Side Effects
Which med reduces the acute sx of neuroleptic induced akathisia? (2x)
BETA BLOCKERS (PROPRANOLOL, ATENOLOL)
Antipsychotic drug adrenergic effect causing orthostatic hypotension
Α1-BLOCKADE
Periodically assess neuroleptic side effects using? (it also shows pt’s awareness of side effects) (2x)
AIMS
60 yo on 6 mg risperidone, 50 mg sertraline. Slowed thinking, drooling, cog-wheeling, masked facies. Mood/paranoia improved on meds. What to do? (5x)
DECREASE DOSE OF THE ANTIPSYCHOTIC
What EPS manifestations are the most common side effect of conventional antipsychotic meds?
AKATHISIA
25 yo pt hospitalized for an acute psychotic break, begins to complain of thickened speech. Physical exam reveals eyes deviated to the upper right, grimacing, and posturing of the arms. The only meds taken were haldol and clonazepam. The most helpful treatment at this point would be: (3x)
DIPHENHYDRAMINE (anticholinergics benztropine & trihexyphenidyl or diphenhydramine)
How do antipsychotic meds elevate prolactin (PRL)? (5x)
PROLACTIN IS UNDER TONIC INHIBITORY CONTROL BY DOPAMINE (disinhibition)
36 yo F pt w/ schizophrenia has been treated w/ olanzapine is discovered prolactin level: 354 ng/ml (normal: 3-30). The first action is:
ORDER A PREGNANCY TEST
What did the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) demonstrate about effectiveness of 2nd gen. antipsychotics for tx of schizophrenia? (2x)
SECOND GEN. ANTIPSYCHOTICS WERE NO MORE EFFECTIVE THAN FIRST GENERATIONS
A patient has a seizure secondary to a supratherapeutic level of clozapine. What changes in a patient’s life could account for this finding? (2x)
SMOKING CESSATION
25 yo pt receives haldol and develops laryngospasm: Tx? (2x)
BENZTROPINE (anticholinergics benztropine & trihexyphenidyl or diphenhydramine)
Mechanism for Qtc prolongation with neuroleptics
K CHANNEL BLOCKED
What hematological finding necessitates immediate dc of clozaril?
WBC 2000-3000, GRANULOCYTES 1000-1500
Superior efficacy for atypical antipsychotics over typical antipsychotics in the treatment of psychosis has been consistently demonstrated in what medications? (x2)
CLOZAPINE
55 yo psychiatrically hospitalized pt with chronic schizophrenia stabilized on Clozapine. Two weeks after d/c pt p/w impending signs of psychotic relapse. Assuming pt adherence to meds and negative serum/urine tox screens, what is the most likely explanation for relapse (2x)?
RESUMPTION OF HEAVY SMOKING
Med most helpful in tx of antipsychotic induced drooling?
GLYCOPYRROLATE
How does abilify reverse neuroleptic induced hyperprolactinemia?
PARTIAL D2 AGONIST
30 yo on Clozapine for treatment resistant schizophrenia presenting with dyspnea, orthostatic hypotension and HR 130bpm. Elevated Eosinophil , EKG with nonspecific T wave changes. Further most likely test to guide treatment (2x)
TROPONIN LEVEL (to assess for clozapine-associated myocarditis)
Which antipsychotic medication has low risk for QTc prolongation?
ARIPIPRAZOLE
Patient started on clozapine for treatment-resistant schizophrenia has initial ANC of 2200/mm3. How frequently should you get a CBC with diff?
WEEKLY
These symptoms make a diagnosis of NMS more likely than other neurological and general medical conditions: (2x)
FEVER AND SEVERE MUSCLE RIGIDITY
Mechanism by which risperidone cause very little EPS despite binding w/ high affinity to a dopaminergic D2 receptor:
SEROTONERGIC 5HT2 ANTAGONISM
After an injection with haldol, a patient appears tremulous, dystonic, confused, and has a fever of 38.8 degrees C. Which of the following would be an essential part of the diagnostic workup for this patient? (2x)
CSF EVALUATION
Psych MD orders quetiapine 50 mg for an 82 yo nursing home pt w/ dementia who has become severely agitated. Soon after, the psychiatrist receives a call from a family member who is concerned about the “black box” warnings associated with antipsychotics in the elderly. Which of the following is the most accurate information the psychiatrist could give the family member regarding the potential safety risks of this medication? (2x)
ATYPICAL ANTIPSYCHOTICS INCREASE MORTALITY; THIS MUST BE BALANCED AGAINST ANY POTENTIAL BENEFIT (increased risk of stroke)
Heavy smoking most likely affects the dose of which antipsychotic?
OLANZAPINE