Antipsychotics

Question 1

SGA - highest metabolic risk

Answer 1

Clozapine, olanzapine, quetiapine

Question 2

SGA - moderate metabolic risk

Answer 2

Risperidone, paliperidone

Question 3

SGA - lower metabolic risk

Answer 3

Aripiprazole, ziprasidone, lurasidone, and asenapine

Question 4

SGA - lowest EPS risk

Answer 4

Quetiapine (recommended in patients with PD who needs antipsychotics)

Question 5

SGA - highest hematologic effects

Answer 5

Clozapine (agranulocytosis)

Question 6

SGA - highest QT prolongation risk

Answer 6

Ziprasidone

Question 7

SGA - highest increased prolactin risk

Answer 7

Risperidone, Paliperidone

Question 8

SGA - highest seizure risk

Answer 8

Clozapine (dose-dependent)

Question 9

Antipsychotic MOA

Answer 9

blocks dopamine and serotonin receptors (less with FGA)

Question 10

BBW for antipsychotics

Answer 10

Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death.

Question 11

Dystonia

Answer 11

prolonged contraction of muscle during initiation of FGAs, including painful muscle spasm; can be fatal if airway is compromised. higher risk with younger males. May prophylactically treat with diphenhydramine, benztropine.

Question 12

Akathisia

Answer 12

restlessness with anxiety and an inability to remain still. Treated with diphenhydramine, benztropine, benzodiazepines or propranolol.

Question 13

Tardive dyskinesia

Answer 13

abnormal facial movement, primarily tongue or mouth. Higher risk with elderly females. Stop the drug and replace with SGA. TD can be irreversible.

Question 14

Dyskinesia

Answer 14

abnormal movements

Question 15

Clozapine monitoring

Answer 15

REMS: Baseline ANC must be 1500/mm2 or more to start the treatment. check ANC weekly x 6 months, then Q2W for 6 months, then monthly. Stop if ANC <1,000

Question 16

Pimavanserin

Answer 16

Drug for psychosis in PD (brand: Nuplazid).

SEs: peripheral edema, confusion.

Question 17

SGAs with DDI w/ smoking

Answer 17

olanzapine and clozapine. Pts who smoke require a higher dose.

Question 18

Latuda administration instruction

Answer 18

take with food that contains at least 350 kcal.

Question 19

SGA taken with food

Answer 19

Latuda and Geodon

Question 20

SGA taken without food

Answer 20

Seroquel XR (light meal up to 300kcal is okay)

Question 21

Best time to take olanzapine

Answer 21

at night because it’s long-acting and sedating.

Question 22

Two treatments for TD

Answer 22

Valbenazine (Ingrezza) and Deutetrabenazine (Austedo)

SEs: somnolence, QT prolongation.

Question 23

Neuroleptic Malignant Syndrome

Answer 23

rare but lethal that could be caused by FGAs (much less risk with SGAs and other dopamine antagonists such as metoclopramide).
S/Sx: hyperthermia, extreme muscle rigidity, mental status change, tachycardia, tachypnea, BP changes, increased in CPK and WBC.
Treatment: taper off quickly. supportive care. cool patient down with cooling bed, antipyretics, cooled IV fluids. Muscle relaxation with benzo or dantrolene.

Question 24

SGAs that can be used for resistant depression

Answer 24

aripiprazole, olanzapine/fluoxetiene (brand: symbyax), quetiapine, brexipiprazole