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
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
