Exam 1: NURS660/ NURS 660 (NEW 2026/ 2027) Psychopharmacology and Advanced Mental Health Exam | 100% Accurate | Complete guide with Questions and Verified Answers - Maryville

Exam 1: NURS660/ NURS 660 (NEW 2026/ 2027) Psychopharmacology and Advanced Mental Health Exam | 100% Accurate | Complete guide with Questions and Verified Answers - Maryville Q. Which response demonstrates both empathy and understanding of the relationship genetics has to the development of schizophrenia in twins? quite a. In fraternal twins, the chance of the other twin developing the disorder is small b. Studies show that 50% of twins develop schizophrenia when it is present in the other twin. c. No one can say what will happen, so we will hope for the best for you and both of your sons. d.You poor woman! I wish I could tell you that your other son he will be free of the disorder. ANSWERS a. In fraternal twins, the chance of the other twin developing the disorder is small Q. A newly admitted patient has a diagnosis of catatonic schizophrenia. Which behavior observed in the patient supports that diagnosis? a. Uses a rhyming form of speech b. Refuses to eat any unwrapped foods c. Laughs when watching a sad movie d. Maintains an immobilized state for hours ANSWERS d. Maintains an immobilized state for hours Q. What would be an appropriate short-term outcome for a patient diagnosed with residual schizophrenia who exhibits ambivalence? a. Decide their own daily schedule. b. Decide which unit groups they will attend. c. Choose which clinic staff member to work with. d. Choose between two outfits to wear each morning. ANSWERS d. Choose between two outfits to wear each morning. Q. What is the priority nursing diagnosis for a catatonic patient? a. Ineffective coping b. Impaired physical mobility c. Impaired social interaction d. Risk for deficient fluid volume ANSWERS d. Risk for deficient fluid volume Q. Which nursing diagnosis is appropriate for a patient who insists being called Your Highness and demonstrates loosely associated thoughts? a. Risk for violence b. Defensive coping c. Impaired memory d. Disturbed thought processes ANSWERS d. Disturbed thought processes Q. Which initial short-term outcome would be appropriate for a patient who was admitted expressing delusional thoughts? a. Accept that delusion is illogical. b. Distinguish external boundaries. c. Explain the basis for the delusions. d. Engage in reality-oriented conversation. ANSWERS d. Engage in reality-oriented conversation. Q. Which of the following interventions should the nurse plan to use to reduce patient focus on delusional thinking? a. Confronting the delusion b. Refuting the delusion with logic c. Exploring reasons the patient has the delusion d. Focusing on feelings suggested by the delusion ANSWERS d. Focusing on feelings suggested by the delusion Q. Which assessment observation supports a patients diagnosis of disorganized schizophrenia? a. Reports suicidal ideations b. Last relapse was 6 years ago c. Consistent inappropriate laughing d. Believes that the government is out to get me ANSWERS c. Consistent inappropriate laughing Q. A patient tried to gouge out his eye in response to auditory hallucinations commanding, If thine eye offends thee, pluck it out. The nurse would analyze this behavior as indicating: a. Derealization b. Inappropriate affect c. Impaired impulse control d. Inability to manage anger ANSWERS c. Impaired impulse control Q. An appropriate intervention for a patient with an identified nursing diagnosis of situational low self-esteem would be: a. Providing large muscle activities to relieve stress b. Attempting to determine triggers to hallucinations c. Engaging patient in activities designed to permit success d. Encouraging verbalization of feelings in a safe environment ANSWERS c. Engaging patient in activities designed to permit success Q. A 19-year-old patient is admitted for the second time in 9 months and is acutely psychotic with a diagnosis of undifferentiated schizophrenia. The patient sits alone rubbing her arms and smiling. She tells the nurse her thoughts cause earthquakes and that the world is burning. The nurse assesses the primary deficit associated with the patients condition as: a. Social isolation b. Disturbed thinking c. Altered mood states d. Poor impulse control ANSWERS b. Disturbed thinking Q. A patient has been admitted with disorganized type schizophrenia. The nurse observes blunted affect and social isolation. He occasionally curses or calls another patient a jerk without provocation. The nurse asks the patient how he is feeling, and he responds, Everybody picks on me. They frobitz me. The patients communication exhibits: a. A neologism b. Loose associations c. Delusional thinking d. Circumstantial speech ANSWERS a. A neologism Q. A patient has been admitted with disorganized type schizophrenia. The nurse asks the patient how he is feeling, and he responds, Everybody picks on me. They frobitz me. The best response for the nurse to make would be: a. Thats really too bad that you are being treated that way. b. Who do you mean when you say everybody? c. What difference does frobitzing make? d. Why do they frobitz? ANSWERS b. Who do you mean when you say everybody? Q. Which patient behavior would support the diagnosis of residual schizophrenia with negative symptoms? a. Communicating using only rhyming phases b. Claims that worms are crawling in my brain c. Maintaining both arms suspended awkwardly overhead d. Shows no emotion when telling the story of a sisters recent death ANSWERS d. Shows no emotion when telling the story of a sisters recent death Q. By discharge, which outcome is appropriate for a patient who hears voices telling him he is evil? a. Respond verbally to the voices. b. Verbalize the reason the voices say he is evil. c. Identify events that increase anxiety and promote hallucinations. d. Integrate the voices into his personality structure in a positive manner. ANSWERS c. Identify events that increase anxiety and promote hallucinations. Q. Which response by the nurse would best assist a patient in de-escalating aggressive behavior? a. Tell me whats going on. b. Why are you getting so upset? c. If you throw something, you will be restrained. d. Its time for group therapy. You can talk there. ANSWERS a. Tell me whats going on. Q. A 34-year-old male admitted with catatonic schizophrenia has been mute and motionless for several days while at home prior to admission. He still appears stuporous in the hospital. Which nursing intervention would be an initial priority? a. Orienting the patient to the unit b. Reinforcing reality with the patient c. Establishing a nonthreatening relationship d. Assessing the patient for physical problems ANSWERS d. Assessing the patient for physical problems Which response is appropriate when a patients mother expresses guilt over causing my child to be schizophrenic? a. I can see how you would be upset over this turn of events. b. New findings suggest this disorder is biological in nature. c. Dont be so hard on yourself; your daughter needs you to be strong.d. Its difficult to see what produces stress for the child at the time its occurring. b. New findings suggest this disorder is biological in nature. The wife of a patient diagnosed with paranoid schizophrenia asks I have been told that my husband's illness is probably related to imbalanced brain chemicals. Can you be more specific? The response based on the dopamine hypothesis is that: Breakdown of dopamine produces LSD, which in large amounts produces a. psychosis. b. An increase in the brain's chemical dopamine explains the presence of delusions and hallucinations c. Decreased amounts of the brain chemical dopamine explain the presence of delusions and hallucinations. d. An increase in the brain chemical dopamine explains the presence of a lack of motivation and disordered affect. b. An increase in the brain's chemical dopamine explains the presence of delusions and hallucinations What is the basis for the reduction in disturbed thought processes when a patient is administered haloperidol (Haldol)? a. Reduction in the number of brain cells that crave dopamine b. Dopamine receptors are blocked, making dopamine less available c. Dopamine receptors are enhanced, making more dopamine available d. Medication causes an increased cellular production of dopamine b. Dopamine receptors are blocked, making dopamine less available During a treatment team meeting, the point is made that a patient with schizophrenia has recovered from the acute psychosis but continues to demonstrate apathy, avolition, and blunted affect. The nurse who relates these symptoms to serotonin (5HT2) excess will suggest that the patient receive: a. Haloperidol (Haldol) b. Chlorpromazine (Thorazine) c. Olanzapine (Zyprexa) d. Phenelzine (Nardil) c. Olanzapine (Zyprexa) What response would be anticipated when a patient who received chlorpromazine (Thorazine) for 15 years to treat schizophrenia is switched to Seroquel (quetiapine)? a. Development of pseudoparkinsonism b. Development of dystonic reactions c. Improvement in tardive dyskinesia d. Worsening of anticholinergic symptoms c. Improvement in tardive dyskinesia A patient admitted with the diagnosis of schizophreniform disorder R/O organic pathology. Based on this information, the nurse can expect that the patient will: a. Be scheduled for a magnetic resonance imaging (MRI) test b. See a mental health specialist for extensive psychological testing c. Have an immunologic assay performed within 2 days of the admission d.Participate in a dexamethasone suppression test (DST) administered by the staff a. Be scheduled for a magnetic resonance imaging (MRI) test In planning aftercare for a patient with schizophrenia and whose insurance benefits have been exhausted, the nurse who is concerned about overcoming negative symptoms will make provisions for the patient to have stimulation, structure, socialization, and support. Which option would best incorporate these factors? a. Day hospitalization b. Attending a psychosocial club c. Living with his elderly mother d. Spending free time in the mall b. Attending a psychosocial club A patient with catatonic schizophrenia has been standing with his left arm upraised and his right foot off the floor for the majority of the last 20 hours, eating only when allowed to eat standing up. Which nursing intervention has priority for this patient? a. Providing high-calorie drinks hourly b. Assessing for lower extremity edema bid c. Taking the patient to activities therapy once daily d. Encouraging the patient to sit or lie down for 30 minutes hourly b. Assessing for lower extremity edema bid Which nursing action best addresses the needs of a paranoid patient who believes the food is poisoned? a. Explaining that others eat the food and are not harmed b. Allowing the patient to select food from vending machines c. Encouraging the patient to discuss why someone would poison the food d. Taking steps to prevent the patient from verbalizing the delusional thoughts b. Allowing the patient to select food from vending machines Prior to discharge, the nurse plans to teach the patient and family about relapse. Which items will the nurse include in the teaching? a. Recognizing warning signs of relapse b. Using street drugs judiciously and only in small amounts c. Lowering medication dosage to manage emerging side effects d. Notifying the nurse of warning signs present for more than one month a. Recognizing warning signs of relapse Because of the cognitive disturbances associated with schizophrenia, which technique will be useful as the nurse teaches a patient about self-management? a. Use only verbal instruction. b. Teach material in small segments. c. Offer opportunities for making numerous choices. d. Plan the teaching for a time when the patient has been recently medicated. b. Teach material in small segments. The wife of a patient newly diagnosed with paranoid schizophrenia is concerned that her husband will be this sick for the rest of his life. What information can the nurse provide to the wife? a. This disorder generally responds well with treatment and follow-up. b. All types of schizophrenia by their nature are chronic relapsing disorders. c. Outcomes are related to the patients pre-hospital symptoms of disorganization. d. The typical outcome for this diagnosis is that total remission is not achievable. a. This disorder generally responds well with treatment and follow-up. A patient is exhibiting auditory hallucinations in addition to being forgetful and easily confused. Which diagnosis does the nurse base this patients interventions on? a. Social isolation b. Deficient knowledge c. Situational low self-esteem d. Impaired cognitive functioning d. Impaired cognitive functioning A patient experiences intrusive, insulting auditory hallucinations. Which independent behavioral technique can the nurse teach the patient to employ when the voices are troublesome? a. Introduce a distraction like reading. b. Use positive talk to offset the insults. c. Sing or whistle to compete with the voices. d. Increase the daily dose of an antipsychotic medication. c. Sing or whistle to compete with the voices. A patient with schizophrenia tells the nurse as they sit in the day room, I hear voices telling me bad things. The most therapeutic response the nurse can make is: a. Tell me what the voices are saying. b. I believe you hear voices, but I don't hear them myself. c. The voices are not real. They're a product of your imagination. d. Do you think the voices would go away if we went into your room to talk? b. I believe you hear voices, but I don't hear them myself. A patient tells the nurse, When Im in the day room, I hear people whispering about me, and that makes me want to punch them. What direction will the nurse provide the staff regarding interacting with this patient? a. To minimize the need to whisper, utilize nonverbal techniques when possible. b. Stay physically close to this patient and use touch as a tool to interact with c. Treat this patient matter-of-factly. Be direct; don't talk about him or others in his presence. d. Interact with this patient only when necessary. The fewer interactions, the fewer misinterpretations there will be. c. Treat this patient matter-of-factly. Be direct; don't talk about him or others in his presence. A patient with schizophrenia is medication compliant and has well-controlled symptoms. He has, however, never been successful in holding a job because of poor social skills and lack of understanding of basic job skills. The nurse case manager should consider referring the patient: a. For cognitive therapy b. To assertiveness training c. To a day hospital program d. For psychosocial rehabilitation d. For psychosocial rehabilitation A patient prescribed an antipsychotic medication develops a high fever, unstable blood pressure, and muscle rigidity. Her next dose of medication is due. The nurse should: a. Administer the medication and monitor the vital signs every 4 hours. b. Give a lower dose of the medication for 24 hours and monitor the blood pressure c. Prepare to administer a prn dose of the anticholinergic drug benztropine (Cogentin). d. Hold the medication and immediately describe the patients symptoms to the doctor. d. Hold the medication and immediately describe the patient's symptoms to the doctor. (Think NMS) Which interventions will the nurse implement to preserve milieu safety when a patient becomes agitated? Select all that apply. a. Project confidence and control. b. Provide a show of force when appropriate. c. Ask the agitated patient why they are feeling so aggressive. d. Move to within 5 feet of the patient to help contain their movement. e. Provide the patient with several options as means of de-escalating the crisis. a. Project confidence and control. b. Provide a show of force when appropriate. e. Provide the patient with several options as means of de-escalating the crisis. Which interventions will the nurse implement to assure effective staff crises management skills? Select all that apply. a. Schedule regular staff crises simulations. b. Encourage the staff to discuss the details of unit crises. c. Attempt to identify staff who are ineffective during crises. d. Review documentation that describe the details of unit crises. e. Review unit crises management policies for needed updates. a. Schedule regular staff crises simulations. b. Encourage the staff to discuss the details of unit crises. d. Review documentation that describe the details of unit crises. e. Review unit crises management policies for needed updates. The nurse is assessing a patient who is complaining of hearing voices. What is this patient experiencing? a. Delusions b. Flight of ideas c. Disorganized thinking d. Hallucinations d. Hallucinations (auditory hallucinations) A patient with schizophrenia has been nonadherent with his home medication regimen. He requires frequent admissions to the intensive psychiatric unit for treatment of acute psychotic episodes. Which medication regimen would be appropriate for this patient? a. Daily home nursing visits to administer the prescribed oral medication b. Continuous inpatient hospitalization for medication therapy c. Administration of depot antipsychotic medication d. Subcutaneous medication administration c. Administration of depot antipsychotic medication (IM injection) What is the most common cause of nonadherence to antipsychotic pharmacologic treatment? a. Expense b. Increased symptoms of chemical dependency c. Extrapyramidal effects d. Inability of the patient to understand the need to take medications c. Extrapyramidal effects Which type of adverse effects is present when a patient displays prolonged tonic contractions of the tongue, oculogyric crisis, and torticollis? a. Dystonic reactions b. Pseudoparkinsonism c. Akathisia d. Tardive dyskinesia a. Dystonic reactions The nurse is teaching a patient who is taking clozapine (Clozaril) to have weekly blood tests for the first 6 months of treatment to monitor for which potential complication? a. Agranulocytosis b. Vitamin deficiencies c. Clotting abnormalities d. Polycythemia a. Agranulocytosis A male patient becomes verbally aggressive and insists the nurse is poisoning him as she attempts to administer haloperidol (Haldol). Which action will the nurse take? a. Support the patients decision to refuse the medication. b. Discreetly ask an assistant to put the medication in the patients food. c. Firmly redirect the patient to take the medication. d. Speak privately with the patient and reinforce medication action. c. Firmly redirect the patient to take the medication. Which statement is true regarding the adverse effects associated with antipsychotic medications? a. Tardive dyskinesia is a common, reversible condition. b. Painful dystonic reactions can occur in the first 72 hours of initiation of therapy. c. Neuroleptic malignant syndrome (NMS) is a common adverse effect. d. Pseudoparkinsonian symptoms can cause Parkinson's disease b. Painful dystonic reactions can occur in the first 72 hours of initiation of therapy. To what does potency of an antipsychotic medication refer? a. Severity of adverse effects associated with the drug b. Length of time that it takes to reach a therapeutic blood level of the drug c. Milligram doses used for the medication d. Effectiveness of the drug in alleviating psychotic behavior c. Milligram doses used for the medication Dystonic reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia are types of which effect? a. Extrapyramidal symptoms b. Allergic reactions c. Idiosyncratic reactions d. Therapeutic responses a. Extrapyramidal symptoms Which is an appropriate nursing intervention for a patient who has recently been prescribed clozapine (Clozaril)? a. Assess for signs and symptoms of hypoglycemia. b. Encourage a low fiber diet. c. Measure the patients waist circumference. d. Monitor for insomnia. c. Measure the patients waist circumference. (Most antipsychotics bear the risk of metabolic syndrome side effects) A young male patient taking an antipsychotic is experiencing an oculogyric crisis. The nurse prepares to administer: a. diphenhydramine. b. haloperidol. c. aripiprazole. d. risperidone. a. diphenhydramine.(for the dystonic reaction) A patient admitted to the hospital is exhibiting psychotic behavior. Which sign(s) and/or symptom(s) would support the diagnosis of psychosis? (Select all that apply.) a. Constant eye contact during the admission history b. Deterioration of social functioning c. Reporting that the FBI has solicited important secret information from his c. phone conversations d. Confirmation of hearing voices in his head e. Changing the topic of conversation inappropriately b. Deterioration of social functioning c. Reporting that the FBI has solicited important secret information from his c. phone conversations d. Confirmation of hearing voices in his head e. Changing the topic of conversation inappropriately Why is a combination of antipsychotic agents with benzodiazepines useful in initial treatment of the agitated patient? (Select all that apply.) a. Antipsychotics are not effective for 2 days. b. Benzodiazepines allow for lower dosages of antipsychotic agents to be used, thereby decreasing serious adverse effects seen with high dose therapy. c. It assists in calming the psychotic patient. It allows for rapid increase in dosing of the antipsychotic agents to expedite d. treatment of hallucinations. e. It effectively treats extrapyramidal adverse effects associated with e. antipsychotic agents. b. Benzodiazepines allow for lower dosages of antipsychotic agents to be used, thereby decreasing serious adverse effects seen with high dose therapy. c. It assists in calming the psychotic patient. Which is/are extrapyramidal adverse effect(s) of antipsychotic agents? (Select all that apply.) a. Spasmodic movements of muscle groups b. Masklike expression c. Lip smacking d. Inability to sit in one place for an extended period e. Weight gain a. Spasmodic movements of muscle groups b. Masklike expression c. Lip smacking d. Inability to sit in one place for an extended period Which sign(s) and symptom(s) may occur in neuroleptic malignant syndrome? (Select all that apply.) a. Fever b. Hypertension c. Severe extrapyramidal symptoms d. Alterations in consciousness e. Bradycardia a. Fever b. Hypertension c. Severe extrapyramidal symptoms d. Alterations in consciousness Which adverse effect(s) may occur as a result of antipsychotic drug therapy? (Select all that apply.) a. Acute dystonia b. Akathisia c. Weight loss d. Neuroleptic malignant syndrome e. Hypoglycemia f. Tardive dyskinesia a. Acute dystonia b. Akathisia d. Neuroleptic malignant syndrome f. Tardive dyskinesia A patient admitted to a psychiatric facility is hallucinating, pacing, and acting highly suspicious. Based on this information, the nurse will take which action(s)? (Select all that apply.) a. Use the most restrictive restraints available to subdue the patient. b. Be open and direct when handling the patient. c. Encourage a variety of interactions with others. d. Provide high-protein, high-calorie foods. e. Reinforce hallucinations. b. Be open and direct when handling the patient. d. Provide high-protein, high-calorie foods. The psychiatric nurse is educating an elderly patient and family about antipsychotic drug therapy. When providing this education, the nurse will include which statement(s)? (Select all that apply.) a. Hallucinations may be reduced within 1 week of starting. b. Rapid increase in dosages will increase frequency of adverse effects. c. Older patients should be observed for hypertension. d. Tardive dyskinesia may be reversible in early stages e. Full therapeutic response may require 6 to 8 weeks to be achieved. b. Rapid increase in dosages will increase frequency of adverse effects. d. Tardive dyskinesia may be reversible in early stages e. Full therapeutic response may require 6 to 8 weeks to be achieved. Which brain region is associated with anhedonia and apathy? Ventromedial prefrontal cortex Which brain region(s) are associated with delusions and hallucinations? Ventral tegmental area Striatum Substantia nigra Which behavioral symptoms are manifested in the striatrum? Agitation Delusions Hallucinations Impulsivity What behavioral symptoms are manifested in the substantia nigra Delusions Hallucinations What behavioral symptoms are manifested in the dorsolateral prefrontal cortex? Disorganized behavior Disorganized thinking Disorganized speech Lab values for psychiatric medications Please reivew these. When dopamine is blocked, prolactin levels Rise 3 Major Hypothesis of psychosis Dopamine Hypothesis (too much) Glutamate Hypothesis (underactive glutamate receptors) Serotonin Hypothesis (Abnormal serotonin activity) Identify 4 Dopamine pathways 1. Nigrostriatal 2. Mesolimbic 3. Mesocortical 4. Tuberoinfundibular Nigrostriatal Pathway the pathway along which axons from the substantia nigra project to the striatum and are responsible for motor planning (nigra to striatum) Mesolimbic Pathway subcortical part of the brain involved in the processing of salience and reward, emotions mesocortical pathway Originates in the VTA and is involved in cognition, exectuve function, emotions Tuberoinfundibular pathway Originates in the hypothalamus and associated with endocrine function. Dopamine blockade in this pathway is associated with an increase in prolactin levels (hyperprolactinemia), which can result in galactorrhea (milk discharge from the nipples) in both men and women, erectile disorder, and anorgasmia Medical Emergencies Neuroleptic Malignant Syndrome Use the FARM pneumonic F ever A Autonomic abnormalities R igidity (lead pipe rigidity) M ental status changes What laboratory studies do you check with NMS creatinine kinase cbc (looking for wbc) Liver enzymes such as AST, ALT 3 multiple choice options Treatment for NMS Dantrolene Bromocriptine Stop causative agent What are they symptoms of Serotonin Syndrome Use the pneumonic MAN GI M ental status changes A autonomic hyperactivity N euromuscular abnormality like clonus GI GI symptoms like N/V, diarrhea How to treat Serotonin syndrome *Discontinue Immediately! Cyproheptadine Severe Adverse effects of Clozapine Agranulocytosis (neutropenia) Myocarditis Seizures Constipation/ileus Deutetrabenazine (Austedo) VMAT2- inhibitor -most commonly expected side effects: -drug interactions: -potentially serious adverse events: -FDA indications: Huntington's chorea and TD -lab work that should be monitored prior to starting and while on the medication: Haloperidol (Haldol) -High potency 1st gen, lacks anticholinergic activity -most commonly expected side effects: high risk for EPS/TD -drug interactions: d/t high potency ^ risk for TD -potentially serious adverse events: prolonged QTc risk (IV admin) -FDA indications: antipscyhotic, reasonable 3rd line p 2 failed SGAs, can augment 2nd gen @ a low dose -1st line as PRN for acute agitation (off-label) -lab work that should be monitored prior to starting and while on the medication: Lurasidone (Latuda) -low metabolic risk, must be taken w/ food (350 cal)- QD dosing -most commonly expected side effects: low sedation risk -drug interactions: Tegretol, St. John's Wort (inducers), grapefruit juice (inhibitor)- could increase dose of med -potentially serious adverse events: poss ^ risk for EPS than the other 'rones' -FDA indications: -lab work that should be monitored prior to starting and while on the medication: -actually may lower than gain weight, improves Hgb A1c Lumateperone (Caplyta) -low metabolic risk, must be taken w/ food -most commonly expected side effects: sedation -drug interactions: -potentially serious adverse events: very low risk for EPS & prolactin elev -FDA indications: newest antipsychotic, only comes in one dose/ once a day -lab work that should be monitored prior to starting and while on the medication: Olanzapine (Zyprexa) -most commonly expected side effects: sedation (pines), weight gain (pines) -drug interactions: if giving IM for acute agitation, avoid giving w/ a benzo for risk of ^ sedation and cardiorespiratory depression, smoking can decrease blood levels by 50% -#1 weight gain and DM risk -potentially serious adverse events: potential risk for agranulocytosis, but not nearly like clozapine -FDA indications: -lab work that should be monitored prior to starting and while on the medication: Paliperidone (Invega) -most commonly expected side effects: -drug interactions: less interactions than risperdone -more sustained release than risperidone, also comes in injectable long acting form -potentially serious adverse events: ^ prolactin- one of 2 SGAs more likely to cause (risperidone other) -FDA indications: -lab work that should be monitored prior to starting and while on the medication: cleared renally, suitable for those w/ liver problems Perphenazine (Trilafon) -1st gen (DA antagonist), medium potency -most commonly expected side effects: -drug interactions: many; EPS, sedation, hypot, anticho, lowers seizure threshold, ^ prolactin, photosensitivity -potentially serious adverse events: -FDA indications: schizo, N/V -lab work that should be monitored prior to starting and while on the medication: Quetiapine (Seroquel) -dose dependent for its MOA, low-hypnotic, medium-antidepressant, high- antipsychotic -most commonly expected side effects: sedation (pines), weight gain (pines) -drug interactions: -potentially serious adverse events: hypotension w/ first few doses -FDA indications: -lab work that should be monitored prior to starting and while on the medication: Risperidone (Risperdal) -2nd gen, at higher doses, behaves more like a 1st gen -most commonly expected side effects: w/ higher doses (6mg)- ^ risk of EPS- TD -drug interactions: -potentially serious adverse events: *highest incidence of ^ prolactin- one of 2 SGAs more likely to cause -FDA indications: 2nd line for men d/t risk of gynecomastia -lab work that should be monitored prior to starting and while on the medication: Thioridazine (Mellaril) 1st gen (DA2 antagonist), low potency -most commonly expected side effects: -drug interactions: -potentially serious adverse events: HIGHEST risk of QT prolongation among all psych meds -FDA indications: refractory schizo only d/t cardio -lab work that should be monitored prior to starting and while on the medication: CYP2D6 genotyping Valbenazine (Ingrezza) NOT an antipsychotic -VMAT2 inhibitor -has longer 1/2 life allowing QD dosing -most commonly expected side effects: -drug interactions: -potentially serious adverse events: -FDA indications: treat TD -lab work that should be monitored prior to starting and while on the medication: Ziprasidone (Geodon) -must be taken w/ food (500 cal) and is dosed BID usually -low metabolic risk -most commonly expected side effects: -drug interactions: -potentially serious adverse events: QT interval prolongation, EPS, ^ prolactin -FDA indications: IM avail for acute agitation -lab work that should be monitored prior to starting and while on the medication: Aripiprazole (Abilify) D2/5HT1A partial agonist effective in tx schizo/maintenance and also agitation (IM) and bipolar mania/maintenance; approved for adjunctive tx to SSRI/SNRI for MDD -improves + sx w/o severe motor SE -low metabolic risk, -most commonly expected side effects: some akathisia, reduce prolactin levels, not sedating -drug interactions: highest risk in its class for akithisa -potentially serious adverse events: -FDA indications: not bipolar depression often used for assuring compliance in IM form, esp in early-onset psychosis, tx of depression or adjunct for, 1st line for schizo and bipolar -lab work that should be monitored prior to starting and while on the medication: Brexpiprazole (Rexulti) -D2/5HT1A partial agonist -more potent 5HT2A antagonism, 5HT1A partial agonism and alpha1 antagonism than aripiprazole theoretically reducing its propensity to cause SE and akathisia. low metabolic risk -most commonly expected SE: lacks action @ receptors usually assc w/ significant sedation, weight gain, and ^ cardiometabolic risk -drug interactions: -potentially serious adverse events: -FDA indications: schizo, NOT acute bipolar mania (aripiprazole is), add on for MDD -more anxiolytic than aripiprazole -lab work that should be monitored prior to starting and while on the medication: Chlorpromazine (Thorazine) -D2 antagonist (1st gen) low potency, 5-HT2 antagonist -dirty drug- antagonizes numerous receptors -most commonly expected side effects: sedation -drug interactions: -potentially serious adverse events: PHOTOsensitivity (PHENOthiazine class SE)- pigmentation changes in skin & eyes, corneal epithelia keratopathy -FDA indications: psychosis or agitation, N/V -lab work that should be monitored prior to starting and while on the medication: Clozapine (Clozaril) -very 1st atypical, most effective for schizo -prescriber, pt & Rx must be enrolled in REMS (Risk Evaluation and Mitigation System) prior to start of tx -SE: sedation (the 'pines' have a high likelihood), weight gain (high risk 'pines'), DM/ metabolic syndrome, orthostatic hypotension, sinus tachycardia, constipation, sailorrhea -Drug interactions: Fluvox is a potent inhibitor of CYP1A2 causing ^ clozapine levels; LOWEST risk for EPS, don't give w/ cholinergics d/t already having high affinity for this and would cause worse SE -Potentially serious adverse effects: severe neutropenia (ANC500) (d/c med, daily CBC until ANC 1000) AGRANULOCYTOSIS, myocarditis/cardiomyopathy, orthostatic hypotension, bradycardia, syncope, seizure, ileus -CYP 1A2: smoking can speed up metabolism, lowering clozapine levels -high risk for lowering seizure threshold -FDA indications: tx resistant schizo, reduce sx of SI in schizo -Lab work: CBC w/ diff (weekly for 6 mo, then q2 wks, then after 1 yr can decrease to monthly) to check ANC- must be 1500 to start, lipids, HbA1C, weight, BMI, ekg, troponin for 1st 8 wks (will help to catch myocarditis/cardiomyopathy), serum level should not really be used with this med- clinical response is more effective, however if your pt is not responding then drawing a level could help assess for compliance or if pt changes their smoking habits -Clozapine levels have been found to be decreased as much as 50% in smokers Tetrabenazine Not FDA approved to treat tardive dyskinesia -requires TID dosing -risk for depression and suicide Deutetrabenazine FDA: IS indicated to tx TD -longer half life than tetrabenazine, BID dosing with food -no suicide warning