Podcast
Questions and Answers
A patient with a history of Parkinson's disease requires antipsychotic treatment. Which of the following medications is MOST likely to exacerbate their Parkinsonian symptoms?
A patient with a history of Parkinson's disease requires antipsychotic treatment. Which of the following medications is MOST likely to exacerbate their Parkinsonian symptoms?
- Quetiapine
- Clozapine
- Haloperidol (correct)
- Aripiprazole
A patient stabilized on clozapine develops a fever and sore throat. Which of the following is the MOST critical initial action?
A patient stabilized on clozapine develops a fever and sore throat. Which of the following is the MOST critical initial action?
- Prescribe a broad-spectrum antibiotic.
- Reduce the clozapine dose by 50%.
- Order a complete blood count (CBC) immediately. (correct)
- Administer antipyretics and monitor symptoms.
Which of the medication classes would be MOST concerning when combined with Chlorpromazine?
Which of the medication classes would be MOST concerning when combined with Chlorpromazine?
- Proton Pump Inhibitors
- Selective Serotonin Reuptake Inhibitors (correct)
- HMG-CoA Reductase Inhibitors
- NSAIDs
What is the primary mechanism of action of haloperidol in treating psychotic symptoms?
What is the primary mechanism of action of haloperidol in treating psychotic symptoms?
Which of the following adverse effects is MOST associated with clozapine and requires regular monitoring?
Which of the following adverse effects is MOST associated with clozapine and requires regular monitoring?
A patient with bipolar I disorder experiencing acute mania is prescribed lithium. Which of the following conditions would be a relative contraindication for lithium use?
A patient with bipolar I disorder experiencing acute mania is prescribed lithium. Which of the following conditions would be a relative contraindication for lithium use?
Why is clozapine often reserved as a later-line treatment option for schizophrenia?
Why is clozapine often reserved as a later-line treatment option for schizophrenia?
Which medication is MOST likely to be prescribed off-label for agitation?
Which medication is MOST likely to be prescribed off-label for agitation?
A patient with bipolar I disorder experiencing a manic episode is started on lithium. Which of the following laboratory findings would warrant immediate discontinuation of the medication?
A patient with bipolar I disorder experiencing a manic episode is started on lithium. Which of the following laboratory findings would warrant immediate discontinuation of the medication?
Which of the following drug interactions poses the greatest risk of serotonin syndrome when combined with a selective serotonin reuptake inhibitor (SSRI)?
Which of the following drug interactions poses the greatest risk of serotonin syndrome when combined with a selective serotonin reuptake inhibitor (SSRI)?
A 28-year-old female with bipolar II disorder presents with depressive symptoms. She is currently taking lamotrigine 200 mg daily. Which of the following is the MOST appropriate next step in managing her depressive symptoms?
A 28-year-old female with bipolar II disorder presents with depressive symptoms. She is currently taking lamotrigine 200 mg daily. Which of the following is the MOST appropriate next step in managing her depressive symptoms?
A patient with bipolar disorder is stabilized on lithium. Which of the following medications, if added to the patient's regimen, would MOST likely increase the risk of lithium toxicity?
A patient with bipolar disorder is stabilized on lithium. Which of the following medications, if added to the patient's regimen, would MOST likely increase the risk of lithium toxicity?
Which of the following is the primary mechanism of action of lithium in the treatment of bipolar disorder?
Which of the following is the primary mechanism of action of lithium in the treatment of bipolar disorder?
A 45-year-old patient with a history of bipolar I disorder presents to the emergency department with confusion, muscle twitching, and ataxia. He takes lithium 900mg daily, and his lab results show a lithium level of 2.1 mEq/L. Which of the following interventions is MOST critical?
A 45-year-old patient with a history of bipolar I disorder presents to the emergency department with confusion, muscle twitching, and ataxia. He takes lithium 900mg daily, and his lab results show a lithium level of 2.1 mEq/L. Which of the following interventions is MOST critical?
A patient with bipolar disorder is being treated with carbamazepine. Which of the following adverse effects requires immediate discontinuation of the medication?
A patient with bipolar disorder is being treated with carbamazepine. Which of the following adverse effects requires immediate discontinuation of the medication?
Which of the following is a known black box warning associated with the use of antipsychotics in elderly patients with dementia-related psychosis?
Which of the following is a known black box warning associated with the use of antipsychotics in elderly patients with dementia-related psychosis?
A 25-year-old patient with schizophrenia overdosed on olanzapine, resulting in a QTc prolongation of 650ms and twisting/jerking movements. Which medication is LEAST appropriate to manage the QTc prolongation acutely?
A 25-year-old patient with schizophrenia overdosed on olanzapine, resulting in a QTc prolongation of 650ms and twisting/jerking movements. Which medication is LEAST appropriate to manage the QTc prolongation acutely?
A 27-year-old patient with a history of schizophrenia is frequently admitted due to medication non-adherence, citing that their pills are often stolen or lost at the shelter. Besides switching to a long-acting injectable antipsychotic, what is the MOST appropriate next step?
A 27-year-old patient with a history of schizophrenia is frequently admitted due to medication non-adherence, citing that their pills are often stolen or lost at the shelter. Besides switching to a long-acting injectable antipsychotic, what is the MOST appropriate next step?
A 30-year-old patient is brought to the emergency department after exhibiting aggressive behavior in public. The patient is yelling about being held hostage and that the FBI is trying to kill them. After initial stabilization, which antipsychotic is LEAST appropriate?
A 30-year-old patient is brought to the emergency department after exhibiting aggressive behavior in public. The patient is yelling about being held hostage and that the FBI is trying to kill them. After initial stabilization, which antipsychotic is LEAST appropriate?
A 23-year-old patient presents with concerns about lack of motivation and paranoid thinking, but these symptoms are not significantly impacting their daily life. They are worried about developing schizophrenia due to their mother's history. What is the MOST appropriate initial approach?
A 23-year-old patient presents with concerns about lack of motivation and paranoid thinking, but these symptoms are not significantly impacting their daily life. They are worried about developing schizophrenia due to their mother's history. What is the MOST appropriate initial approach?
Which statement BEST describes the mechanism of action of aripiprazole in treating bipolar disorder?
Which statement BEST describes the mechanism of action of aripiprazole in treating bipolar disorder?
Which of the following is the MOST significant advantage of using long-acting injectable (LAI) antipsychotics compared to oral antipsychotics in the management of bipolar disorder?
Which of the following is the MOST significant advantage of using long-acting injectable (LAI) antipsychotics compared to oral antipsychotics in the management of bipolar disorder?
A patient with bipolar disorder is being treated with lithium. Which of the following medications is MOST likely to significantly increase lithium levels, potentially leading to toxicity?
A patient with bipolar disorder is being treated with lithium. Which of the following medications is MOST likely to significantly increase lithium levels, potentially leading to toxicity?
Which of the following is a PRIMARY benefit of incorporating assertive community treatment (ACT) into the care plan for individuals with Schizophrenia?
Which of the following is a PRIMARY benefit of incorporating assertive community treatment (ACT) into the care plan for individuals with Schizophrenia?
A 25-year-old woman presents with rapid mood swings, tangential thinking, and decreased need for sleep. Which of the following mood stabilizers would require the closest monitoring of renal function?
A 25-year-old woman presents with rapid mood swings, tangential thinking, and decreased need for sleep. Which of the following mood stabilizers would require the closest monitoring of renal function?
A patient experiencing acute mania is prescribed an atypical antipsychotic as a first-line treatment. Which of the following mechanisms of action is most likely responsible for its mood-stabilizing effects?
A patient experiencing acute mania is prescribed an atypical antipsychotic as a first-line treatment. Which of the following mechanisms of action is most likely responsible for its mood-stabilizing effects?
A patient with bipolar disorder is being treated with lithium. Which of the following medications, when added to the patient's regimen, is MOST likely to significantly increase the risk of lithium toxicity?
A patient with bipolar disorder is being treated with lithium. Which of the following medications, when added to the patient's regimen, is MOST likely to significantly increase the risk of lithium toxicity?
A patient presents with recurrent episodes of both depressive lows and elevated moods. While the depressive episodes meet the criteria for major depressive disorder, the elevated moods are characterized by increased energy, impulsivity, and talkativeness, but do not cause marked impairment in social or occupational functioning and do not require hospitalization. Which of the following is the MOST likely classification for this patient's condition according to the DSM-5?
A patient presents with recurrent episodes of both depressive lows and elevated moods. While the depressive episodes meet the criteria for major depressive disorder, the elevated moods are characterized by increased energy, impulsivity, and talkativeness, but do not cause marked impairment in social or occupational functioning and do not require hospitalization. Which of the following is the MOST likely classification for this patient's condition according to the DSM-5?
A 35-year-old male with bipolar I disorder, currently stabilized on lithium, reports experiencing increased thirst and frequent urination. Lab results show a slightly elevated TSH level, but normal creatinine and lithium levels within the therapeutic range. Which of the following is the MOST probable cause of his new symptoms and lab finding?
A 35-year-old male with bipolar I disorder, currently stabilized on lithium, reports experiencing increased thirst and frequent urination. Lab results show a slightly elevated TSH level, but normal creatinine and lithium levels within the therapeutic range. Which of the following is the MOST probable cause of his new symptoms and lab finding?
Valproic acid is frequently used in the management of bipolar disorder. Which statement BEST describes its primary mechanism of action in mood stabilization?
Valproic acid is frequently used in the management of bipolar disorder. Which statement BEST describes its primary mechanism of action in mood stabilization?
A 28-year-old female with bipolar I disorder presents to the emergency department exhibiting acute mania. Considering the provided information, which of the following medication classes is generally considered FIRST-LINE for rapidly managing her acute manic symptoms?
A 28-year-old female with bipolar I disorder presents to the emergency department exhibiting acute mania. Considering the provided information, which of the following medication classes is generally considered FIRST-LINE for rapidly managing her acute manic symptoms?
A patient with bipolar disorder is being initiated on lithium therapy. Which of the following pre-treatment assessments is MOST critical to perform to ensure patient safety and optimize treatment outcomes?
A patient with bipolar disorder is being initiated on lithium therapy. Which of the following pre-treatment assessments is MOST critical to perform to ensure patient safety and optimize treatment outcomes?
A patient is prescribed lamotrigine for the maintenance treatment of bipolar disorder, particularly for depressive episodes. Which of the following adverse effects, while rare, is MOST critical to monitor for and educate the patient about due to its potentially life-threatening nature?
A patient is prescribed lamotrigine for the maintenance treatment of bipolar disorder, particularly for depressive episodes. Which of the following adverse effects, while rare, is MOST critical to monitor for and educate the patient about due to its potentially life-threatening nature?
Considering the multifactorial etiology of bipolar disorder, which of the following factors is believed to have the MOST significant influence on the DEVELOPMENT of bipolar disorder?
Considering the multifactorial etiology of bipolar disorder, which of the following factors is believed to have the MOST significant influence on the DEVELOPMENT of bipolar disorder?
A patient with bipolar II disorder, currently managed with lamotrigine, presents with a new episode of depression. According to the provided information, which of the following medication adjustments would be the MOST appropriate FIRST-LINE strategy to manage this depressive episode, assuming lamotrigine monotherapy has been insufficient?
A patient with bipolar II disorder, currently managed with lamotrigine, presents with a new episode of depression. According to the provided information, which of the following medication adjustments would be the MOST appropriate FIRST-LINE strategy to manage this depressive episode, assuming lamotrigine monotherapy has been insufficient?
A patient with bipolar disorder is started on lithium. Which pre-existing condition would be of greatest concern due to the potential for adverse effects and toxicity?
A patient with bipolar disorder is started on lithium. Which pre-existing condition would be of greatest concern due to the potential for adverse effects and toxicity?
A patient taking carbamazepine reports experiencing muscle weakness and increased thirst. Lab results reveal a serum sodium level of 128 mEq/L. Which of the following adverse effects is the most likely cause of these symptoms?
A patient taking carbamazepine reports experiencing muscle weakness and increased thirst. Lab results reveal a serum sodium level of 128 mEq/L. Which of the following adverse effects is the most likely cause of these symptoms?
A young adult patient with bipolar disorder is being treated with valproic acid. Which of the following potential adverse effects is of greatest concern if the patient plans to become pregnant?
A young adult patient with bipolar disorder is being treated with valproic acid. Which of the following potential adverse effects is of greatest concern if the patient plans to become pregnant?
Which of the following mechanisms of action primarily accounts for the mood-stabilizing effects of lamotrigine in bipolar disorder?
Which of the following mechanisms of action primarily accounts for the mood-stabilizing effects of lamotrigine in bipolar disorder?
An elderly patient with dementia-related psychosis is prescribed risperidone. What is the most critical risk associated with this medication in this population, as highlighted by the FDA's black box warning?
An elderly patient with dementia-related psychosis is prescribed risperidone. What is the most critical risk associated with this medication in this population, as highlighted by the FDA's black box warning?
Apatient is started on aripiprazole for bipolar disorder. What is the primary mechanism of action of this medication?
Apatient is started on aripiprazole for bipolar disorder. What is the primary mechanism of action of this medication?
A clinician is considering prescribing olanzapine to a patient with acute mania. What is the most important counseling point regarding adverse effects?
A clinician is considering prescribing olanzapine to a patient with acute mania. What is the most important counseling point regarding adverse effects?
Which of the following medications used in the treatment of bipolar disorder requires monitoring for serum drug levels due to its narrow therapeutic index?
Which of the following medications used in the treatment of bipolar disorder requires monitoring for serum drug levels due to its narrow therapeutic index?
A patient of Asian descent is about to start carbamazepine. Which of the following genetic tests is most important to conduct prior to initiating treatment, given the risk of severe dermatological reactions?
A patient of Asian descent is about to start carbamazepine. Which of the following genetic tests is most important to conduct prior to initiating treatment, given the risk of severe dermatological reactions?
A patient on valproic acid develops acute confusion. Besides liver function tests, what is another important lab test to consider?
A patient on valproic acid develops acute confusion. Besides liver function tests, what is another important lab test to consider?
A patient with bipolar disorder who is currently stable on lamotrigine is started on oral contraceptives. What adjustment to their lamotrigine dosage may be necessary?
A patient with bipolar disorder who is currently stable on lamotrigine is started on oral contraceptives. What adjustment to their lamotrigine dosage may be necessary?
A patient with bipolar disorder presents with a constellation of symptoms including fever, muscle rigidity, altered mental status and autonomic dysfunction. They are currently being treated with haloperidol. Which of the following is the most likely diagnosis?
A patient with bipolar disorder presents with a constellation of symptoms including fever, muscle rigidity, altered mental status and autonomic dysfunction. They are currently being treated with haloperidol. Which of the following is the most likely diagnosis?
A patient with Bipolar I disorder is being discharged and prescribed Quetiapine. Which of the following is NOT a common side effect of Quetiapine that the patient should be educated on?
A patient with Bipolar I disorder is being discharged and prescribed Quetiapine. Which of the following is NOT a common side effect of Quetiapine that the patient should be educated on?
A physician is seeing a patient who states they have been experiencing hallucinations and delusions, and disorganized thoughts. They are considering prescribing either Haloperidol or Aripiprazole. What is an advantage of prescribing Aripiprazole compared to Haloperidol?
A physician is seeing a patient who states they have been experiencing hallucinations and delusions, and disorganized thoughts. They are considering prescribing either Haloperidol or Aripiprazole. What is an advantage of prescribing Aripiprazole compared to Haloperidol?
Which medication used in the treatment of bipolar disorder is LEAST likely to cause weight gain as an adverse effect?
Which medication used in the treatment of bipolar disorder is LEAST likely to cause weight gain as an adverse effect?
A patient with bipolar I disorder presents in acute mania. Which of the following medication combinations would be MOST appropriate for rapid symptom control if the patient has no prior history of treatment?
A patient with bipolar I disorder presents in acute mania. Which of the following medication combinations would be MOST appropriate for rapid symptom control if the patient has no prior history of treatment?
A patient taking carbamazepine for bipolar disorder reports experiencing frequent nausea, vomiting blurred vision, and unsteady gait. Which of the following is MOST likely the cause?
A patient taking carbamazepine for bipolar disorder reports experiencing frequent nausea, vomiting blurred vision, and unsteady gait. Which of the following is MOST likely the cause?
A patient with schizophrenia is being treated with an antipsychotic medication. They develop muscle rigidity, fever, and altered mental status. Which of the following is the MOST appropriate initial step in managing this potential adverse effect?
A patient with schizophrenia is being treated with an antipsychotic medication. They develop muscle rigidity, fever, and altered mental status. Which of the following is the MOST appropriate initial step in managing this potential adverse effect?
Which of the following BEST describes the rationale behind the black box warning for antipsychotics in elderly patients with dementia-related psychosis?
Which of the following BEST describes the rationale behind the black box warning for antipsychotics in elderly patients with dementia-related psychosis?
A patient with bipolar disorder is prescribed lamotrigine. Which of the following signs or symptoms should the patient be instructed to report IMMEDIATELY to their healthcare provider due to the risk of a serious adverse reaction?
A patient with bipolar disorder is prescribed lamotrigine. Which of the following signs or symptoms should the patient be instructed to report IMMEDIATELY to their healthcare provider due to the risk of a serious adverse reaction?
A patient with acute mania is being treated with quetiapine. What is the primary advantage of choosing quetiapine over lithium in this situation?
A patient with acute mania is being treated with quetiapine. What is the primary advantage of choosing quetiapine over lithium in this situation?
Which of the following long-term maintenance strategies for bipolar disorder is MOST appropriate for a patient who primarily experiences depressive episodes with minimal manic symptoms?
Which of the following long-term maintenance strategies for bipolar disorder is MOST appropriate for a patient who primarily experiences depressive episodes with minimal manic symptoms?
A patient with bipolar I disorder presents with acute mania and is already taking lamotrigine for maintenance. Which of the following is the MOST appropriate ADD-ON treatment to manage the acute manic symptoms?
A patient with bipolar I disorder presents with acute mania and is already taking lamotrigine for maintenance. Which of the following is the MOST appropriate ADD-ON treatment to manage the acute manic symptoms?
A patient is being started on carbamazepine. Which of the following statements reflects the MOST important consideration regarding its use in bipolar disorder?
A patient is being started on carbamazepine. Which of the following statements reflects the MOST important consideration regarding its use in bipolar disorder?
Which of the following monitoring parameters is MOST critical when prescribing valproic acid to a female patient of childbearing potential for bipolar disorder?
Which of the following monitoring parameters is MOST critical when prescribing valproic acid to a female patient of childbearing potential for bipolar disorder?
A patient with bipolar disorder develops a rash while taking lamotrigine. Which of the following factors would MOST increase the likelihood that this rash could progress to Stevens-Johnson Syndrome (SJS)?
A patient with bipolar disorder develops a rash while taking lamotrigine. Which of the following factors would MOST increase the likelihood that this rash could progress to Stevens-Johnson Syndrome (SJS)?
An elderly patient with dementia-related psychosis is prescribed an antipsychotic. Which of the following potential side effects carries the HIGHEST risk of mortality in this population?
An elderly patient with dementia-related psychosis is prescribed an antipsychotic. Which of the following potential side effects carries the HIGHEST risk of mortality in this population?
A patient treated with haloperidol for schizophrenia develops muscle rigidity, fever, and altered mental status. Which of the following is the MOST appropriate initial management strategy?
A patient treated with haloperidol for schizophrenia develops muscle rigidity, fever, and altered mental status. Which of the following is the MOST appropriate initial management strategy?
A patient with schizophrenia is being transitioned from oral haloperidol to intramuscular haloperidol decanoate. Which of the following BEST describes the rationale for this change?
A patient with schizophrenia is being transitioned from oral haloperidol to intramuscular haloperidol decanoate. Which of the following BEST describes the rationale for this change?
Which of the following atypical antipsychotics is LEAST likely to cause significant weight gain and metabolic disturbances?
Which of the following atypical antipsychotics is LEAST likely to cause significant weight gain and metabolic disturbances?
A patient is started on clozapine for treatment-resistant schizophrenia. Which of the following monitoring parameters is MOST critical due to the risk of a potentially life-threatening side effect?
A patient is started on clozapine for treatment-resistant schizophrenia. Which of the following monitoring parameters is MOST critical due to the risk of a potentially life-threatening side effect?
A patient with schizophrenia develops akathisia after starting a high-potency first-generation antipsychotic. Which of the following is the MOST appropriate initial treatment strategy?
A patient with schizophrenia develops akathisia after starting a high-potency first-generation antipsychotic. Which of the following is the MOST appropriate initial treatment strategy?
What is the PRIMARY reason long-acting injectable (LAI) antipsychotics are often preferred over oral formulations in patients with schizophrenia?
What is the PRIMARY reason long-acting injectable (LAI) antipsychotics are often preferred over oral formulations in patients with schizophrenia?
A patient with bipolar disorder is being treated with carbamazepine. Which of the following potential adverse effects requires immediate discontinuation of the medication?
A patient with bipolar disorder is being treated with carbamazepine. Which of the following potential adverse effects requires immediate discontinuation of the medication?
Which of the following best describes the rationale behind using second-generation antipsychotics (SGAs) as first-line treatment for schizophrenia, compared to first-generation antipsychotics (FGAs)?
Which of the following best describes the rationale behind using second-generation antipsychotics (SGAs) as first-line treatment for schizophrenia, compared to first-generation antipsychotics (FGAs)?
Which of the following statements is MOST accurate regarding the use of antipsychotics in elderly patients with dementia-related psychosis, considering the FDA's black box warning?
Which of the following statements is MOST accurate regarding the use of antipsychotics in elderly patients with dementia-related psychosis, considering the FDA's black box warning?
A patient on long-term haloperidol treatment develops persistent lip smacking and tongue movements. Which of the following is the MOST appropriate course of action?
A patient on long-term haloperidol treatment develops persistent lip smacking and tongue movements. Which of the following is the MOST appropriate course of action?
A patient with a history of bipolar I disorder presents with acute mania. Which of the following medication classes is generally considered FIRST-LINE for rapidly managing her symptoms?
A patient with a history of bipolar I disorder presents with acute mania. Which of the following medication classes is generally considered FIRST-LINE for rapidly managing her symptoms?
Which of the following lab parameters is MOST critical to monitor regularly in a patient taking clozapine?
Which of the following lab parameters is MOST critical to monitor regularly in a patient taking clozapine?
A 78-year-old patient with dementia-related psychosis is prescribed an antipsychotic. According to the FDA's black box warning, which of the following is the MOST significant risk associated with antipsychotic use in this population?
A 78-year-old patient with dementia-related psychosis is prescribed an antipsychotic. According to the FDA's black box warning, which of the following is the MOST significant risk associated with antipsychotic use in this population?
What is the primary reason for the black box warning associated with lamotrigine?
What is the primary reason for the black box warning associated with lamotrigine?
During acute therapy for a manic episode in bipolar disorder, which of the following medication classes is generally considered FIRST-LINE?
During acute therapy for a manic episode in bipolar disorder, which of the following medication classes is generally considered FIRST-LINE?
Which statement is MOST accurate regarding the use of antidepressants in bipolar disorder?
Which statement is MOST accurate regarding the use of antidepressants in bipolar disorder?
A patient who has been stable on lithium for several years develops new-onset tremor, confusion, and gastrointestinal distress. Which of the following is the MOST important initial step?
A patient who has been stable on lithium for several years develops new-onset tremor, confusion, and gastrointestinal distress. Which of the following is the MOST important initial step?
Which of the following antipsychotics is MOST likely to cause significant weight gain due to its combined antagonism of dopamine, serotonin, histamine, and adrenergic receptors?
Which of the following antipsychotics is MOST likely to cause significant weight gain due to its combined antagonism of dopamine, serotonin, histamine, and adrenergic receptors?
A patient on haloperidol develops muscle rigidity, fever, and altered mental status. Which of the following conditions is the MOST likely cause, and what is the MOST appropriate initial intervention?
A patient on haloperidol develops muscle rigidity, fever, and altered mental status. Which of the following conditions is the MOST likely cause, and what is the MOST appropriate initial intervention?
A patient with a history of poorly controlled seizures is being considered for antipsychotic treatment. Which of the following antipsychotics would be LEAST appropriate due to its known association with lowering the seizure threshold?
A patient with a history of poorly controlled seizures is being considered for antipsychotic treatment. Which of the following antipsychotics would be LEAST appropriate due to its known association with lowering the seizure threshold?
A patient taking carbamazepine for bipolar disorder reports feeling unsteady and experiencing double vision. Lab results show a sodium level of 125 mEq/L. Which of the following is the MOST likely cause of these symptoms?
A patient taking carbamazepine for bipolar disorder reports feeling unsteady and experiencing double vision. Lab results show a sodium level of 125 mEq/L. Which of the following is the MOST likely cause of these symptoms?
A patient with bipolar disorder who is stable on lamotrigine wishes to start taking oral contraceptives. What is the MOST important consideration regarding their lamotrigine dosage?
A patient with bipolar disorder who is stable on lamotrigine wishes to start taking oral contraceptives. What is the MOST important consideration regarding their lamotrigine dosage?
Which of the following adverse effects of lithium is MOST likely to be irreversible, even after discontinuation of the medication?
Which of the following adverse effects of lithium is MOST likely to be irreversible, even after discontinuation of the medication?
What distinguishes second-generation antipsychotics (SGAs) from first-generation antipsychotics (FGAs) concerning their mechanism of action and resulting side effect profile?
What distinguishes second-generation antipsychotics (SGAs) from first-generation antipsychotics (FGAs) concerning their mechanism of action and resulting side effect profile?
A 70-year-old patient with dementia-related psychosis is prescribed risperidone. According to the FDA black box warning, what is the primary risk associated with this medication in this population?
A 70-year-old patient with dementia-related psychosis is prescribed risperidone. According to the FDA black box warning, what is the primary risk associated with this medication in this population?
Which of the following antipsychotics is LEAST likely to cause significant weight gain?
Which of the following antipsychotics is LEAST likely to cause significant weight gain?
A patient on an antipsychotic develops restlessness and an inability to sit still. Which medication would be most appropriate?
A patient on an antipsychotic develops restlessness and an inability to sit still. Which medication would be most appropriate?
A patient with bipolar I disorder is being treated with lithium. Which of the following findings would warrant immediate discontinuation of the medication?
A patient with bipolar I disorder is being treated with lithium. Which of the following findings would warrant immediate discontinuation of the medication?
A patient with schizophrenia is started on clozapine. Which of the following is MOST crucial to monitor regularly due to a potentially life-threatening adverse effect?
A patient with schizophrenia is started on clozapine. Which of the following is MOST crucial to monitor regularly due to a potentially life-threatening adverse effect?
Which of the following pre-treatment assessments is MOST critical when initiating lithium therapy in a patient with bipolar disorder?
Which of the following pre-treatment assessments is MOST critical when initiating lithium therapy in a patient with bipolar disorder?
A patient taking carbamazepine should be monitored for which of the following potentially severe dermatological reactions, particularly if they are of Asian descent?
A patient taking carbamazepine should be monitored for which of the following potentially severe dermatological reactions, particularly if they are of Asian descent?
Which of the following medications used to treat bipolar disorder has a black box warning for hepatotoxicity, teratogenicity, and pancreatitis?
Which of the following medications used to treat bipolar disorder has a black box warning for hepatotoxicity, teratogenicity, and pancreatitis?
Elderly patients with dementia-related psychosis face an increased risk of mortality when treated with which class of medications?
Elderly patients with dementia-related psychosis face an increased risk of mortality when treated with which class of medications?
Which of the following antipsychotics is known for a higher risk of extrapyramidal symptoms (EPS), especially at higher doses?
Which of the following antipsychotics is known for a higher risk of extrapyramidal symptoms (EPS), especially at higher doses?
A patient presents with acute dystonia after starting haloperidol. Which of the following medications is MOST appropriate for immediate management?
A patient presents with acute dystonia after starting haloperidol. Which of the following medications is MOST appropriate for immediate management?
Which of the following is a significant risk associated with lithium treatment that requires careful monitoring due to its narrow therapeutic index?
Which of the following is a significant risk associated with lithium treatment that requires careful monitoring due to its narrow therapeutic index?
A patient on valproic acid becomes acutely confused. Besides liver function tests, what other lab test should be ordered?
A patient on valproic acid becomes acutely confused. Besides liver function tests, what other lab test should be ordered?
A patient is newly prescribed carbamazepine. What baseline lab tests are most important prior to starting this medication?
A patient is newly prescribed carbamazepine. What baseline lab tests are most important prior to starting this medication?
A patient on Quetiapine has a prolonged QTc interval on their ECG. Which medication would be LEAST appropriate to manage the QTc prolongation acutely?
A patient on Quetiapine has a prolonged QTc interval on their ECG. Which medication would be LEAST appropriate to manage the QTc prolongation acutely?
Which medication used in the treatment of bipolar disorder is LEAST likely to cause sedation as an adverse effect?
Which medication used in the treatment of bipolar disorder is LEAST likely to cause sedation as an adverse effect?
Flashcards
Bipolar Disorder
Bipolar Disorder
Characterized by extreme mood swings, including mania and depression; types include Bipolar I, Bipolar II, and Cyclothymic Disorder.
Etiology of Bipolar Disorder
Etiology of Bipolar Disorder
Combination of genetic predisposition, environmental factors, and altered brain structure and function.
Major Drug Classes for Bipolar Disorder
Major Drug Classes for Bipolar Disorder
Mood stabilizers, antipsychotics, and antidepressants.
Drugs for Long-Term Bipolar Prevention
Drugs for Long-Term Bipolar Prevention
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Lithium: Medication Class
Lithium: Medication Class
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Lithium: Indications
Lithium: Indications
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Lithium: Adverse Effects
Lithium: Adverse Effects
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Lithium Interactions
Lithium Interactions
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Chlorpromazine
Chlorpromazine
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Chlorpromazine MOA
Chlorpromazine MOA
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Chlorpromazine Indications
Chlorpromazine Indications
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Chlorpromazine Adverse Effects
Chlorpromazine Adverse Effects
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Haloperidol
Haloperidol
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Haloperidol Adverse Effects
Haloperidol Adverse Effects
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Clozapine MOA
Clozapine MOA
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Clozapine Adverse Effects
Clozapine Adverse Effects
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Clinical Presentation of Mania
Clinical Presentation of Mania
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Hypomania
Hypomania
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Mood Cycling in Bipolar Disorder
Mood Cycling in Bipolar Disorder
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Clinical Presentation of Mixed Episode
Clinical Presentation of Mixed Episode
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Treatment of Bipolar Depression
Treatment of Bipolar Depression
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Bipolar I
Bipolar I
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Bipolar II
Bipolar II
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Cyclothymic Disorder
Cyclothymic Disorder
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Rapid Cycling
Rapid Cycling
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Mood Stabilizers
Mood Stabilizers
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Antipsychotics Use
Antipsychotics Use
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TSH Monitoring
TSH Monitoring
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Creatinine Monitoring
Creatinine Monitoring
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Aripiprazole advantage
Aripiprazole advantage
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Olanzapine use case
Olanzapine use case
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Non-drug schizophrenia therapies
Non-drug schizophrenia therapies
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Case #1 symptoms
Case #1 symptoms
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Case #2 symptoms
Case #2 symptoms
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Case #3 reason for non-adherence
Case #3 reason for non-adherence
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Case #4 ECG result
Case #4 ECG result
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Schzophrenia Adherence Rates
Schzophrenia Adherence Rates
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Aripiprazole MOA
Aripiprazole MOA
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Aripiprazole Indication
Aripiprazole Indication
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Aripiprazole Adverse Effects
Aripiprazole Adverse Effects
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Olanzapine Interactions
Olanzapine Interactions
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Olanzapine Clinical Pearls
Olanzapine Clinical Pearls
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Lithium MOA
Lithium MOA
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Lithium Contraindications
Lithium Contraindications
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Lithium Clinical Pearls
Lithium Clinical Pearls
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Carbamazepine MOA
Carbamazepine MOA
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Lamotrigine MOA
Lamotrigine MOA
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Valproic Acid MOA
Valproic Acid MOA
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Risperidone Indication
Risperidone Indication
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Risperidone Adverse Effects
Risperidone Adverse Effects
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First-Generation Antipsychotics (FGAs)
First-Generation Antipsychotics (FGAs)
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Second-Generation Antipsychotics (SGAs)
Second-Generation Antipsychotics (SGAs)
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Extrapyramidal Side Effects (EPS)
Extrapyramidal Side Effects (EPS)
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Antipsychotic Black Box Warning
Antipsychotic Black Box Warning
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Clozapine Black Box Warning
Clozapine Black Box Warning
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Acute Mania Therapy
Acute Mania Therapy
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Bipolar Depressive Episode Therapy
Bipolar Depressive Episode Therapy
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Bipolar Long-Term Prevention
Bipolar Long-Term Prevention
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Antipsychotic Generations: Key Difference
Antipsychotic Generations: Key Difference
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Black Box Warnings: Mood Stabilizers
Black Box Warnings: Mood Stabilizers
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Acute Manic Episode Therapy
Acute Manic Episode Therapy
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Major Drugs for Bipolar Disorder
Major Drugs for Bipolar Disorder
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Black Box Warning
Black Box Warning
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Bipolar Disorder Tx
Bipolar Disorder Tx
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Major Bipolar Drugs
Major Bipolar Drugs
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Major Schizophrenia Drugs
Major Schizophrenia Drugs
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Black Box Warnings (Bipolar Meds)
Black Box Warnings (Bipolar Meds)
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Antipsychotic Generations
Antipsychotic Generations
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Bipolar Disorder Treatment
Bipolar Disorder Treatment
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Major Drugs
Major Drugs
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Akathisia
Akathisia
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Tardive Dyskinesia
Tardive Dyskinesia
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Neuroleptic Malignant Syndrome (NMS)
Neuroleptic Malignant Syndrome (NMS)
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Black Box Warnings: Key Examples
Black Box Warnings: Key Examples
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Acute Depressive Episode Therapy in Bipolar
Acute Depressive Episode Therapy in Bipolar
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Long-Term Bipolar Prevention
Long-Term Bipolar Prevention
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Major Drugs: Bipolar & Schizophrenia
Major Drugs: Bipolar & Schizophrenia
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Antipsychotics: Key Adverse Effects
Antipsychotics: Key Adverse Effects
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EPS Risk: 1st Gen vs. 2nd Gen
EPS Risk: 1st Gen vs. 2nd Gen
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Carbamazepine Black Box Warnings
Carbamazepine Black Box Warnings
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Lamotrigine Black Box Warning
Lamotrigine Black Box Warning
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Valproic Acid Black Box Warnings
Valproic Acid Black Box Warnings
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Aripiprazole Black Box Warning
Aripiprazole Black Box Warning
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Olanzapine Black Box Warning
Olanzapine Black Box Warning
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Risperidone Black Box Warning
Risperidone Black Box Warning
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Quetiapine Black Box Warning
Quetiapine Black Box Warning
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Antipsychotic Black Box Warning (General)
Antipsychotic Black Box Warning (General)
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Lithium Black Box Warning
Lithium Black Box Warning
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Schizophrenia Positive Symptoms
Schizophrenia Positive Symptoms
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Schizophrenia Negative Symptoms
Schizophrenia Negative Symptoms
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Schizophrenia Secondary Symptoms
Schizophrenia Secondary Symptoms
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Bipolar Disorder Treatment Phases
Bipolar Disorder Treatment Phases
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Study Notes
Schizophrenia: Etiology
- Schizophrenia is a neurodevelopmental disorder.
- Neuropathological changes begin in utero.
Schizophrenia: Clinical Presentation
- Schizophrenia presents as a syndrome with positive and negative symptoms.
- Cognitive impairments and mood/anxiety disorders may also arise.
Schizophrenia: Positive Symptoms
- Hallucinations are a typical positive symptom.
- Delusions are a typical positive symptom.
- Disorganization is also considered a positive symptom.
Schizophrenia: Negative Symptoms
- Negative symptoms typically present first.
- Negative symptoms are often resistant to treatment.
- Blunted affect is a negative symptom.
- Apathy is a negative symptom.
- Asociality is a negative symptom.
- Alogia (thought blocking) is a negative symptom.
Schizophrenia: Cognitive Impairment
- Impacts process speed, attention and working memory.
- Learning (verbal/visual), reasoning, and social cognition are impacted.
Schizophrenia: Mood/Anxiety
- Higher rates of mood and anxiety disorders are typical.
Antipsychotic Generations
- The two Antipsychotic Generations are 1st and 2nd.
Antipsychotic Generations: 1st Generation
- Haloperidol
- Chlorpromazine
- Common AEs: Higher risk of EPS, higher sedation and weight gain.
Antipsychotic Generations: 2nd Generation
- Aripiprazole
- Quetiapine
- Olanzapine
- Clozapine
- Risperidone
- Common AEs: higher risk of metabolic syndrome and higher risk of QT prolongation.
Extrapyramidal Side Effects
- Include both early and late symptoms
Extrapyramidal Side Effects: Early
- Acute dystonia
- Neuroleptic Malignant Syndrome
- Akathisia
- Management: Benztropine, Dantrolene + Benzos, Propranolol
Extrapyramidal Side Effects: Late
- Pseudoparkinsonism
- Tardive Dyskinesia
- Management: Amantadine, discontinue offending agent, Benzos
Adverse Effects Management
- Address anticholinergic effects by limiting dose, increasing water, and oral balance.
- Treat dysrhythmias through QT monitoring, IV magnesium, and avoiding other QT agents.
Prescribing and Patient Education
- Assess A1c, baseline lipids and also ECG
- Advise regarding sedation, weight gain, and also cholesterol risk.
Depot Preparation Considerations
- Benefits: Improved adherence, reduced hospitalization, predictable effects, less risk of overdose.
- Depot preparations bypass hepatic elimination.
- Risks: Delayed clinical improvement, adverse effects persist, perceived lack of autonomy and high acquisition costs.
- Depot preparations require special storage.
Schizophrenia Treatment Objectives
- Treatment aims to reduce symptoms.
- Treatment aims to prevent relapses.
- Treatment aims to improve quality of life.
General Treatment
- Aripiprazole correlates with less weight gain.
- A low effective dose should be used.
- If rapid improvement is needed, use Olanzapine/Haldol.
- Base decisions on symptom degrees to choose the route.
General Treatment: Maintenance
- Taper can occur when stable.
General Treatment: Adherence
- Consider adherence as 50-60% can be an issue
- Side effects and poor planning make adherence more difficult.
General Treatment: Non-Drug Therapy
- CBT
- Dialogue
- Social skill training
- Community Treatment (Assertive)
- Vocational rehab
Bipolar Disorder: Characteristics
- Rapid cycling involves 4+ episodes/year
Bipolar Disorder: Types
- Bipolar I: Mania
- Bipolar II: Hypomania
- Cyclothymic: Mild depression
Bipolar Disorder: Etiology
- Multifactorial, genetics, trauma
Bipolar Disorder: Three Major Drug Classes
- Anticonvulsants: Includes Valproic Acid and Lamotrigine
- Mood stabilizers: Includes Lithium
- Antipsychotics: Includes Quetiapine
Bipolar Disorder: Medication Selection
- Acute Mania: Quetiapine, Olanzapine
- Depressive Episodes: Valproic Acid, Lamotrigine, Lithium
- Long term: Monotherapy or combination of other agents
Lithium Management: Prescribing Considerations
- Kidney disease
- Monitoring ability
- Intake
Lithium Management: Lab Monitoring
- TSH
- Creatinine
- Lithium Levels
Lithium Management: Patient Education
- Need to note the small therapeutic window.
- Hydration
- Routine monitoring
- Thyroid risk </existing_notes>
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Description
This quiz assesses knowledge of antipsychotic medications, their side effects, and appropriate use in patients with mental health conditions like Parkinson's disease, schizophrenia, and bipolar disorder. Topics include clozapine monitoring, contraindications for lithium, and mechanisms of action.
