CMN 548 MODULE 5 PSYCHOPHARMACOLOGY EXAM QUESTIONS AND ANSWERS VERIFIED 100% CORRECT

CMN 548 MODULE 5 PSYCHOPHARMACOLOGY EXAM QUESTIONS AND ANSWERS VERIFIED 100% CORRECT What are withdrawal emergent dyskinesias? - ANSWER -If patients have their dosages of antipsychotic medication either decreased or discontinued, abnormal movements may worsen temporarily or appear for the first time and then diminish. Which patient populations are at highest risk for tardive dyskinesia? - ANSWER -- Older women - Patients with affective disorders - 10-20% incidence in treatment >1 year How often should patients receiving dopamine blockers be evaluated for tardive dyskinesia? - ANSWER -Every 6 months - Can evaluate severity using the Abnormal Involuntary Movements Scale (AIMS) Why does clozapine (Clozaril, DSA antipsychotic) have a lower risk of tardive dyskinesia? - ANSWER -It does not result in the increased sensitivity of striatal D2 receptors, which is associated with typical neuroleptics and has been theorized to result in TD. What is the mechanism of action of the two medications approved for treatment of Tardive Dyskinesia? - ANSWER -VMAT2 inhibitors - Can be given in conjunction with antipsychotics What medication is contraindicaated in the treatment of antipsychotic induced hypotension? - ANSWER -Epinephrine - due to beta stimulation it worsens hypotension What is the only dopamine serotonin antagonist (DSA) that is more effective than other antipsychotics at improving overall symptoms? - ANSWER -Clozapine (Clozaril) - This is why antipsychotics are typically chosen based on side effect profile Olanzapine (Zyprexa, DSA antipsychotic) causes what side effects in children? - ANSWER -- Somnolence - Liver enzyme elevation - Prolactin elevation - Weight gain *Due to these effects it should be used only when other antipsychotics have failed Olanzipine (Zyprexa, DSA antipsychotic) has what effect of liver enzymes? - ANSWER -Increases ALT to 3 times the upper limit of normal in 2% of cases Which medication in the DSA antipsychotic family has a low liability for metabolic side effects? - ANSWER -Lurasidone (Latuda) - take with food - potent antagonist at 5-HT2A, D2, and 5-HT7 receptors and a partial agonist at the 5-HT1A receptor. - Side effects include sedation, EPS, nausea Lurasidone (Latuda, DSA antipsychotic) is FDA approved for the treatment of what? - ANSWER -- Schizophrenia in adults - Adults with bipolar depression as a monotherapy or adjunct to lithium or valproate Which DSA antipsychotic does not cause EPS, but is associated with significant hematologic toxicity? - ANSWER -Clozapine (Clozaril) - Agranulocytosis - Reversible when drug is stopped - Propranolol increases risk of agranulocytosis Clozapine (Clozaril) is indicated for patients with which psychiatric diagnosis who are treatment resistant or unable to tolerate side effects? - ANSWER Schizophrenia - Clozapine (Clozaril, DSA antipsychotic) - Minimal EPS side effects or tardive dyskinesia The lack of EPS side effects when taking Clozapine (Clozaril, DSA antipsychotic) is likely attributed to what in the mechanism o action? - ANSWER -- Low affinity to the D2 receptor - Fast dissociation from the D2 receptor - Looser association to D2 receptor and more readily dissociate in presence of dopamine Patients with higher ratios of this metabolite to the parent compound may have better clinical outcomes to closapine (Clozaril, DSA antipsychotic)? - ANSWER N-desmethylclozapine - has M1 agonist activity What is the only antipsychotic indicated for suicidal behavior in schizophrenia and schizoaffective isorder? - ANSWER -Clozapine (Cloarzil, DSA antipsychotic) What is the lab value for agranulocytosis? - ANSWER -ANC < 500 cells WBC < 1,000 Which patient population is at higher risk of agranulocytosis from clozapine (Clozaril, DSA antipsychotic)? - ANSWER -Older women - Patients must register in a clozapine monitoring program What is the starting ANC requirement for clozapine initiation and how often must it be checked? - ANSWER -ANC >1,500 - Weekly for the first 6 months, every 2 weeks the next 6 months - Monthly after first year - Continues for 1 month after discontinuation What is the discontinuation threshold for ANC in patients taking Clozapine (Clozaril, DSA antipsychotic)? - ANSWER -ANC <3,000 Patients who develop agranulocytosis should not receive clozapine again. - Rechallenge can occur for patients who recover from moderate neutropenia (500 999) What should the clinician do if a patient taking lozapine (Clozaril, DSA antipsychotic) develops seizures? - ANSWER -Lower dose and add anticonvulsant (sodium valproate, gabapentin, topiramate) - Do not add carbamazepine due to risk for neutropenia Patients with a history of head injury should have an EEG prior to starting what medication? - ANSWER -Clozapine (Clozaril, DSA antipsychotic) - Due to seizure risk A patient taking Clozapine presents with chest pain, tachycardia, and flu like symptoms. They are likely experiencing what side effect? - ANSWER Myocarditis - palpitations, dyspnea and hypotension are also symptoms