front 1 What is schizophrenia? | back 1 A chronic, severe and disabling thought disorder |
front 2 What are common positive symptoms of schizophrenia? | back 2
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front 3 What are common negative symptoms of schizophrenia? | back 3
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front 4 Definitions of extrapyramidal side effects (EPS): Dystonias | back 4
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front 5 Definitions of extrapyramidal side effects (EPS): Akathisia | back 5
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front 6 Definitions of extrapyramidal side effects (EPS): Parkinsonism | back 6
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front 7 Definitions of extrapyramidal side effects (EPS): Tradive dyskinesias (TD) | back 7
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front 8 Definitions of extrapyramidal side effects (EPS): Dyskinesias | back 8
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front 9 Which molecules are primarily involved in the pathophysiology behind schizophrenia? | back 9
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front 10 Medications/Illicit drugs that can cause psychotic symptoms | back 10
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front 11 T/F: FGAs block dopamine (DA-2) receptors | back 11 True |
front 12 What is a natural product used for psychosis and other psychiatric disorders (ex: ADHD, depression) | back 12 Fish oils |
front 13 T/F: SGAs are used first-line due to lower incidence of EPS | back 13 True |
front 14 Formulations of antipsychotics (d/t poor adherence in schizophrenia patients) | back 14
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front 15 Haldol cocktail | back 15 Haloperidol, lorazepam and diphenhydramine |
front 16 T/F: It is okay to give olanzapine and BZDs | back 16 False |
front 17 T/F: Antipsychotics are not indicated for agitation control in elderly with dementia-related psychosis due to increased risk of mortality | back 17 True |
front 18 High potency FGA still used | back 18 Haloperidol (Haldol, haldol decanoate) |
front 19 How often is haldol decanoate administered intramuscularly? | back 19 Monthly |
front 20 Which long-acting injections are administered every 4 weeks? | back 20
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front 21 Which long-acting injections are administered every 2 weeks? | back 21
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front 22 Which long-acting injection is administered every 3 months? | back 22 Invega Trinza |
front 23 Which drugs are available as fast-acting injections? | back 23
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front 24 Which drugs are available as orally disintegrating tablets? | back 24
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front 25 How do you convert Haldol PO to monthly injection? | back 25 Use 10-20x the PO dose |
front 26 Boxed warning for FGA, thioridazine | back 26 QT prolongation |
front 27 Warnings: First-generation antipsychotics | back 27
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front 28 Side effects: First-generation antipsychotics | back 28
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front 29 T/F: Lower potency FGAs have increased sedation and decreased EPS | back 29 True |
front 30 T/F: Higher potency FGAs have increased sedation and decreased EPS | back 30 False |
front 31 What drug class is Haldol also apart of? | back 31 Butyrophenone, also used for Tourette syndrome |
front 32 SGAs block which receptors? | back 32 D2 and 5-HT2A |
front 33 Which antipsychotics are unique in that they are D2 and 5-HT1A partial agonists? | back 33
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front 34 T/F: Aripiprazole is also approved for irritability with autism and Tourette disorder | back 34 True |
front 35 Side effects: Aripiprazole | back 35 Akathisia, activating or sedating, HA, anxiety, constipation |
front 36 Different formulations of Aripiprazole and their differences | back 36
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front 37 Indication: Clozapine | back 37 Must be used only if failed to respond to treatment with 2 standard AP treatments, or had significant ADRs |
front 38 Why is Clozapine used no sooner tha3rd-line | back 38 Due to severe side effect potential |
front 39 What is the boxed warning for SGA, Clozapine? | back 39 Severe neutropenia/agranulocytosis (REMS) |
front 40 Define severe neutropenia related to clozapine use | back 40
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front 41 Side effects: Clozapine | back 41
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front 42 T/F: Pharmacies must be REMS certified and patient must be enrolled with Clozapine REMS prior to initiating treatment | back 42 True |
front 43 T/F: Smoking reduces drug levels of clozapine and olanzapine | back 43 True |
front 44 Highest QT prolongation of antipsychotics | back 44 Thioridazine < Haloperidol < Ziprasidone |
front 45 Counseling points with Lurasidone (Latuda) | back 45
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front 46 Brand name for Olanazpine injection | back 46 Relprevv IM suspension, lasts 2-4 weeks, restricted use, monitor for 3-hours post-injection |
front 47 Side effects: Olanzapine | back 47
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front 48 Can patient start on Invega trinza? | back 48 Only after receiving Invega Sustenna x 4 months |
front 49 Active drug in Invega | back 49 Paliperidone |
front 50 Side effects: Paliperidone | back 50
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front 51 Side effects: Quetiapine | back 51
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front 52 Side effects: Risperidone | back 52
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front 53 Paliperidone is the active metabolite of what agent/drug? | back 53 Risperidone |
front 54 T/F: Risperidone is also approved for irritability associated with autism | back 54 True |
front 55 Side effects: Ziprasidone | back 55
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front 56 Active ingredient in SL tablet, Saphris | back 56 Asenapine |
front 57 T/F: Saphris SL tablet can cause tongue numbness | back 57 True |
front 58 Important AEs of SGAs Metabolic side effects -- highest risk | back 58
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front 59 Important AEs of SGAs Metabolic side effects -- lowest risk | back 59
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front 60 Important AEs of SGAs EPS -- lowest risk | back 60
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front 61 Important AEs of SGAs Hematologic effects -- highest risk | back 61 Clozapine (agranulocytosis) |
front 62 Important AEs of SGAs Increased prolactin -- highest risk | back 62
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front 63 Important AEs of SGAs Seizure -- highest risk | back 63 Clozapine (Dose-dependent) |
front 64 Drug of choice to treat psychosis in Parkinson disease d/t low risk of EPS | back 64 Quetiapine |
front 65 Drug approved for psychosis with Parkinson disease; dose not affect DA receptors | back 65 Pimavanserin (Nuplazid) |
front 66 T/F: Only some antipsychotics can prolong the QT interval | back 66 False |
front 67 What is Valbenazine (Ingrezza) indicated for? | back 67 Treatment of TD |
front 68 How does Valbenazine work? | back 68 Reversibly inhibits vesicular monoamine transporter 2 (VMAT2), a transporter that regulates monamine uptake from the cytoplasm to synaptic vesicle for storage and release |
front 69 Other than Valbenazine, what is another VMAT2 inhibitor indicated for TD? | back 69 Deutetrabenazine (Austedo) |
front 70 Deutetrabenazine (Austedo) is also approved for what indication? | back 70 Chorea associated with Huntington's disease |
front 71 Side effect: Valbenazine (Ingrezza) and Deutetrabenazine (Austedo) | back 71 Somnolence |
front 72 Contraindication for use of Deutetrabenazine (Austedo) | back 72 Hepatic impairment, administration within 14 days of MAOI |
front 73 Valbenazine (Ingrezza) and Deutetrabenazine (Austedo) are substrates of CYP3A4 and 2D6, therefore dose reduction is required when given with _____________________ | back 73 Strong inhibitors of CYP3A4 (itraconazole, clarithromycin) or 2D6 (paroxetine, fluoxetine) |
front 74 Because Valbenazine (Ingrezza) is a P-gp inhibitor, it can increase the concentration of what cardiac drug? | back 74 Digoxin |
front 75 What are signs of Neuroleptic Malignant Syndrome (NMS)? | back 75
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front 76 In addition to stoping the antipsychotic, what is a drug that can be used to relax the muscles in treatment of NMS | back 76 Dantrolene (Ryanodex, Dantrium, Revonto) |
front 77 Correct chemical class for chlorpromazine? | back 77 Phenothiazine The phenothiazines are strong DA blockers; when used for other conditions (nausea), movement disorders are possible side effects and sedation is expected. |
front 78 CD presents to the pharmacy with a prescription for lurasidone. What is an appropriate substitute? | back 78 Latuda Latuda is the brand name for lurasidone. |
front 79 BG is a 34 yr old male diagnosed with schizophrenia. He presents to the clinic for routine follow-up and for his monthly injection of Invega Sustenna, which he has been taking for 11 months. His PMH includes obesity, HTN, HLD, and 2 suicide attempt. His medications include amlodipine 10mg PO daily and atorvastatin 40mg PO at bedtime. He smokes 1/2 pack of cigarettes per day. Which of the following medications can be given monthly or less frequently than monthly (ex: every 3 months)? SATA | back 79
Abilify Maintena and haloperidol decanoate are both administered monthly. Invega Trinza is administered every 3 months Both fluphenazine decanoate and Risperdal Consta are given more frequently than monthly (every 2 weeks) |
front 80 Which of the following is the generic name for the once-monthly injection Invega Sustenna? | back 80 Paliperidone Invega Sustenna is a once-monthly injection of paliperidone. Nonadherance with therapy is the #1 problem with drug therapy in patients with schizophrenia. The long-acting formulations are important because they help improve adherence. |
front 81 A physician has a patient who is forgetful and dose not take her antipsychotic on a regular basis. The physician wishes to use an atypical ("second generation") agent that can be administered every 2 weeks. Which agent comes in a 2-week intramuscular injection? | back 81 Risperidone Risperdal Consta is given every 2 weeks. |
front 82 A 23 yr old male was picked up by the police for acting erratically and threatening patrons at a subway stop. He was placed into the acute lock-down ward of the psychiatric hospital and given an injection of haloperidol and lorazepam. He quickly developed a very painful sustained contraction of his neck and trunk. Which medication can be administered to treat this side effect? | back 82 Benztropine The treatment for dystonic reactions (in this case caused by haloperidol) includes a centrally-acting anticholinergic (such as benztropine and diphenhydramine). These are administered by injection for fast relief, or can be given orally for prophylaxis during therapy initiation. |
front 83 A pharmacist will counsel a patient beginning therapy with Zyprexa. Which of the following are correct counseling statements? SATA | back 83
Olanzapine is sedating and is take QHS. It causes weight gain, elevated blood glucose and lipids and (like the others that cause similar problems) the patient will need all of these monitored, along with the blood pressure. |
front 84 Select the correct chemical class for Haldol | back 84 Butyrophenone The butyrophenones haloperidol (Haldol) and droperidol (Inapsine) are among the agents with the highest QT-prolongation risk. They work mainly by blocking D2 receptors |
front 85 A patient gave the pharmacist a prescription for Seroquel 25mg BID #60. Which of the following is an appropriate generic substitution for Seroquel? | back 85 Quetiapine The generic name of Seroquel is quetiapine |
front 86 Haloperidol is available in which of the following formulations? SATA | back 86
Haloperidol comes in an oral tablet, a short-acting injection and a monthly "decanoate" injection that is useful option for patients who have adherence issues. |
front 87 VT is an 18 yr old male high school student who no longer wishes to socialize with his former friends. He is speaking little and has little desire for social interaction. When asked by his mother if he is interested in seeing his former friends, he states that he does not care. When considering the diagnosis criteria for schizophrenia, VT would best be described as exhibiting which type of symptoms? | back 87 Negative symptoms Negative symptoms include a flat affect (emotionless face), alogia (hardly speaking) and abolition (not motivated to do anything). The negative symptoms contribute to social withdrawal and apathy. People with schizophrenia may also display disorganized speech and behavior. |
front 88 A patient gave the pharmacist a prescription for Geodon 60mg PO BID #60. Which of the following is an appropriate generic substitution for Geodon? | back 88 Ziprasidone The generic name of Geodon is ziprasidone |
front 89 A female patient with a congenital heart defect is being started on an antipsychotic for treatment of schizophrenia. Which drug should be considered contraindicated due to the high risk for QT prolongation? | back 89 Ziprasidone Thioridazine, haloperidol, chlorpromazine and ziprasidone have the highest risk of QT prolongation |
front 90 BY is an elderly gentleman with advanced Parkinson disease. He has lived in a SNF for about 1 yr since he because unable to feed himself. BY tried to hit his roommate with a butter knife. He explained to the nurse that the roommate was planning to attack him when he was sleeping in order to take his eyes out and sell them. Which of the following medcaitions are possibly contributing to BY's psychosis? | back 90
Both levodopa/carbiodpa and dopamine agonists can aggravate psychosis; the DA agonists are higher risk. |
front 91 Antipsychotics such as chlorpromazine and haloperidol exert their mechanism of action by blocking this receptor | back 91 Dopamine Antipsychotics are primarily dopamine (D2) blocking agents, which is why they cause movement disorders. Some of the newer drugs act on serotonin receptors as well. |
front 92 DB is a 72 yr old male suffering from dementia. Recently, DB struck his wife while she was helping him eat. The wife asked the physician for help and DB was prescribed risperidone 1mg BID. The pharmacist is concerned about which safety issue if DB takes the medication prescribed? | back 92 Cerebrovascular accident |
front 93 An 18 yr old female is given a drug she has never used before, and it results in a drug-induced psychosis. Which of the following drugs can cause drug-induced psychosis? | back 93
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front 94 AB has been taking an atypical antipsychotic as an adjunctive agent to treat resistant depression. After beginning the antipsychotic, she began to have feelings of restlessness and an urge to move. She states she cannot keep her legs still. AB is displaying what adverse effect from the use of an antipsychotic? | back 94 Akathisia |
front 95 Which antipsychotic has the lowest risk of EPS? | back 95 Quetiapine |
front 96 A pharmacist will counsel a patient who is starting treatment with asenapine. Which fo the following counseling statements is correct? | back 96 The medcication is a SL tablet that can make the tongue numb |
front 97 A patient gave the pharmacist a prescription for Zyprexa 5mg PO QHS #30. Which of the following is an appropriate generic substitution for Zyprexa? | back 97 Olanzapine |
front 98 A patient gave the pharmacist a prescription for Risperal 1mg PO TID #90. Which of the following is an appropriate generic substitution for Risperal? | back 98 Risperidone |
front 99 RR is a 27 yr old female graduate student who is seen mumbling to herself repeatedly in class. When confronted, it is apparent that RR believes she is talking to someone. Choose the response that best describes the symptom of schizophrenia displayed by this patient | back 99 Hallucination |
front 100 Which of the following prescription drug classes may induce or exacerbate psychotic symptoms? SATA | back 100
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front 101 A patient prescribed risperidone experienced weight gain and had trouble managing his diabetes. Which of the following antipsychotics has a lower risk of metabolic side effects? | back 101 Aripiprazole |
front 102 A 28 yr old female patient experienced high prolactin levels while using the atypical agent risperidone. She experienced decreased, irregular menstrual periods. She found this very bothersome and discontinued the drug. Which of the following agents would put her at repeated risk for the same adverse reaction? | back 102 Paliperidone |
front 103 BM is a 24 yr old male who has failed trails with olanzapine and ziprasidone. The psychiatrist plans to initiate clozapine therapy and sends the patient to have a CBC drawn. The patient cannot be started on clozapine if the ANC is below: | back 103 1500/mm3 |
front 104 A patient gave the pharmacist a prescription for Abilify 10mg PO daily #30. Which of the following is an appropriate generic substitution for Abilify? | back 104 Aripiprazole |
front 105 JK is a 72 yr old female with a variety of medical conditions. 2 years ago, her family reported that she was displaying paranoid delusions, including the belief that her daughter was trying to kill her by poisoning her food. The physician prescribed risperidone, which has been helpful. At clinic today, JK is darting her tongue in and out and blinking in an involuntary manner. She is displaying the following AE from the use of an antipsychotic: | back 105 Tardive dyskinesia |
front 106 SJ has failed several trials of antipsychotics. He continues to respond to "voices" that constantly torment him. He has tried to commit suicide several times. His other medical conditions include seizures (well-controlled since childhood), depression, anxiety, elevated cholesterol and prediabetes. SJ's HCP would like to start clozapine. His WBC count in 5,500 cells/mm3 and his ANC is 1,890/mm3. Choose the correct statements. SATA | back 106
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front 107 A female patient has been taking haloperidol 1mg BID. Her family noticed an unusual "smacking" motion made with her lips and unusual eye movements. What is the best course of action? | back 107 Switch to quetiapine |
front 108 RD is a 52 yr old female patient with schizophrenia, depression, elevated cholesterol, pre-diabetes and hypothyroidism. The physician is considering a trial with olanzapine. Choose the correct statements regarding the use of olanzapine in this patient. SATA | back 108
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front 109 What is the rationale behind the production of several different formulations of ODTs for schizophrenia? | back 109 Some patients with schizophrenia will "cheek" the medication and spit it out later |
front 110 CF is 74 yr old female who has a unilateral tremor in her right hand consistent with Parkinson disease. The physician needs to choose an antipsychotic for CF. Which of the following agents has the lowest risk for movement disorders? | back 110 Quetiapine |
front 111 Which of the following drugs requires prescribers, pharmacists, and patients to participate in a REMS program? | back 111 Clozapine |