Antipsychotic Drugs Overview
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Questions and Answers

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?

<p>Reducing dopamine receptor stimulation (A)</p> Signup and view all the answers

Which class of antipsychotics includes the drug asenapine?

<p>Dibenzo-oxepino pyrroles (A)</p> Signup and view all the answers

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

<p>Chlorpromazine (Thorazine) (C)</p> Signup and view all the answers

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

<p>Rigidity (A)</p> Signup and view all the answers

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

<p>Akathisia (A)</p> Signup and view all the answers

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

<p>CNS depressants (C)</p> Signup and view all the answers

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

<p>Tardive dyskinesia (A)</p> Signup and view all the answers

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

<p>Shuffling gait (A)</p> Signup and view all the answers

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

<p>Tardive dyskinesia (B)</p> Signup and view all the answers

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

<p>Increased risk of metabolic syndrome (C)</p> Signup and view all the answers

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

<p>Check BMI quarterly and order laboratory work-ups annually (C)</p> Signup and view all the answers

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

<p>Blocking serotonin receptors in the cortex, which increases dopamine release (C)</p> Signup and view all the answers

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

<p>They have a wide range of half-lives, with clozapine having a shorter half-life than olanzapine (B)</p> Signup and view all the answers

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

<p>All of the above (D)</p> 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?

<p>Weight gain (D)</p> 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?

<p>Clozapine has a higher risk of potentially fatal agranulocytosis (D)</p> Signup and view all the answers

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

<p>Olanzapine (D)</p> 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?

<p>They are primarily metabolized in the liver and excreted through the renal system (A)</p> 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?

<p>Onset of action is within a few days to a few weeks, and steady state is reached within a few days (C)</p> Signup and view all the answers

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

<p>Overactivity of D2 receptors in certain brain regions (B)</p> Signup and view all the answers

What are typical antipsychotics less effective in treating?

<p>Negative symptoms of schizophrenia (A)</p> Signup and view all the answers

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

<p>78% (B)</p> Signup and view all the answers

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

<p>Chlorpromazine (D)</p> Signup and view all the answers

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

<p>Neuroleptic malignant syndrome (NMS) (C)</p> Signup and view all the answers

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

<p>They are rapidly absorbed and distributed widely to adipose tissue. (D)</p> Signup and view all the answers

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

<p>60% to 70% (B)</p> Signup and view all the answers

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

<p>Narrow-angle glaucoma (A)</p> Signup and view all the answers

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

<p>It warns about increased mortality in older adult patients with dementia-related psychosis. (D)</p> Signup and view all the answers

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

<p>They have a higher risk of causing extrapyramidal symptoms. (C)</p> Signup and view all the answers

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

<p>Aripiprazole (B)</p> Signup and view all the answers

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

<p>800 mg (C)</p> 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?

<p>Males under 25 years and females over 70 years (A)</p> Signup and view all the answers

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

<p>12-30 mg/day (D)</p> 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?

<p>Pimozide (D)</p> 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?

<p>10 mg bid (A)</p> Signup and view all the answers

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

<p>Pimozide (C)</p> Signup and view all the answers

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

<p>$4$ mg/d (D)</p> Signup and view all the answers

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

<p>Clozapine (B)</p> 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?

<p>Thioridazine (C)</p> 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?

<p>Avoid concomitant use (A)</p> Signup and view all the answers

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

<p>Reduce the iloperidone dose by one-half (D)</p> Signup and view all the answers

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

<p>Coadminister with caution (C)</p> Signup and view all the answers

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

<p>Double the aripiprazole dose (A)</p> 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?

<p>Reduce the aripiprazole dose by one-half (C)</p> 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?

<p>Increase the lurasidone dose (A)</p> Signup and view all the answers

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

<p>Increased orthostasis (A)</p> 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?

<p>Ciprofloxacin (Cipro) (D)</p> Signup and view all the answers

What is a possible implication of combining clozapine with anticholinergics?

<p>Increased CNS depression (D)</p> Signup and view all the answers

How does smoking affect the metabolism of antipsychotics?

<p>Speeds up metabolism (C)</p> Signup and view all the answers

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

<p>Decreased effect of the antipsychotics (D)</p> Signup and view all the answers

What is the implication of combining carbamazepine with olanzapine?

<p>Decreased serum levels of olanzapine (B)</p> Signup and view all the answers

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

<p>Using drugs that prolong QT interval with pimavanserin and ziprasidone (C)</p> Signup and view all the answers

What potential effect does carbamazepine have when combined with clozapine?

<p>Decreased serum levels of clozapine (A)</p> Signup and view all the answers

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

<p>Weight gain and increased appetite (A)</p> Signup and view all the answers

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

<p>It requires regular monitoring of white blood cell (WBC) count. (B)</p> Signup and view all the answers

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

<p>QT interval prolongation in about 5% of patients (B)</p> Signup and view all the answers

Which of the following statements about aripiprazole is correct?

<p>It may be unpleasantly activating to some patients. (B)</p> 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?

<p>Increased risk of stroke, transient ischemic attack, and death (A)</p> Signup and view all the answers

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

<p>Tachycardia and orthostatic hypotension (B)</p> Signup and view all the answers

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

<p>It has a high incidence of akathisia and tachycardia. (C)</p> Signup and view all the answers

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

<p>Peripheral edema (B)</p> Signup and view all the answers

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

<p>Elevation of prolactin levels (A)</p> Signup and view all the answers

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

<p>The most common side effects are dizziness and somnolence. (B)</p> Signup and view all the answers

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

<p>To identify early signs of extrapyramidal side effects (B)</p> Signup and view all the answers

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

<p>Hypertension (A)</p> Signup and view all the answers

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

<p>Avoid sudden withdrawal of the medication (B)</p> Signup and view all the answers

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

<p>$400 mg/day$ (C)</p> Signup and view all the answers

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

<p>Noncompliance with medication (A)</p> Signup and view all the answers

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

<p>Increase fluid intake and dietary bulk (A)</p> Signup and view all the answers

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

<p>To improve medication compliance (B)</p> 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?

<p>Extrapyramidal symptoms (B)</p> Signup and view all the answers

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

<p>Avoid activities requiring alertness due to drowsiness (A)</p> Signup and view all the answers

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

<p>Every 2 to 4 weeks (C)</p> Signup and view all the answers

Which of the following statements about typical antipsychotics is correct?

<p>Intravenous haloperidol can be used for rapid control of agitation and dangerous psychosis. (C)</p> Signup and view all the answers

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

<p>All of the above: past response, initial response, family history, and side-effect profile (D)</p> Signup and view all the answers

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

<p>Perphenazine has a peak effect within 2-4 hours and a duration of 6 hours. (B)</p> Signup and view all the answers

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

<p>Typical antipsychotics can increase the risk of neurotoxicity and extrapyramidal symptoms when used with lithium. (C)</p> Signup and view all the answers

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

<p>Paliperidone has an onset of 30-33 days and a half-life of 84-95 days. (C)</p> Signup and view all the answers

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

<p>Lurasidone (B)</p> Signup and view all the answers

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