Medication Titration in Psychosis
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Questions and Answers

What is the primary concern of a patient being considered for cross-titration to aripiprazole or brexpiprazole?

  • Comorbid medical condition
  • Acute psychosis
  • Adverse effects of current medication (correct)
  • Lack of response to current treatment

    • What is the unique feature shared by aripiprazole, brexpiprazole, and cariprazine?

  • 5-HT2A receptor antagonism
  • D2 receptor antagonism
  • Mu receptor agonism
  • D2 partial agonism (correct)

    • In what setting are aripiprazole and brexpiprazole most commonly prescribed?

  • Inpatient setting
  • Outpatient setting (correct)
  • Intensive care unit
  • Emergency room

    • What is the main difference between the two pips and the rip?

    <p>Their mechanism of action</p> Signup and view all the answers

    What is the primary benefit of cross-titrating a patient from a medication like risperidone to aripiprazole or brexpiprazole?

    <p>Reduced adverse effects</p> Signup and view all the answers

    What generation of antipsychotics do aripiprazole, brexpiprazole, and cariprazine represent?

    <p>Third generation</p> Signup and view all the answers

    Why might aripiprazole, brexpiprazole, and cariprazine be considered useful in treating patients with psychosis?

    <p>They modulate dopamine activity in the mesolimbic pathway</p> Signup and view all the answers

    What is the significance of the term 'pip' in the context of antipsychotics?

    <p>Refers to a specific class of antipsychotics</p> Signup and view all the answers

    What is the primary mechanism of action of cariprazine?

    <p>D3 antagonist</p> Signup and view all the answers

    What is the significance of D3 receptors in the brain?

    <p>They are found in areas implicated in psychotic symptoms</p> Signup and view all the answers

    What is the potential advantage of targeting D3 receptors?

    <p>Sparing of D2 receptors, leading to a more tolerable side effect profile</p> Signup and view all the answers

    What is the significance of the D3 and D4 subtypes of receptors?

    <p>They have very similar functions to D2 receptors, but are less abundant</p> Signup and view all the answers

    What is the current understanding of the role of D3 antagonism in cariprazine?

    <p>It is unclear, but likely to be significant</p> Signup and view all the answers

    What is unique about cariprazine compared to other antipsychotics?

    <p>It is the first antipsychotic to introduce D3 antagonism</p> Signup and view all the answers

    What brain regions are implicated in psychotic symptoms and have a high concentration of D3 receptors?

    <p>Ventral striatum, nucleus accumbens, thalamus, and hippocampus</p> Signup and view all the answers

    What is the potential benefit of cariprazine's D3 antagonism on its side effect profile?

    <p>Decreased risk of extrapyramidal symptoms</p> Signup and view all the answers

    What is a potential consequence of elevated creatine phosphate kinase levels in a patient taking an antipsychotic?

    <p>Increased risk of death</p> Signup and view all the answers

    What is the first step in managing a patient who has developed sudden unexplained high fever, muscle rigidity, and confusion while taking an antipsychotic?

    <p>Stop the antipsychotic immediately</p> Signup and view all the answers

    What is the typical setting where Dantrolene may be necessary for a patient experiencing adverse effects of an antipsychotic?

    <p>Inpatient setting</p> Signup and view all the answers

    What is the primary goal of cooling a patient who has developed high fever, muscle rigidity, and confusion while taking an antipsychotic?

    <p>Prevent death</p> Signup and view all the answers

    What is the correlation between creatine phosphate kinase levels and muscle rigidity?

    <p>Directly correlated</p> Signup and view all the answers

    What is a characteristic of a patient experiencing adverse effects of an antipsychotic?

    <p>Confusion</p> Signup and view all the answers

    What is the reason for stopping the antipsychotic immediately in a patient who has developed sudden unexplained high fever, muscle rigidity, and confusion?

    <p>To prevent further deterioration of the patient's condition</p> Signup and view all the answers

    Which of these options are correct? (Select all that apply)

    <p>Option 3</p> Signup and view all the answers

    This is an example statement that is true

    <p>False</p> Signup and view all the answers

    Example question?

    <p>example answer</p> Signup and view all the answers

    The ______ barked

    <p>dog</p> Signup and view all the answers

    Match the following programming languages with their primary usage:

    <p>Python = General-purpose programming JavaScript = Client-side scripting for web applications SQL = Database queries CSS = Styling web pages</p> Signup and view all the answers

    What is the primary function of the prefrontal cortex in social situations?

    <p>To recognize and regulate appropriate emotional responses</p> Signup and view all the answers

    What is the relationship between dopamine activity and psychosis in the mesolimbic pathway?

    <p>Increased dopamine activity leads to increased psychosis</p> Signup and view all the answers

    What is the primary characteristic of negative symptoms in schizophrenia?

    <p>Flattened affect and reduced emotional range</p> Signup and view all the answers

    What is the role of the mesocortical dopamine pathway in cognitive function?

    <p>Facilitating multitasking and problem-solving</p> Signup and view all the answers

    What is the relationship between dopamine activity and cognitive function in patients with schizophrenia?

    <p>Suboptimal dopamine activity leads to impaired cognitive function</p> Signup and view all the answers

    What is the primary difference between positive and negative symptoms of schizophrenia?

    <p>Positive symptoms are characterized by hallucinations and delusions, while negative symptoms are characterized by flat affect and reduced emotional range</p> Signup and view all the answers

    What is the role of the cortex in social interactions?

    <p>To regulate emotional responses to social stimuli</p> Signup and view all the answers

    What is the relationship between the mesocortical dopamine pathway and multitasking?

    <p>The mesocortical dopamine pathway is involved in multitasking and prioritization</p> Signup and view all the answers

    Study Notes

    Antipsychotics

    • Not urgent or high-dose drugs for acute psychosis, but rather for stabilizing patients with concerns about adverse effects
    • Can be used to cross-titrate patients from other antipsychotics

    Two Pips and a Rip

    • Aripiprazole and brexpiprazole (two pips) and cariprazine (the rip) are referred to as third-generation antipsychotics
    • These drugs are D2 partial agonists, which is a unique feature compared to other antipsychotics
    • Cariprazine (the rip) is the first antipsychotic to emphasize its role as a D3 antagonist

    D3 Antagonism

    • D3 receptors are less abundant in the brain than D2 receptors, but have similar functions
    • D3 receptors are predominantly located in areas of the brain implicated in psychotic symptoms (ventral striatum, nucleus accumbens, thalamus, and hippocampus)
    • Cariprazine's D3 antagonism may spare some D2 receptors, making it more tolerable and with a lesser adverse effect profile

    Adverse Effects

    • High fever, encephalopathy, and elevated white cells and creatine phosphate kinase can be dangerous adverse effects of antipsychotics
    • If a patient develops sudden unexplained high fever, muscle rigidity, and confusion while on an antipsychotic, stop the drug immediately and cool the patient down

    Physiology of Psychosis

    • The physiology of psychosis is one of the best understood in psychiatry
    • Four neural pathways are implicated in schizophrenia symptom presentation and pharmacotherapy:
      • Mesolimbic pathway: involved in psychosis and dopamine activity
      • Mesocortical pathway: regulates affect, emotion, and multitasking, and is often suboptimal in schizophrenic patients
      • Other two pathways not specified in the text

    Schizophrenia Symptoms

    • Positive symptoms: psychosis, including hallucinations and delusions
    • Negative symptoms: #at affect, lack of emotional range, and depressive-like symptoms

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    Related Documents

    Pharmacodynamics of Antipsychotic Medications PDF

    Description

    This quiz covers the use of medication in stabilizing patients with psychosis, focusing on cross-titration and adverse effects.

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