NRNP 6635 FINAL EXAM ACTUAL QUESTIONS AND
ANSWERS RATED A+
✔✔Antipsychotic medications form the centerpiece of treatment for schizophrenia,
especially the positive symptoms.
Only caroprazine has been shown to have significant effects on negative symptoms.
The choice of a specific agent is mostly based on the adverse effect profile, the required
route of administration, and the patient's previous response to the drug.
Patients who respond usually show the most rapid improvement in the 1st 2 weeks and
will often continue to improve during the following weeks.
While there is a wide variety of mechanisms of action, most antipsychotics block
postsynaptic dopamine receptors. - ✔✔Pharmacological treatment for schizophrenia
✔✔older medications before 1989.
dopamine receptor antagonist
Common side effects include EPS (which may become irreversible),
hyperprolactinemia, neuroleptic malignant syndrome, QT prolongation, sudden death,
and an increased risk of mortality in older adult patients with dementia.
Examples include haloperidol, fluphenazine, and chlorpromazine. - ✔✔1st-generation
antipsychotics
✔✔Newer medications, starting with clozapine (approved in 1989).
Associated with a lower risk for EPS compared with FGAs and therefore the 1st-line
drugs to use (although the risk of metabolic syndrome is increased with SGAs).
The decreased risk for EPS is the most important distinction from FGAs, as the
pharmacologic properties, therapeutic effects, and adverse effects are not distinct
between the 2 groups.
Serotonin and dopamine antagonists.
Common side effects include metabolic syndrome, hypotension, sedation,
anticholinergic symptoms, hyperprolactinemia, EPS, cardiac effects, cardiomyopathies,
cataracts, and sexual dysfunction.
Examples are risperidone, aripiprazole, quetiapine, olanzapine, ziprasidone, clozapine. -
✔✔2nd-generation (atypical) antipsychotics
✔✔Requires immediate attention.
Use oral antipsychotic and benzodiazepine (may require intramuscular due to
noncompliance or for more rapid effect).
, Usually lasts 4-6 weeks. - ✔✔treatment of acute psychosis in schizophrenia
✔✔- Obtain laboratory tests: CBC (including differential if clozapine used), electrolytes,
fasting glucose, lipid profile, liver, renal, and thyroid function tests, and a pregnancy test
in females of fertile age.
- ECG if history of heart disease or if using drugs that may prolong the QT interval
(clozapine, thioridazine, iloperidone, ziprasidone).
- Monitor for the 1st few weeks and then regularly for involuntary movement
disorders/EPS, since they may become irreversible.
- The goal is to minimize symptoms, avoid relapses, and promote recovery that allows
integration into society.
- Minimize side effect profile.
- Recommended maintenance treatment is > 5 years.
- May use long-acting injectable antipsychotics for non-compliant patients after checking
for tolerability/efficacy with an oral agent. - ✔✔treatment of Maintenance phase in
schizophrenia
✔✔- Roughly 40% of treated patients will demonstrate positive symptoms that are
resistant to treatment.
- Assess proper dosage and duration of treatment.
- Do not use 2 antipsychotics at the same time as studies show no benefits.
- Consider the use of clozapine, which can be an effective treatment in persons with
schizophrenia that is resistant to treatment with other antipsychotic drugs. Also reduces
suicide risk. However, clozapine is associated with a risk for agranulocytosis and
requires frequent, intense blood monitoring. - ✔✔Treatment for individuals with
schizophrenia that are poor responders
✔✔1. EPS
2. Tardive dyskinesia
3. elevated prolactin
4. metabolic
5. neuroleptic malignant syndrome - ✔✔side effects to antipsychotics (both)
✔✔definition/ treatment:
- Movement disorders secondary to drugs that block dopamine receptors.
- Movement phenotypes include: dystonia (involuntary muscle contractions), akathisia
(inner restlessness), parkinsonism.
- Treatment options include decreasing dosage, changing to a drug having a lower risk
of EPS, or adding an antimuscarinic agent such as benztropine or diphenhydramine;
propanolol and benzodiazepines are also used, and botulinum toxin injections are used
for focal dystonia. - ✔✔extrapyramidal symptoms
✔✔- A subset of EPS.
ANSWERS RATED A+
✔✔Antipsychotic medications form the centerpiece of treatment for schizophrenia,
especially the positive symptoms.
Only caroprazine has been shown to have significant effects on negative symptoms.
The choice of a specific agent is mostly based on the adverse effect profile, the required
route of administration, and the patient's previous response to the drug.
Patients who respond usually show the most rapid improvement in the 1st 2 weeks and
will often continue to improve during the following weeks.
While there is a wide variety of mechanisms of action, most antipsychotics block
postsynaptic dopamine receptors. - ✔✔Pharmacological treatment for schizophrenia
✔✔older medications before 1989.
dopamine receptor antagonist
Common side effects include EPS (which may become irreversible),
hyperprolactinemia, neuroleptic malignant syndrome, QT prolongation, sudden death,
and an increased risk of mortality in older adult patients with dementia.
Examples include haloperidol, fluphenazine, and chlorpromazine. - ✔✔1st-generation
antipsychotics
✔✔Newer medications, starting with clozapine (approved in 1989).
Associated with a lower risk for EPS compared with FGAs and therefore the 1st-line
drugs to use (although the risk of metabolic syndrome is increased with SGAs).
The decreased risk for EPS is the most important distinction from FGAs, as the
pharmacologic properties, therapeutic effects, and adverse effects are not distinct
between the 2 groups.
Serotonin and dopamine antagonists.
Common side effects include metabolic syndrome, hypotension, sedation,
anticholinergic symptoms, hyperprolactinemia, EPS, cardiac effects, cardiomyopathies,
cataracts, and sexual dysfunction.
Examples are risperidone, aripiprazole, quetiapine, olanzapine, ziprasidone, clozapine. -
✔✔2nd-generation (atypical) antipsychotics
✔✔Requires immediate attention.
Use oral antipsychotic and benzodiazepine (may require intramuscular due to
noncompliance or for more rapid effect).
, Usually lasts 4-6 weeks. - ✔✔treatment of acute psychosis in schizophrenia
✔✔- Obtain laboratory tests: CBC (including differential if clozapine used), electrolytes,
fasting glucose, lipid profile, liver, renal, and thyroid function tests, and a pregnancy test
in females of fertile age.
- ECG if history of heart disease or if using drugs that may prolong the QT interval
(clozapine, thioridazine, iloperidone, ziprasidone).
- Monitor for the 1st few weeks and then regularly for involuntary movement
disorders/EPS, since they may become irreversible.
- The goal is to minimize symptoms, avoid relapses, and promote recovery that allows
integration into society.
- Minimize side effect profile.
- Recommended maintenance treatment is > 5 years.
- May use long-acting injectable antipsychotics for non-compliant patients after checking
for tolerability/efficacy with an oral agent. - ✔✔treatment of Maintenance phase in
schizophrenia
✔✔- Roughly 40% of treated patients will demonstrate positive symptoms that are
resistant to treatment.
- Assess proper dosage and duration of treatment.
- Do not use 2 antipsychotics at the same time as studies show no benefits.
- Consider the use of clozapine, which can be an effective treatment in persons with
schizophrenia that is resistant to treatment with other antipsychotic drugs. Also reduces
suicide risk. However, clozapine is associated with a risk for agranulocytosis and
requires frequent, intense blood monitoring. - ✔✔Treatment for individuals with
schizophrenia that are poor responders
✔✔1. EPS
2. Tardive dyskinesia
3. elevated prolactin
4. metabolic
5. neuroleptic malignant syndrome - ✔✔side effects to antipsychotics (both)
✔✔definition/ treatment:
- Movement disorders secondary to drugs that block dopamine receptors.
- Movement phenotypes include: dystonia (involuntary muscle contractions), akathisia
(inner restlessness), parkinsonism.
- Treatment options include decreasing dosage, changing to a drug having a lower risk
of EPS, or adding an antimuscarinic agent such as benztropine or diphenhydramine;
propanolol and benzodiazepines are also used, and botulinum toxin injections are used
for focal dystonia. - ✔✔extrapyramidal symptoms
✔✔- A subset of EPS.
