Antipsychotic Tidbits
Massively Random
Randomly Psych
Side Effects
(Mostly) American Music Genres
100
Main reasons why typical antipsychotics are seen as more toxic than 2nd gen.
What are:
They were typically used at much higher doses relative to what is used today.
And
The association with EPS, especially tardive dyskinesia?
In OD, 2nd gen may be less safe. Page 33 of Clinical Psychopharmacology, a Practical Approach.
Also, some better effects on cognition and negative sx for the 2nd gen and fewer cardiac risks in general, although not with all of them.
100
This feature is most characteristic of Lewy body dementia.
B. Stepwise decline
C. Visual hallucinations
D. Personality change
E. Early aphasia
B. Stepwise decline
C. Visual hallucinations
D. Personality change
E. Early aphasia
F. Early Parkinson features
What is C?
For F, that can come well after cognitive changes.
100
A patient on lithium presents with tremor, diarrhea, vomiting, and confusion. This medication most likely precipitated lithium toxicity.
A. Acetaminophen
B. Furosemide
C. Propranolol
D. Omeprazole
E. Lorazepam
What is B, furosemide?
100
The most common medication induced psychosis or mania we will see on CL.
What is corticosteroid induced psychosis or mania?
High doses are used in autoimmune disease and COPD.
100
Originating in the Pacific northwest in the late 80's/early 90s.
"Defined by distorted electric guitars, introspective angst-filled lyrics, and anti-consumerist fashion, it was spearheaded by the "Big Four" bands: Nirvana, Pearl Jam, Soundgarden, and Alice in Chains."
What is Grunge?
200
A 35-year-old woman on clozapine presents with abdominal pain, bloating, and no bowel movement for 7 days. Vitals are stable.
This is the most serious potential complication.
A. Ileus
B.Massive gas
C. Neuroleptic malignant syndrome
D. Agranulocytosis
E. This is somatic symptom disorder
What is A, ileus?
Clozapine constipation is not benign
Can lead to ileus, bowel ischemia, death
PRITE loves this because people underestimate it
200
A patient on ziprasidone starts erythromycin and develops syncope.This is the most likely mechanism.
A. CYP3A4 induction
B. Additive QT prolongation
C. Increased renal clearance
D. Dopamine blockade
E. Serotonin toxicity
What is B, additive QTc prolongation.
Don't forget to check the non-psych meds for risk.
200
A patient reports early morning awakening, weight loss, psychomotor retardation, excessive guilt, and mood worse in the morning.
This diagnosis best fits.
A. Atypical depression
B. Persistent depressive disorder
C. Major depressive disorder with melancholic features
D. Major depressive disorder with atypical features
E. Massive Bang Energy Drink toxicity
What is C?
200
Class of meds associated with behavioral adverse effects including gambling, impulsive behavior, or psychosis.
What are dopaminergic agents?
200
"A 1980s sub-genre of hard rock and heavy metal, characterized by pop-influenced hooks, high-pitched vocals, flashy guitar solos, and, notably, an aesthetic of big hair, makeup, and spandex."
Bands included Motley Crue, Poison, Cinderalla, Ratt, Def Leppard, Whitesnake, and so on.
What is Hair or Glam Metal?
300
A patient with treatment-resistant schizophrenia and epilepsy is being considered for clozapine. Of the list below, this adverse effect is dose-dependent and requires monitoring.
A. QT prolongation
B. Seizures
C. Agranulocytosis
D. Hyperprolactinemia
E. Tardive dyskinesia
What are seizures, QTc prolongation?
QTc prolongation is generally insignificant. In the Black Book, clozapine is listed near aripiprazole with "No Known QTc Prolongation."
Neutropenia can occur any time during titration. PRL is relatively minimal.
Key dose-related, often manageable, side effects include seizures, sedation, sialorrhea (excessive salivation), and severe constipation. Other dose-dependent risks involve orthostatic hypotension, tachycardia, and weight gain.
300
A patient has progressive memory loss, fluctuating cognition, REM sleep behavior disorder, loss of smell, and walks bent over. This medication should be avoided.
B. Donepezil
C. Quetiapine
D. Haloperidol
E. Melatonin
B. Donepezil
C. Quetiapine
D. Haloperidol
E. Melatonin
F. Ice cold beers
What is D?
Give the man a beer.
300
A 29-year-old man with treatment-resistant schizophrenia is started on clozapine. Two weeks later, his partner reports that he soaks his pillow with saliva every night. He is otherwise stable.
This is the best next step:
A. Stop clozapine
B. Add benztropine
C. Add atropine sublingual drops
D. Switch to risperidone.
E. Add glycopyrrolate PO.
What is C? This treat locally. Atropine eye drops or ipratropium nasal inhaler given SL.
Glycopyrrolate is used as well because it does not cross the blood brain barrier. If needing an antidepressant, amitriptyline could be useful.
M4 blockade is the mechanism here. A2 blockade could be responsible and meds like guanfacine and sometimes terazosin are used.
https://www.pharmacytimes.com/view/psychiatry-clozapine-induced-sialorrhea
300
Rabbit syndrome and rolling pill syndrome.
What are presentations of TD?
https://www.instagram.com/reel/DUQch_1k2iV/
Pill rolling is also seen n PD.
300
A catch-all term for post-punk pop/rock.
"Blending punk's energy with catchy melodies, synthesizers, and diverse influences like disco, funk, and reggae, creating a commercially viable sound with iconic bands like Blondie, Talking Heads, and The Police, defined by MTV-driven visuals and electronic experimentation."
What is New Wave?
400
Antipsychotics associated with the rare side effect of impulsive/disinhibited behavior such as shoping, binge eating, or gambling?
What are aripiprazole and brexpiprazole?
They are partial D2 agonists.
Brexpiprazole is more of an antagonist. It should also cause less akathisia and activation than aripiprazole.
400
A patient with schizophrenia has been stable on clozapine for years. One week after starting this antidepressant augment, he develops sedation, hypersalivation, and confusion.
A. Sertraline
B. Escitlopram
C. Fluvoxamine
D. Paroxetine
E. Bupropion
F. Boost Donettes
A. Sertraline
B. Escitlopram
C. Fluvoxamine
D. Paroxetine
E. Bupropion
F. Boost Donettes
What is fluvoxamine?
This is due to CYP1A2 inhibition.
Boost Donettes do make you drool, especially Caramel Macchiato.
400
This feature distinguishes mania from hypomania.
B. Elevated mood
C. Increased goal-directed activity
D. Psychotic features
E. Distractibility
B. Elevated mood
C. Increased goal-directed activity
D. Psychotic features
E. Distractibility
F. Can't stop watching trashy reality real estate shows
What is D, psychotic features?
400
A 44M with chronic schizophrenia comes in to clinic. He has been fairly stable, with some ongoing AH and odd ideas with mild agitation, on risperidone 5mg PO qHS. He had to be admitted psychiatrically some months back and did well with an increase from 3mg to 5mg. He reports feeling low, sluggish. His GF complains that he is not as interested in her and is not performing sexually. This is the next course of action:
A. Add bupropion.
B. Add sertraline.
C. Get labs, including a prolactin level.
D. Add aripiprazole.
E. Lower the dose of risperidone.
What is C, get a prolactin level?
Lowering the dose isn't a good idea. You could eventually add aripiprazole for the PRL, if it is elevated.
400
This is a 'fast-paced, highly complex style of modern jazz that emerged in the early-to-mid 1940s. It marked a radical shift from the danceable, large-ensemble swing of the 1930s toward a "musician's music" designed for listening and intellectual engagement.' Known for long, complex solos, small ensembles, a faster pace, and complex harmonies with key changes. Mostly from New York. The main figure associated with it is Charlie Parker. Also, Thelonious Monk, John Coltrane, Dizzy Gillespie, and Max Roach.
What is bebop?
500
In the CATIE trial, time to discontinuation was noticeably different for this antipsychotic.
What is olanzapine?
However, the number of patients abandoning treatment was so high in all the groups it makes little difference. 74% abandoned treatment.
Mean modal dose was only ~20mg though. 543 for quetiapine, 113 for ziprasidone, 4mg for risperidone.
500
These long-acting injectables require oral overlap during initiation.
A. Paliperidone palmitate
B. Risperidone microspheres
C. Aripiprazole lauroxil
D. Haloperidol decanoate
E. Olanzapine pamoate
F. Fluphenazine decanoate
A. Paliperidone palmitate
B. Risperidone microspheres
C. Aripiprazole lauroxil
D. Haloperidol decanoate
E. Olanzapine pamoate
F. Fluphenazine decanoate
What are B, D, and F?
The recommended initiation regimen for INVEGA SUSTENNA (234 mg on day 1 and 156 mg on day 8 via deltoid injection) is required for this transition. However, no oral antipsychotic supplementation is required.
For lauroxil, a one-day initiation regimen using a single 675-mg dose of Aristada Initio with one 30-mg dose of oral aripiprazole eliminates the need for a 3-week overlap.
Nobody uses the olanzapine LAI.
500
This lab abnormality would be most concerning in a patient on lithium who presents with confusion and ataxia.
A. Lithium level 1.3 mEq/L
B. Creatinine rise from 0.9 → 1.2
C. Sodium 128 mEq/L
D. TSH mildly elevated
E. Massive levels of Berserk Gorilla
What is C, hyponatremia?
Low sodium would increase Li reabsorption in the proximal tubules. 
500
The "prolactin sparing" antipsychotics:
What are quetiapine, clozapine, aripiprazole, and iloperidone (nobody uses that one much)?
500
"A high-energy, syncopated accordion-based music genre created in rural Southwest Louisiana by French-speaking Creoles of African and Native American descent."
The main instrument is the accordion, with a frottoir or wash board, and often a full rhythm section (sometimes horns, or just a sax).
