Schizophrenia Dr. Jackson Pollev

Bob has taken his clozapine for twelve months and has been adherent with getting his blood work done every other week. Going forward, how frequently can he get his blood drawn?

Weekly

Monthly

Biannually

Annually

Monthly (initiation is weekly)

How often should you monitor waist circumference according to the Diabetes Care Guidelines for monitoring antipsychotics?

Baseline

Every eight weeks

Quarterly

Annually

Baseline
+
Annually

Patients with severe neutropenia can be rechallenged with clozapine, with caution, if the benefits outweigh the risks.

True

False

True (benefits now outweigh the risks)

Most long acting injections (LAIs) recommend using an oral antipsychotic prior to initiation of the LAI. Why is this recommended?

It helps the LAI achieve steady state

It keeps psychosis under control continuously

It is intended to make sure the patient can tolerate the drug

It decreases the number of side effects associated with the LAI

It is intended to make sure the patient can tolerate the drug

Which LAI should be given on a monthly basis?

Risperidone Consta

Invega Trinza

Abilify Maintena

Fluphenazine decanoate

Abilify Maintena

(Invega Trinza every 3 months)

(Risperidone Consta every 2 weeks)

(Fluphenazine decanoate every 2-3 weeks)

Which antipsychotic has a Risk Evaluation and Mitigation Strategy (REMS)?

Clozapine oral

Olanzapine long acting injection

Loxapine inhalation

Asenapine oral

Clozapine oral
+
Olanzapine long acting injection
+
Loxapine inhalation

Which LAI does not require oral antipsychotic overlap?

Olanzapine

Paliperidone

Aripiprazole

Risperidone

Olanzapine
+
Paliperidone

Which dosage forms is loxapine available as?

Long acting injectable

Oral

Short acting injections

Orally disintegrating tablet

Patch

Inhaler

Sublingual

Oral
+
Inhaler

Which of the following counseling would you give to a patient on asenapine?

Do not chew or swallow

Eat with 350 calories

Avoid food or drink 10 minutes after taking

Eat with 500 calories

Do not chew or swallow
+
Avoid food or drink 10 minutes after taking
(stomach acid will 'deactivate' it)

Orally disintegrating tablets (ODT) are difficult to cheek or discard

True

False

True

The Black Box Warning "Increased mortality (ex: sudden death, stroke, pneumonia, heart attack) in elderly patients with dementia related psychosis" is used for which antipsychotic?

Clozapine only

Olanzapine only

Pimavaserin only

All antipsychotics

All antipsychotics

Which antipsychotic causes neuroleptic malignant syndrome (NMS)?

All antipsychotics

Haloperidol

Risperidone

Clozapine

All antipsychotics

Sedation, orthostatic hypotension, and anticholinergic effects occur most frequently with which antipsychotics?

Second generation antipsychotics

High potency antipsychotics

Low potency antipsychotics

Mid potency antipsychotics

Low potency antipsychotics (Chlorpromazine, Thioridazine)

You are counseling a 30 year old female about sexual side effects of risperidone. Which adverse effects to you counsel her about?

Erectile dysfunction, retrograde ejaculation, difficulty with orgasm

Difficulty with orgasm, decreased libido, retrograde ejaculation

Gynecomastia, amenorrhea, galactorrhea

Gynecomastia, galactorrhea, erectile dysfunction

Gynecomastia, amenorrhea, galactorrhea

How much weight can a patient gain from baseline before guidelines recommend changing therapy?

3%

5%

7%

9%

7%
(at 5%, monitor closely, could consider change in therapy)

Which of the following lipid changes are observed clinically more than other lipid changes?

Increased total cholesterol

Increased triglycerides

Increased LDL

Increased HDL

Increased triglycerides

Choose a treatment for a patient who has transportation as a barrier to care.

Clozapine (Clozaril)

Risperidone long acting injection (LAI) (Risperidal Consta)

Fluphenazine long acting injection (Prolixin Decanoate)

Paliperidone long acting injection (Invega Trinza)

Paliperidone long acting injection (Invega Trinza)

How often should an ANC (absolute neutrophil count) be checked when a patient starts clozapine (Clozaril)?

Daily

Weekly

Every other week

Monthly

Annually

Weekly

If a patient has been compliant with getting ANC's drawn weekly for 6 months, in the future those blood draws can be checked:

Daily

Weekly

Every other week

Monthly

Annually

Every other week/biweekly
(between months 6-12 of therapy)

If patients have been taking clozapine without missing an ANC blood draw for one year how often can they get blood drawn thereafter?

Daily

Weekly

Biweekly

Monthly

Annually

Monthly (>12 months of therapy)

What is an advantage of using a decanoate or other antipsychotic injection?

Greater efficacy than oral tablets

Greater safety than other forms

Good for individuals with non-adherence

Good for treatment of agitation

Good for individuals with non-adherence

Which of the following rating scales should be used to monitor for tardive dyskinesia?

Simpson Angus Scale (SAS)

Abnormal Involuntary Movement Scale (AIMS)

Dyskinesia Identificaton System Condensed User Scale (DISCUS)

Barnes Akathisia Rating Scale (BARS)

Abnormal Involuntary Movement Scale (AIMS)
+
Dyskinesia Identificaton System Condensed User Scale (DISCUS)

AJ has a PANSS Score of 90. Four weeks after his new antipsychotic was initiated his PANSS Score is 68. AJ has achieved a response on his PANSS.

True

False

True (response = 20% better)

How often should lipids be monitored for patients on antipsychotics

Baseline, 12 weeks, and annually thereafter

Baseline, 4 weeks, 8 weeks, 12 weeks and quarterly

Baseline, 12 weeks and every 5 years thereafter

Baseline and annually

Baseline, 12 weeks and every 5 years thereafter

How often should blood pressure be monitored for patients on antipsychotics?

Baseline, 12 weeks, annually

Baseline, 4 weeks, 8 weeks, 12 weeks, quaterly

Baseline, 12 weeks, every 5 years

Baseline, annually

Baseline, 12 weeks, annually

How often should fasting plasma glucose be monitored for patients on antipsychotics?

Baseline, 12 weeks, annually

Baseline, annually

Baseline 12 weeks, every 5 years

Baseline, 4 weeks, 8 weeks, 12 weeks, quarterly

Baseline, 12 weeks, annually

What is the definition of benign ethnic neutropenia?

ANC of less than 2000 in individuals of African descent in the absense of other causes

ANC of less than 1500 in individuals of African descent in the absense of other causes

ANC of less than 1000 in individuals of African descent in the absence of other causes

ANC of more than 2000 in individuals of African descent in the absense of other causes

ANC of less than 1500 in individuals of African descent in the absense of other causes

Which of the following is considered to be mild neutropenia?

ANC less than 1500

ANC less than 1000

ANC less than 500

ANC less than 250

ANC less than 1500

Which of the following in considered to be moderate neutropenia?

ANC of less than 1500

ANC of less than 1000

ANC of less than 500

ANC of less than 250

ANC of less than 1000

Which ANC is associated with severe neutropenia?

ANC of less than 1500

ANC of less than 1000

ANC of less than 500

ANC of less than 250

ANC of less than 500 (very severe is >250)

What is the minimum baseline ANC an individual with BEN must have to start clozapine?

ANC of 5000

ANC of 2500

ANC of 1000

ANC of 500

ANC of 1000

AJ is taking thiothixene 40 mg (high potency AP), but is switching to risperidone. What is the chorpromazine equivalent dose?

Risperidone 2 mg

Risperidone 4 mg

Risperidone 20 mg

Risperidone 40 mg

Risperidone 20 mg (risp 2mg = thio 4mg)

Which antipsychotic is available as a nasal spray (for agitiation)?

Loxapine

Perphenazine

Lurasidone

Asenapine

Loxapine

Which antipsychotics come as short acting injections (for agitation)?

Risperidone, aripiprazole, haloperidon

Haloperidol, olanzapine, ziprasidone

Fluphenazine, paliperidone, aripiprazole

Olanzapine, paliperidone, risperidone

Haloperidol, olanzapine, ziprasidone

Which antipsychotics come as orally disintegrating tablets (ODTs)?

Brexpiprazole, asenapine, lurasidone

Paliperidone, haloperidol, fluphenazine

Clozapine, risperidone, aripiprazole

Asenapine, Iloperidone, paliperidone

Clozapine, risperidone, aripiprazole

Which antipsychotic must be taken with food to be absorbed?

Ziprasidone

Clozapine

Risperidone

Brexpiprazole

Ziprasidone (and Lurasidone)

Which antipsychotic should be taken with 350 calories to be absorbed?

Ziprasidone

Brexpiprazole

Asenapine

Lurasidone

Lurasidone

What kind of extrapyramidal side effects causes the neck to twist to the side?

Akathisia

Acute dystonia

Pseudoparkinsonism

Tardive dyskinesia

Acute dystonia (Torticollis)

Which extrapyramidal side effect causes stiffness and tremor?

Akathisia

Pseudoparkinsonism

Acute dystonia

Tardive dyskinesia

Pseudoparkinsonism

Which extrapyramidal effect is associated with pacing?

Akathisia

Pseudoparkinsonism

Acute dystonia

Tardive dyskinesia

Akathisia

Which of the antipsychotics cause the most weight gain?

Clozapine, olanzapine, quetiapine

Risperidone, brexpiprazole, aripiprazole

Lurasidone, iloperidone, asenapine

Paliperidone, ziprasidone, aripiprazole

Clozapine, olanzapine, quetiapine
(these 3 also cause metabolic syndrome)

Which antipsychotic causes the least amount of weight gain?

Risperidone

Lurasidone

Iloperidone

Cariprazine

Lurasidone

Which antipsychotic causes the least sedation?

Haloperidol

Thioridazine

Quetiapine

Cariprazine

Haloperidol

Which antipsychotics cause the most sedation?

Aripiprazole, asenapine, brexpiprazole

Lurasidone, iloperidone, paliperidone

Quetiapine, Olanzapine, Clozapine

Haloperidol, fluphenazine, trifluoperazine

Quetiapine, Olanzapine, Clozapine

What serotonin receptor causes sedation?

5HT1A

5HT2A

5HT4

5HT7

5HT7

Which antipsychotics cause orthostatic hypotension?

Aripiprazole, asenapine, ziprasidone

Quetiapine, thioridazine, clozapine

Lurasidone, iloperidone, risperidone

Paliperidone, haloperidol, thiothixene

Quetiapine, thioridazine, clozapine

You just gave a Risperidone Consta long acting injection. What should you do with the syringe after you give the shot?

Response recorded

Put the syringe and needle in your pocket

Put the syringe and needle in your soda can

Put the syringe and needle in the closest trash can

Put the syringe and needle in a sharps box

Put the syringe and needle in a sharps box

A new drug came to market in March 2023 and it significantly blocks D2 in the basal ganglia. What adverse effect would you expect?

Anticholinergic effects

Orthostatic hypotension

Parkinsonian symptoms

QTc interval prolongation

Parkinsonian symptoms

Which of the following medications is a partial agonist at dopamine 2 receptors?

Olanzapine, quetiapine, risperidone

Cariprazine, aripiprazole, brexpiprazole

Chlorpromazine, perphenazine, lurasidone

Paliperidone, loxapine, thiothixene

Cariprazine, aripiprazole, brexpiprazole ('3rd gen')

How would you counsel a patient on ziprasidone?

Take in the morning one hour before meals

Do not take with food or drink

Take at night with a light snack

Take with 500 calories twice daily

Take with 500 calories twice daily

How frequently should a AIMS scale be completed in a first generation antipsychotic (FGA)?

At baseline and every week for 6 months

At baseline and every 6 months

At baseline and every 12 months

At baseline,6 months, then annually thereafter

At baseline and every 6 months

How frequently should an AIMS scale been completed with a second generation antipsychotic (SGA)?

Baseline and weekly thereafter

Baseline and every 6 months

Baseline and 6 months, then annually

Baseline and once every 12 months

Baseline and once every 12 months

Which antipsychotic is metabolized by CYP1A2

Thioridazine

Olanzapine

Clozapine

Lurasidone

Thioridazine
+
Olanzapine
+
Clozapine

Cigarette smoking induces which CYP enzyme?

CYP1A2

CYP2D6

CYP2C19

CYP3A4

CYP1A2

Which antipsychotic(s) causes akathisia?

Haloperidol

Risperidone

Aripiprazole

Cariprazine

Haloperidol
+
Risperidone
+
Aripiprazole
+
Cariprazine

Which antipsychotics cause the greatest risk of metabolic syndrome?

Clozapine, olanzapine, quetiapine

Aripiprazole, paliperidone, asenapine

Risperidone, ziprasidone, lurasidone

Brexpiprazole, cariprazine, iloperidone

Clozapine, olanzapine, quetiapine

Which antipsychotics cause the least risk of metabolic syndrome?

Clozapine, olanzapine, quetiapine

Aripiprazole, lurasidone, ziprasidone

Risperidone, paliperidone, quetiapine

Paliperidone, iloperidone, olanzapine

Aripiprazole, lurasidone, ziprasidone

Pseudoparkinsonism is characterized by which of the following symptoms?

Unilateral hand tremor, pacing, stiff neck

Grimacing, tongue protrusion, foot dropping

Stiffness, bilateral tremor, cogwheel rigidity

Inability to sit still, laryngospasm, pacing

Stiffness, bilateral tremor, cogwheel rigidity

Response on the BPRS is defined as a decrease of 20% and remission is defined as a score equal or less than 3.

True

False

True