4$ mg/d Signup and view all the answers

Which atypical antipsychotic drug could be most beneficial for patients concerned about cognitive functioning interference?

Clozapine Signup and view all the answers

Which of the following antipsychotics has tablets available in 10, 12, 25, 50, 100, 120, and 200 mg doses?

Thioridazine Signup and view all the answers

According to the information provided, what should be done when lurasidone is coadministered with strong CYP3A4 inhibitors like ketoconazole or clarithromycin?

Avoid concomitant use Signup and view all the answers

What is recommended when iloperidone is coadministered with CYP2D6 inhibitors like fluoxetine or paroxetine?

Reduce the iloperidone dose by one-half Signup and view all the answers

How should the asenapine dose be adjusted when coadministered with fluvoxamine?

Coadminister with caution Signup and view all the answers

What is recommended when aripiprazole is coadministered with carbamazepine or other CYP3A4 inducers?

Double the aripiprazole dose Signup and view all the answers

How should the aripiprazole dose be adjusted when coadministered with quinidine or other CYP2D6 inhibitors like fluoxetine or paroxetine?

Reduce the aripiprazole dose by one-half Signup and view all the answers

According to the information provided, what should be done when lurasidone is coadministered with moderate CYP3A4 inducers like St. John's wort or phenytoin?

Increase the lurasidone dose Signup and view all the answers

What is the potential effect of combining atypical antipsychotics with antihypertensives?

Increased orthostasis Signup and view all the answers

Which drug interaction may lead to increased atypical antipsychotic levels due to its effect as a potent 1A2 inhibitor?

Ciprofloxacin (Cipro) Signup and view all the answers

What is a possible implication of combining clozapine with anticholinergics?

Increased CNS depression Signup and view all the answers

How does smoking affect the metabolism of antipsychotics?

Speeds up metabolism Signup and view all the answers

What may happen when olanzapine and quetiapine are used concurrently with rifampin or SSRIs?

Decreased effect of the antipsychotics Signup and view all the answers

What is the implication of combining carbamazepine with olanzapine?

Decreased serum levels of olanzapine Signup and view all the answers

Which drug interaction should prompt ECG monitoring due to potentially life-threatening cardiac changes?

Using drugs that prolong QT interval with pimavanserin and ziprasidone Signup and view all the answers

What potential effect does carbamazepine have when combined with clozapine?

Decreased serum levels of clozapine Signup and view all the answers

Which of the following adverse effects is associated with the use of olanzapine?

Weight gain and increased appetite Signup and view all the answers

According to the passage, which of the following statements about clozapine is correct?

It requires regular monitoring of white blood cell (WBC) count. Signup and view all the answers

Which of the following adverse effects is associated with the use of ziprasidone?

QT interval prolongation in about 5% of patients Signup and view all the answers

Which of the following statements about aripiprazole is correct?

It may be unpleasantly activating to some patients. Signup and view all the answers

Which of the following adverse effects is associated with the use of brexpiprazole or cariprazine in older adult patients with dementia-related psychosis?

Increased risk of stroke, transient ischemic attack, and death Signup and view all the answers

According to the passage, which of the following adverse effects is associated with the use of iloperidone?

Tachycardia and orthostatic hypotension Signup and view all the answers

Which of the following statements about paliperidone is correct, according to the passage?

It has a high incidence of akathisia and tachycardia. Signup and view all the answers

According to the passage, which of the following adverse effects is associated with the use of pimavanserin?

Peripheral edema Signup and view all the answers

Which of the following adverse effects is associated with the use of risperidone, according to the passage?

Elevation of prolactin levels Signup and view all the answers

According to the passage, which of the following statements about quetiapine is correct?

The most common side effects are dizziness and somnolence. Signup and view all the answers

What is the primary reason for monitoring patients taking typical antipsychotics with the Abnormal Involuntary Movement Scale (AIMS)?

To identify early signs of extrapyramidal side effects Signup and view all the answers

Which of the following is NOT a potential consequence of chronic prolactin elevation caused by typical antipsychotics?

Hypertension Signup and view all the answers

Which of the following is the BEST advice to give a patient taking typical antipsychotics?

Avoid sudden withdrawal of the medication Signup and view all the answers

What is the MAXIMUM recommended daily oral dose for an adult of the typical antipsychotic chlorpromazine (Thorazine)?

$400 mg/day$ Signup and view all the answers

What is the MOST common cause of increased symptoms and hospitalization in patients taking typical antipsychotics?

Noncompliance with medication Signup and view all the answers

Which of the following is a recommended strategy to address constipation, a potential anticholinergic effect of typical antipsychotics?

Increase fluid intake and dietary bulk Signup and view all the answers

What is the MAIN purpose of using the depot or decanoate form of a typical antipsychotic medication?

To improve medication compliance Signup and view all the answers

Which of the following is a potential side effect of the typical antipsychotic fluphenazine (Prolixin) that may require dose adjustment?

Extrapyramidal symptoms Signup and view all the answers

Which of the following is the MOST appropriate advice to give a patient taking a typical antipsychotic medication?

Avoid activities requiring alertness due to drowsiness Signup and view all the answers

How often is the depot or decanoate form of a typical antipsychotic medication typically administered?

Every 2 to 4 weeks Signup and view all the answers

Which of the following statements about typical antipsychotics is correct?

Intravenous haloperidol can be used for rapid control of agitation and dangerous psychosis. Signup and view all the answers

Which of the following factors should guide the choice of a specific antipsychotic medication?

All of the above: past response, initial response, family history, and side-effect profile Signup and view all the answers

Which of the following statements about the pharmacokinetics of typical antipsychotics is incorrect?

Perphenazine has a peak effect within 2-4 hours and a duration of 6 hours. Signup and view all the answers

Which of the following statements about drug interactions with typical antipsychotics is correct?

Typical antipsychotics can increase the risk of neurotoxicity and extrapyramidal symptoms when used with lithium. Signup and view all the answers

Which of the following statements about the pharmacokinetics of atypical antipsychotics is correct?

Paliperidone has an onset of 30-33 days and a half-life of 84-95 days. Signup and view all the answers

Which of the following atypical antipsychotics is primarily excreted through feces?

Lurasidone Signup and view all the answers