2
MH 701 SAFETY Exam 2 with accurate detailed solutions
|| || || || || || || ||
What differentiates SGAs from FGAs? - ✔✔SGAs have:
|| || || || || || ||
D2 and 5HT2A receptor antagonism
|| || || ||
+ Antidepressant action, treat pos and neg schizo sx, metabolic SE, D2D interactions,
|| || || || || || || || || || || || ||
approved for schizophrenia, mania, and acute mania
|| || || || || ||
FGAs have positive symptom antipsychotic actions
|| || || || ||
- EPS, hyperprolactinemia
|| ||
Mostly D2 receptor antagonism || || ||
Which SGA has lowest EPS SE, but is associated with substantial risk of agranuloycytosis? -
|| || || || || || || || || || || || || || ||
✔✔Clozapine ||
The lower D2 receptor action is probably why clozapine does not cause EPS
|| || || || || || || || || || || ||
Weekly WBC counts are indicated to monitor the patient for development of
|| || || || || || || || || || || ||
agranulocytosis.
What causes breast secretions while receiving perphenazine? Is this typical with both FGAs
|| || || || || || || || || || || || ||
and SGAs? - ✔✔Perphenazine blocks dopamine 2 receptors in the pituitary, causing
|| || || || || || || || || || || ||
hyperprolactinemia, which can cause galactorrhea. || || || || ||
Except for risperidone, SGAs do not elevate prolactin.
|| || || || || || ||
Which of the SGAs is most likely and which is least likely to worsen a metabolic profile? -
|| || || || || || || || || || || || || || || || || ||
✔✔Most likely: olanzapine || ||
-weight gain, metabolic risk || || ||
,2
Least likely: ziprasidone
|| || ||
-weight neutral, lowers triglyceride levels
|| || || ||
Describe a cross taper from risperidone to olanzapine - ✔✔Taper the risperidone off over
|| || || || || || || || || || || || || ||
three weeks while simultaneously beginning olanzapine at 10 mg per day
|| || || || || || || || || ||
risperidone, quetiapine, and ziprazodone lack anticholinergic effects.
|| || || || || || ||
Abrupt transition from a DRA, olanzapine, or clozapine to one of these agents may cause
|| || || || || || || || || || || || || || ||
cholinergic rebound ||
What are some monotherapy agents used as primary treatment of acute mania? - ✔✔"All of
|| || || || || || || || || || || || || || ||
the SDAs (except clozapine) are FDA approved for this.
|| || || || || || || || ||
Serotonin dopamine antagonist (SDAs) || || ||
risperidone (Risperdal), and olanzapine (Zyprexa), ziprasidone (Geodon)
|| || || || || ||
Explain Serotonin Dopamine antagonist (SDA) - ✔✔The newer second-generation
|| || || || || || || || ||
antipsychotic drugs, also called atypical antipsychotics are dopamine and 5HT2a
|| || || || || || || || || ||
antagonists. Down regulate both Dopamine and Serotonin receptors.
|| || || || || || ||
SDAs include clozapine (Clozaril), risperidone (Risperdal), and olanzapine (Zyprexa).
|| || || || || || || ||
Which medications are FDA-approved for use in bipolar depression? - ✔✔quetiapine
|| || || || || || || || || || ||
(Seroquel) is approved for bipolar depression. || || || || ||
A fixed combination of olanzapine and fluoxetine known as Symbyax is approved as a
|| || || || || || || || || || || || || ||
treatment for acute bipolar depression, || || || ||
, 2
The FDA has added a new warning about which SGA, cautioning prescribers about
|| || || || || || || || || || || || ||
potential QT interval prolongation when above-recommended doses of this drug are
|| || || || || || || || || || ||
combined with which specific drugs? - ✔✔paliperidone (Invega) may cause an increase in
|| || || || || || || || || || || || ||
QT interval and should be avoided in combination with other drugs that may cause QT
|| || || || || || || || || || || || || || ||
interval prolongation. ||
Effectiveness in treating symptom types in schizophrenia and schizoaffective disorder: || || || || || || || || || ||
DRAs compared to SDAs - ✔✔Positive symptoms: SDA = or > DRA
|| || || || || || || || || || ||
Negative & cognitive symptoms: || || || ||
SDA > DRA || ||
The presumed antipsychotic effects of the SDAs are blockade of D2 dopamine receptors.
|| || || || || || || || || || || || ||
How do the SDAs differ from older antipsychotic drugs? - ✔✔Higher ratio interactions with
|| || || || || || || || || || || || || ||
serotonin receptor subtypes, most notably the 5-HT2A subtype, as well as with other
|| || || || || || || || || || || || ||
neurotransmitter systems. This yields antidepressant effects. || || || || ||
FDA approved antipsychotics for use in children and adolescents with aggression, severe
|| || || || || || || || || || || ||
behavioral issues, and severe psychiatric disorders? - ✔✔Second Generation antipsychotics
|| || || || || || || || ||
Dopamine Seratonin antagonists || ||
What mood stabilizer carries the greatest risk of serious birth defects? - ✔✔Valproate -
|| || || || || || || || || || || || || ||
Risk of neural tube defects ranging from 1 to 6%
|| || || || || || || || ||
Also not recommended in women of childbearing age
|| || || || || || ||
What mood stabilizer is being used with increasing regularity for the treatment of pregnant
|| || || || || || || || || || || || || ||
women with bipolar disorder? - ✔✔Lamictal - there is a small but documented increased
|| || || || || || || || || || || || || ||
risk for oral cleft defects.
|| || || ||
MH 701 SAFETY Exam 2 with accurate detailed solutions
|| || || || || || || ||
What differentiates SGAs from FGAs? - ✔✔SGAs have:
|| || || || || || ||
D2 and 5HT2A receptor antagonism
|| || || ||
+ Antidepressant action, treat pos and neg schizo sx, metabolic SE, D2D interactions,
|| || || || || || || || || || || || ||
approved for schizophrenia, mania, and acute mania
|| || || || || ||
FGAs have positive symptom antipsychotic actions
|| || || || ||
- EPS, hyperprolactinemia
|| ||
Mostly D2 receptor antagonism || || ||
Which SGA has lowest EPS SE, but is associated with substantial risk of agranuloycytosis? -
|| || || || || || || || || || || || || || ||
✔✔Clozapine ||
The lower D2 receptor action is probably why clozapine does not cause EPS
|| || || || || || || || || || || ||
Weekly WBC counts are indicated to monitor the patient for development of
|| || || || || || || || || || || ||
agranulocytosis.
What causes breast secretions while receiving perphenazine? Is this typical with both FGAs
|| || || || || || || || || || || || ||
and SGAs? - ✔✔Perphenazine blocks dopamine 2 receptors in the pituitary, causing
|| || || || || || || || || || || ||
hyperprolactinemia, which can cause galactorrhea. || || || || ||
Except for risperidone, SGAs do not elevate prolactin.
|| || || || || || ||
Which of the SGAs is most likely and which is least likely to worsen a metabolic profile? -
|| || || || || || || || || || || || || || || || || ||
✔✔Most likely: olanzapine || ||
-weight gain, metabolic risk || || ||
,2
Least likely: ziprasidone
|| || ||
-weight neutral, lowers triglyceride levels
|| || || ||
Describe a cross taper from risperidone to olanzapine - ✔✔Taper the risperidone off over
|| || || || || || || || || || || || || ||
three weeks while simultaneously beginning olanzapine at 10 mg per day
|| || || || || || || || || ||
risperidone, quetiapine, and ziprazodone lack anticholinergic effects.
|| || || || || || ||
Abrupt transition from a DRA, olanzapine, or clozapine to one of these agents may cause
|| || || || || || || || || || || || || || ||
cholinergic rebound ||
What are some monotherapy agents used as primary treatment of acute mania? - ✔✔"All of
|| || || || || || || || || || || || || || ||
the SDAs (except clozapine) are FDA approved for this.
|| || || || || || || || ||
Serotonin dopamine antagonist (SDAs) || || ||
risperidone (Risperdal), and olanzapine (Zyprexa), ziprasidone (Geodon)
|| || || || || ||
Explain Serotonin Dopamine antagonist (SDA) - ✔✔The newer second-generation
|| || || || || || || || ||
antipsychotic drugs, also called atypical antipsychotics are dopamine and 5HT2a
|| || || || || || || || || ||
antagonists. Down regulate both Dopamine and Serotonin receptors.
|| || || || || || ||
SDAs include clozapine (Clozaril), risperidone (Risperdal), and olanzapine (Zyprexa).
|| || || || || || || ||
Which medications are FDA-approved for use in bipolar depression? - ✔✔quetiapine
|| || || || || || || || || || ||
(Seroquel) is approved for bipolar depression. || || || || ||
A fixed combination of olanzapine and fluoxetine known as Symbyax is approved as a
|| || || || || || || || || || || || || ||
treatment for acute bipolar depression, || || || ||
, 2
The FDA has added a new warning about which SGA, cautioning prescribers about
|| || || || || || || || || || || || ||
potential QT interval prolongation when above-recommended doses of this drug are
|| || || || || || || || || || ||
combined with which specific drugs? - ✔✔paliperidone (Invega) may cause an increase in
|| || || || || || || || || || || || ||
QT interval and should be avoided in combination with other drugs that may cause QT
|| || || || || || || || || || || || || || ||
interval prolongation. ||
Effectiveness in treating symptom types in schizophrenia and schizoaffective disorder: || || || || || || || || || ||
DRAs compared to SDAs - ✔✔Positive symptoms: SDA = or > DRA
|| || || || || || || || || || ||
Negative & cognitive symptoms: || || || ||
SDA > DRA || ||
The presumed antipsychotic effects of the SDAs are blockade of D2 dopamine receptors.
|| || || || || || || || || || || || ||
How do the SDAs differ from older antipsychotic drugs? - ✔✔Higher ratio interactions with
|| || || || || || || || || || || || || ||
serotonin receptor subtypes, most notably the 5-HT2A subtype, as well as with other
|| || || || || || || || || || || || ||
neurotransmitter systems. This yields antidepressant effects. || || || || ||
FDA approved antipsychotics for use in children and adolescents with aggression, severe
|| || || || || || || || || || || ||
behavioral issues, and severe psychiatric disorders? - ✔✔Second Generation antipsychotics
|| || || || || || || || ||
Dopamine Seratonin antagonists || ||
What mood stabilizer carries the greatest risk of serious birth defects? - ✔✔Valproate -
|| || || || || || || || || || || || || ||
Risk of neural tube defects ranging from 1 to 6%
|| || || || || || || || ||
Also not recommended in women of childbearing age
|| || || || || || ||
What mood stabilizer is being used with increasing regularity for the treatment of pregnant
|| || || || || || || || || || || || || ||
women with bipolar disorder? - ✔✔Lamictal - there is a small but documented increased
|| || || || || || || || || || || || || ||
risk for oral cleft defects.
|| || || ||
