Updated: 12/6/2018

Antipsychotics

Topic
Review Topic
0
0
Questions
26
0
0
Evidence
25
0
0
Videos
1
Snapshot
  • A 23-year-old male is brought into the inpatient psychiatric hospital after a suicide attempt.  When talking with the patient he seemed to be responding to internal stimuli at times.  He states that he heard voices telling him to kill himself.  He said he has heard these voices for over a year now but within the past month they have become louder, more persistent and convincing.
Overview
  • 2 classes
    • typical
      • older
      • stronger D2 receptor antagonism 
        • ↑ [cAMP]
    • atypical
      • newer
      • weaker D2 receptor antagonism and stronger 5-HT2, α, and H1 antagonism 
  • Targets
    • dopaminergic neurons
      • specific pathways affected include:
        • nigrostriatal (extrapyramidal motor)
        • mesolimbic (mood and reward)
        • tuberoinfundibular (prolactin release) 
Typical Antipsychotics Overview

Typical Antipsychotics
High Potency Antipsychotics (in Descending Order)
Advantages Disadvantages Unique Features
Haloperidol  • Fewer side effects of sedation and hypotension
 • High association with extrapyramidal symptoms
 • Able to use as long-acting depot injections

 • Can be given IM in acute situations
Fluphenazine
Perphenazine
Chlorpromazine  • Lower frequency of extrapyramidal side effects
 • Greater incidence of anticholinergic side-effects, hypotension, sedation
 • Corneal deposits
Thioridazine  • Retinal deposits
QT prolongation
 
Introduction
  • Overview
    • also known as neuroleptics
    • highly fat soluble results in storage for long time in body fat
  • Drugs ("haloperidol + -azines")
    • high potency - low dose needed
      • haloperidol 
      • trifluoperazine
      • fluphenazine 
    • low potency - high dose needed
      • thioridazine
      • chlorpromazine
  • Clinical use
    • schizophrenia
      • primarily positive symptoms
    • psychosis
    • acute mania
      • temporary treatment because lithium has slow onset
    • Tourette's syndrome
  • Toxicity
    • high potency
      • ↑ extrapyramidal system (EPS) side effects
        • due to high affinity for D2 receptor
        • has characteristic time course
          • early onset/reversible symptoms
            • 4 hours = acute dystonia  
              • spasm of face, neck, tongue, extraocular muscles
              • treat with benztropine or diphenhydramine 
            • 4 days = Parkinsonism
              • muscle rigidity, ankinesia, tremor, shuffling gait
            • 4 days to 4 weeks = akathisia 
              • urge to move
          • late onset/irreversible symptoms
            • 4 months = tardive dyskinesia 
              • involuntary, repetitive movements of facial, tongue, neck muscles
              • anticholinergics worsen!
              • must reduce dose or switch to an atypical antipsychotic
              • can be treated with valbenazine
                • a vesicular monoamine transporter 2 inhibitor
      • ↓ non-specific side effects
      • fluphenazine has been implicated in causing hypothermia in select cases 
    • low potency
      • ↓ EPS side effects
      • ↑ non-specific side effects
        • due to low affinity to D2 receptors and high concentrations needed to achieve effect
        • muscarinic receptor antagonism
          • dry mouth and constipation
          • vision problems
        • α receptor antagonism
          • orthostatic hypotension
          • sexual dysfunction
        • histamine receptor antagonism
          • sedation
        • chlorpromazine can cause corneal deposits
        • thioridazine can cause retinal deposits
    • endocrine side effects
      • dopamine normally inhibits prolactin secretion
        • antagonism of receptor may result in hyperprolactinemia can cause galactorrhea
    • neuroleptic malignant syndrome (NMS)   
      • presentation
        • high fever, hypertension, tachycardia, “lead pipe” rigidity, elevated CPK, leukocytosis, metabolic acidosis
      • treatment 
        • discontinue offending agent
        • use of muscle relaxant (e.g., dantrolene)  
 Side Effects of High Potency Antipsychotics
 
Extrapyramidal Side Effects of High Potency D2 Blockers (Haloperidol, Fluphenazine, Perphenazine)
3 Hours: Acute Dystonia
3 Days - Weeks: Bradykinesia (Pseudo-Parkinsonism)
3 Months: Akathisia
3 Years: Tardive Dyskinesia
Emergency: Neuroleptic Malignant Syndrome
 • Muscle spams (neck, eye, diffuse)
 • Trouble swallowing
 • Symptoms of Parkinson's disease: tremors, bradykinesia, rigidity
 • Sustained feeling of motion/restlessness
 • Uncontrollable repetitive, stereotypical writhing movements, usually of the tongue
 • High fever
 • Muscle rigidity
 • Unstable vitals
 • Increased CK, K+, and WBC's
Treatment of Side Effects
 • Anticholinergic medications:(benztropine, diphenhydramine, trihexyphenidyl)
 • β-blockers
 • Benzodiazepines

 • Stop high potency D2 blockers and swith to atypicals
 • Can be treated with valbenazine

 • Stop antipsychotic
 • IV fluids
 • Cooling
 • Dantrolene 
NOTE: You can always decrease the dose or switch to a different antipsychotic – choose the drug with the side-effect profile that the patient can tolerate.
 
Atypical Antipsychotics Overview
 
Atypical Antipsychotics
Medication Unique features and side effects
Risperidone  • High potency
 • Usually first line
 • Hyperprolactinemia
 • Weight gain

Olanzapine

 • Severe weight gain
 • Very sedating
Ziprasidone  • Minimal to no weight gain
 • Increased QTc
Quetiapine  • Low potency
 • Sedating
 • Weight gain
 • Useful in bipolar depression and augmentation of major depression therapy
Lurasidone  • Minimal weight gain
 • Useful in biploar depression
Clozapine 

 • Weight gain
 • Most effective anti-psychotic
 • Decreased suicide risk
 • Agranulocytosis
 • Myocarditis
 • Sialorrhea
 • Orthostatic hypotension
 • Increased seizures

Aripiprazole  • D2 partial agonist
 • Augmentation of major depression therapy
 
Introduction
  • Drugs
    • olanzapine
    • clozapine
    • quetiapine
    • risperidone
    • aripiprazole
    • ziprasidone
  • Mechanism
    • antagonist at 5-HT2, α, H1, and dopamine receptors
  • Clinical use
    • schizophrenia
      • both positive and negative symptoms
    • olanzapine
      • OCD
      • anxiety disorder
      • depression
      • mania
      • Tourette's syndrome
  • Toxicity
    • less EPS and anticholinergic side effects as compared to traditional antipsychotics
    • olanzipine
      • weight gain   
    • clozapine
      • agranulocytosis
        • requires patients to have weekly WBC monitoring 
        • treat with drug cessation, neutropenic protocol, possibily filgrastim
      • weight gain
    • ziprasidone
      • prolonged QT and possible resultant torsades
    • risperidone
      • EPS
 

Please rate topic.

Average 4.3 of 8 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (26)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
Calculator

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M3.PY.21) An 83-year-old man is admitted to the hospital with fever, weakness, and decreased responsiveness. He is diagnosed with urosepsis based on urinalysis and culture, and started on ceftriaxone and intravenous fluids. By hospital day #3, he defervesces and is clinically improving. That evening, however, the patient becomes mildly agitated, paranoid, and restless; he is unable to be reassured by nurses or physicians. The on-call provider considers administering quetiapine to help address the patient's behavior. Which of the following is the most accurate statements regarding this medication? Review Topic

QID: 102962
1

Its use is associated with increased mortality, therefore should not be used

43%

(3/7)

2

This patient does not have delirium and should be assessed for other etiologies

0%

(0/7)

3

A benzodiazepine is a good alternative medication given the increased mortality risk

29%

(2/7)

4

Although increased mortality has been found, the benefit of treatment outweighs the risk

14%

(1/7)

5

This medication is safe to administer and is warranted in this clinical situation

14%

(1/7)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(M2.PY.17) A 28-year-old male arrives at the local psychiatric clinic and tells you that he has not been taking his medication recently. His medication acts by blocking the dopamine-D2 receptors. Which of the following medications was he supposed to be taking? Review Topic

QID: 105687
1

Carbamazepine

0%

(0/7)

2

Risperidone

100%

(7/7)

3

Amoxapine

0%

(0/7)

4

Citalopram

0%

(0/7)

5

Zolpidem

0%

(0/7)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

(M3.PY.47) A 40-year-old homeless woman is brought to the emergency department by police for accosting travelers in a train station. She is acutely agitated on presentation and is screaming. Upon an attempt by the patient to pull out her IV lines, she is given an IM injection of haloperidol. Three hours later she develops an adverse reaction to the haloperidol that is effectively treated with an injection of diphenhydramine (Benadryl). Her adverse reaction to haloperidol most likely presented with which of the following symptoms? Review Topic

QID: 103782
1

Bradykinesia

0%

(0/4)

2

Torticollis

75%

(3/4)

3

Constant urges to move

0%

(0/4)

4

Involuntary and repetitive movements of the tongue

0%

(0/4)

5

Fever

25%

(1/4)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 2
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M2.PY.136) A 22-year-old man with a new diagnosis of schizophrenia presents to his primary care physician. His psychiatrist recently started him on a medication which has decreased his positive symptoms. He presents today for a general health exam. He has no complaints except for ten pounds of weight gained over the past month. Vital signs are stable with the exception of increased blood pressure. Labs reveal hyperglycemia and dyslipidemia. A complete blood count is within normal limits. If this patient's new symptoms are the result of a medication, what medication is the patient now taking? Review Topic

QID: 105806
1

Haloperidol

0%

(0/8)

2

Trifluoperazine

0%

(0/8)

3

Olanzapine

100%

(8/8)

4

Lithium

0%

(0/8)

5

Fluoxetine

0%

(0/8)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(M2.PY.16) A 26-year-old female with schizophrenia is currently undergoing inpatient treatment. She is going to be started on fluphenazine as a new medication. Which of the following is a rare side effect of this medicine that the prescribing physician should warn the patient of prior to initiating treatment? Review Topic

QID: 105626
1

Diarrhea

27%

(9/33)

2

Kidney failure

24%

(8/33)

3

Hypothermia

18%

(6/33)

4

Increased sweating

21%

(7/33)

5

Weight loss

6%

(2/33)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(M2.PY.13) A 23-year-old Hispanic male is found in an incoherent state on a street near the hospital and is brought to the ED. He is disoriented and has significant rigidity in all four extremities. His temperature is 40.1 C, pulse 113 bpm, BP 163/97, and respiratory rate is 18 breaths/minute. A bottle of fluphenazine is found in his pocket. What is the most appropriate medical management for his condition? Review Topic

QID: 105623
1

Acetominophen

0%

(0/46)

2

Alprazolam

4%

(2/46)

3

Haloperidol

0%

(0/46)

4

Dantrolene

89%

(41/46)

5

Naloxone

4%

(2/46)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(M2.PY.24) A 34-year-old male experiences abrupt onset of confusion and agitation as well as muscle cramps and tremor. His medical history is significant for schizophrenia poorly controlled with haloperidol; as a result, the dosage of this medicine was increased starting 3 days prior. Vital signs are as follows: T 39.1 C, BP 90/55 mmHg, HR 76 bpm, and RR 22 rpm. Physical exam is notable for a diaphoretic male with impaired level of consciousness as well as hypertonia and rigidity in bilateral upper and lower extremities. Which of the following is the best treatment for this patient's current condition? Review Topic

QID: 105634
1

Observation and supportive care

0%

(0/13)

2

Administer acetaminophen

8%

(1/13)

3

Administer levodopa and apply cooling blankets

8%

(1/13)

4

Stop haloperidol, administer cooling methods, and initiate dantrolene

69%

(9/13)

5

Stop haloperidol and switch to quetiapine

15%

(2/13)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(M3.PY.13) A 68-year-old gentleman with a history of schizophrenia has been taking haloperidol for approximately four weeks. If he were to have an adverse reaction to this medicine, with what signs and symptoms would he most likely present? Review Topic

QID: 103748
1

Mask-like face, monotonous speech, shuffling gait, and pill-rolling tremors

43%

(3/7)

2

Urge to move and restlessness

43%

(3/7)

3

Rhythmic movements of the jaw, lips, or tongue

14%

(1/7)

4

Sustained contraction of various muscle groups, which is usually very painful

0%

(0/7)

5

Fever, tachycardia, HTN, tremor, elevated CPK, and “lead pipe” rigidity

0%

(0/7)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

(M2.PY.32) A 49-year-old male has been taking an antipsychotic medication for many years. He has recently started experiencing symptoms that his physician is calling "tardive dyskinesia". What would these symptoms look like in this patient? Review Topic

QID: 105702
1

Tremors, fever, tachycardia, and "lead pipe" rigidity

0%

(0/8)

2

Involuntary writhing of the face, tongue, or head

50%

(4/8)

3

Cogwheel rigidity, masked facies, and bradykinesia

50%

(4/8)

4

Restlessness, agitation, and fidgetiness

0%

(0/8)

5

Sustained contraction of muscles of neck, tongue, eyes

0%

(0/8)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

(M2.PY.22) A 30-year-old man is brought to the emergency department by police after attempting to steal several recording devices from an electronics store. During initial police questioning, the patient was extremely agitated and insisted that an alien race had instructed him to steal the equipment in order to establish communication with their planet. In the hospital, the patient admits that he is currently hearing voices and he insists that he be allowed to leave. He is given haloperidol to treat his agitation. Several hours later, the patient experiences a side effect of the medication as seen in Figure A and is subsequently treated with benztropine. The patient likely suffered from which of the following antipsychotic medication side effects? Review Topic

QID: 105692
FIGURES:
1

Acute dystonia

86%

(79/92)

2

Akinesia

0%

(0/92)

3

Akathisia

3%

(3/92)

4

Tardive dyskinesia

7%

(6/92)

5

Seizures

2%

(2/92)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 1

(M2.PY.112) A 27-year-old male recently diagnosed with schizophrenia 6 months ago presents to your office for a check-up. Upon diagnosis, the patient was started on a single medication for his psychiatric symptoms. Today, he complains of 20 pound weight gain over the prior six months. Laboratory studies reveal that serum LDL cholesterol has increased significantly over the same time interval. The patient’s side effects are typical of which of the following drugs? Review Topic

QID: 105782
1

Haloperidol

6%

(3/51)

2

Fluphenazine

0%

(0/51)

3

Olanzapine

92%

(47/51)

4

Buspirone

0%

(0/51)

5

Duloxetine

0%

(0/51)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(M2.PY.18) A 44-year-old gentleman with a history of schizophrenia has recently been started on a typical antipsychotic. After the initial administration of the medication, he experiences an adverse event that requires the use of dantrolene. What symptoms was this individual experiencing that necessitated the use of dantrolene? Review Topic

QID: 105688
1

Choreoathetoid muscle movements of tongue and mouth

0%

(0/5)

2

Masklike face, cogwheel rigidity, and a pill-rolling tremor

0%

(0/5)

3

Hyperthermia, autonomic instability, altered sensorium, and muscular rigidity

100%

(5/5)

4

Restlessness, agitation, and writhing movements

0%

(0/5)

5

Sustained contraction of muscles of neck, tongue, eyes, and diaphragm

0%

(0/5)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(M2.PY.24) A 39-year-old woman with schizophrenia has recently had to discontinue her second neuroleptic medication because of unusual repetitive motions of her tongue and poor control of auditory and visual hallucinations that she experiences. She is subsequently started on a new medication. Basic labs and a CBC are drawn at this time and are unremarkable. She returns one week later with her symptoms well controlled stating that she feels better than ever, and her motor symptoms are improving.

Blood work is drawn and lab values are below:
Hemoglobin: 14 g/dL
Leukocytes: 1000/mm^3
Neutrophils: 50%
Lymphocytes: 33%
Eosinophils: 1%
Monocytes: 7%
MCV: 90 micrometers cubed
Platelet count: 200,000/mm^3
Reticulocyte count: 1.0%
PTT: 30 seconds
PT: 12 seconds

On physical exam the patient is healthy and no abnormalities are noted. You note an improvement in her extra-pyramidal symptoms from the last time you saw her.

Which of the following is the best next step in management for this patient? Review Topic

QID: 105694
1

Continue the medication as scheduled

0%

(0/10)

2

Slowly increase the dose of the new medication until it reaches a therapeutic dose

0%

(0/10)

3

Add lithium as an adjunctive therapy

0%

(0/10)

4

Discontinue the medication

100%

(10/10)

5

Continue the medication as scheduled with weekly CBC's

0%

(0/10)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(M3.PY.49) A 23-year-old man is brought to the emergency department by his friends for what they describe as erratic behavior, including lack of proper hygiene, increasing isolation, and hearing "voices." Which of the following agents is paired with one of its known associated side effect? Review Topic

QID: 103784
1

Olanzapine - Extrapyramidal symptoms

0%

(0/3)

2

Ziprasidone - Weight gain

0%

(0/3)

3

Risperidone - Retinal pigmentation

0%

(0/3)

4

Clozapine - Agranulocytosis

100%

(3/3)

5

Thioridazine - Corneal pigmentation

0%

(0/3)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(M3.PY.5) A 25-year-old gentleman with a history of schizophrenia has recently been started on haloperidol decanoate. Which of the following could be a reason for starting this form of medication? Review Topic

QID: 103740
1

Patient recently experienced the onset of tardive dyskinesia

0%

(0/5)

2

Concern for the risk of neuroleptic malignant syndrome

0%

(0/5)

3

Patient requires a more potent form of an atypical antipsychotic

20%

(1/5)

4

To lower the risk of extrapyramidal symptoms

20%

(1/5)

5

Patient has a history of noncompliance with his antipsychotic medications

60%

(3/5)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

(M2.PY.15) A 25-year-old female with a history of schizophrenia presents to her physician complaining of milky discharge from both breasts. The patient’s medication regimen includes haloperidol. Blockade of which of the following neurotransmitters is responsible for this patient's clinical presentation? Review Topic

QID: 105685
1

Serotonin

0%

(0/8)

2

Norepinephrine

0%

(0/8)

3

GABA

0%

(0/8)

4

Dopamine

100%

(8/8)

5

Nitric Oxide

0%

(0/8)

M2

Select Answer to see Preferred Response

PREFERRED RESPONSE 4
ARTICLES (27)
VIDEOS (1)
Topic COMMENTS (17)
Private Note