Neuro: Exam Four Review

Neuro: Exam Four Review

Tyler Aucoin

​PharmD Candidate 2023

​ULM College of Pharmacy

Antipsychotic Medicinal Chemistry ​

​Jois

​Objectives

​1)    Analyze the SAR and metabolism of phenothiazine template based antipsychotic drugs.

2)    Identify and analyze the SAR and metabolism of butyrophenone neuroleptics.

3)    Identify and analyze the SAR and metabolism of benzamide based neuroleptics.

4)    Analyze the SAR and metabolism of benzazepine and benzisoxazole based antipsychotic drugs.

5)    Analyze the SAR and metabolism of benzodiazepine based antianxiety drugs.

Fill in the Blank

Why are antipsychotics termed "dirty drugs"?

Multiple Choice

The addition of which of the following moieties to Tyrosine allows the molecule to form DOPA?

Fill in the Blank

Tyrosine is (metabolized/synthesized) via tyrosine hydroxylase (TH) to form DOPA via the addition of -OH

Multiple Choice

Dopamine is (metabolized/synthesized) by COMT and MAO to form metabolites of 3-MT, HVA, and DOPAC.

• Metabolized

• Synthesized

Multiple Choice

How does DA convert into NorEpi?

• Hydroxylation

• Decarboxylation

• N-Methylation

• Oxidation

Multiple Choice

How does NorEpi convert into Epi?

• Hydroxylation

• Decarboxylation

• N-Methylation

• Oxidation

Multiple Choice

What type of reaction is occurring at this step of synthesis?

• Oxidation

• Decarboxylation

• Alkylation

• Hydroxylation

Multiple Choice

What type of reaction is occurring at this step of synthesis?

• Oxidation

• Decarboxylation

• Alkylation

• Hydroxylation

Multiple Choice

Which type of moiety is created at this step of metabolism?

• Carboxylic Acid

• Alkyl

• Hydroxyl

• Aldehyde

Multiple Choice

Which type of moiety is created at this step of metabolism?

• Carboxylic Acid

• Alkyl

• Hydroxyl

• Aldehyde

Fill in the Blank

Why is it important to have the three carbon chain between the N groups?

Hint: loses ___________ activity

Multiple Choice

Which of the following is the cis - α - rotamer of Dopamine?

Multiple Choice

Which of the following is the trans - α - rotamer of Dopamine?

Multiple Choice

Which of the following is the trans - β - rotamer of Dopamine?

Multiple Choice

Which of the following molecules indicate the prodrug of fluphenazine?

Multiple Select

Which of the following moieties of this neuroleptic would allow for the longest duration of action?

Allows for 1-6 weeks (IM Depot)

(select all that apply)

• long-chain fatty acid esters

• Chlorine group 

• Fluorine group

• Amine group

Multiple Choice

Replacing the N-CH2 structure w/ a double bond to form Thioxanthene makes for different functional groups, but the same activity... What is this called?

• Bio-isosteres

• Bio-equivalents

• Bio-similars

• Bioavailability

Multiple Choice

Which of the following derivatives of Piperidine would have the most activity?

Open Ended

Explain your reasoning for the last question regarding Piperadine...

Multiple Select

Which of the following answer choices would allow for activity when dealing w/ Piperizine?

• 3 carbons in between the two N groups

• 2 N's in the ring

• Fluorine

• Chlorine

Metabolism of Chlorpromazine​

​Discussion...

Multiple Choice

Which of the following side groups may be added to haloperidol by replacing the keto functional group? Results in a longer duration of action and are effective at treating schizophrenia.

Fill in the Blank

Patients who consume ________ -containing beverages while taking clozapine show signs of increased arousal and extrapyramidal symptoms, and removal of this results in resolution of these problems

Multiple Choice

Patients who smoke while taking clozapine may have significantly lower/higher serum levels of clozapine?

• Lower

• Higher

Multiple Choice

Which of the following reactions of Olanzapine will give you this molecule?

• Hydroxy

• Oxidation

• Demethylation

• Reduction

Multiple Choice

Which of the following reactions of Olanzapine will give you this molecule?

• Hydroxylation

• Oxidation

• Phase II Glucuronic Acid Conjugation

• Demethylation

Multiple Choice

Which of the following reactions of Olanzapine will give you this molecule?

• N-Oxide formation

• Oxidation

• Reduction

• Dealkalation

Multiple Choice

Which of the following reactions of Olanzapine will give you this molecule?

• Hydroxylation

• Reduction

• Demethylation

• Decarboxylation

Multiple Choice

Which of the following reactions of Quetiapine will give you this molecule?

• Hydroxylation

• Sulfoxide

• Demethylation

• Oxidation

Multiple Choice

Which of the following reactions of Quetiapine will give you this molecule?

• Hydroxylation

• Sulfoxide

• Demethylation

• Oxidation

Multiple Choice

Which of the following reactions of Quetiapine will give you this molecule?

• Hydroxylation

• Sulfoxide

• Demethylation

• Oxidation

Multiple Choice

Which of the following reactions of Quetiapine will give you this molecule?

• Hydroxylation

• Sulfoxide

• Demethylation

• Oxidation

Multiple Choice

Which of the following reactions of Quetiapine will give you this molecule?

• Hydroxylation

• Sulfoxide

• Demethylation

• Oxidation

Multiple Choice

Which of the following is the active metabolite for risperidone?

Multiple Select

Which moiety groups make-up aripiprazole?

Select all that apply

• Aryl

• Piperadine

• Piperazine

• Quinolinone

Multiple Choice

Which of the following is the active metabolite of aripiprazole?

• Molindone

• Aryl-aripiprazole

• Ziprasidone

• Dehydro-aripiprazole

Fill in the Blank

__________ is a chemical reaction in which a new ring is constructed on a molecule.

​Antipsychotic Therapy

Sylvester​

​Objectives

• Describe the causes, characteristics and symptoms of psychosis.

• Know the mechanism of action of specific antipsychotic drugs.

• Understand the various pharmacological and physiological effects (beneficial and adverse) of antipsychotic drug therapy.

• Describe the possible causes and characteristics of tardive dyskinesia

​

Fill in the Blank

What is limited by sensory input and the ability of the brain to interpret this information?

Multiple Choice

Which of the following is a general term for any major mental disorder of organic and/or functional origin characterized by derangement of the personality and loss of contact with reality, often with delusions, hallucinations or illusions

• Schizophrenia

• Pyschosis

• Depression

• Bipolar

Multiple Select

What are some signs/symptoms of Psychosis?

Select all that apply

• Hallucinations & Illusions

• Delusions

• Ideas of Reference

• Delusion of Reference

• Thought insertion/deletion

Fill in the Blank

What are the two types of Psychosis?

Multiple Choice

T/F: Organic Psychosis is caused by physical damage or chemical imbalances in the brain

• True

• False

Multiple Choice

Which of the following is not true?

• Alcoholism is produced by the withdrawing from alcohol

• Cerebral arteriosclerosis is a consequence of hardening the arteries and decreased blood flow to the brain

• Seizures can produce psychotic symptoms and behaviors when normal function becomes impaired

• Infectious organisms, such as Syphilis enter the brain but do not alter function

• Direct injury to the head can result in brain damage and abnormal function

Fill in the Blank

T/F: Functional Psychosis results from acute trauma or depression, causing chemical abnormalities brought on by stressful situations or conditions

(war, death, loss of loved one, life-threatening experience, etc)

Fill in the Blank

Senile Psychosis is associated w/ which disease state?

Multiple Choice

Which of the following is a general term, which refers to a group of, severe emotional disorders characterized by misinterpretation and retreat from reality? 

(a type of Organic Psychosis)

• Depresi

• Mania

• Schizophrenia

• All of the above are severe emotional disorders

Multiple Choice

Which of the following types of Schizophrenia pertain to the reduction of external relationships and interests?

• Simple

• Hebephrenic

• Catatonic

• Paranoid

Multiple Choice

Which of the following types of Schizophrenia pertain to silly behavior and regressive features?

• Simple

• Hebephrenic

• Catatonic

• Paranoid

Multiple Choice

Which of the following types of Schizophrenia pertain to an emotionally disturbing experience leading to complete withdrawal from interacting w/ the external environment?

• Simple

• Hebephrenic

• Catatonic

• Paranoid

Multiple Choice

Which of the following types of Schizophrenia pertain to unrealistic illogical thinking, bizarre delusions of being persecuted or being a great person like Jesus Christ or Napoleon?

• Simple

• Hebephrenic

• Catatonic

• Paranoid

​Schizophrenia Symptoms

• ​Positive: mental phenomena absent in normal individuals

  • ​hallucinations / delusions

• ​Negative: loss of impairment of normal function

  • ​amotivation, impoverishment of thoughts or speech

• ​Cognitive: deficits in executive function (loss of working memory). This is associated w/ DA neurons and why antipsychotic drugs (D1 blockers) worsen working memory performance

  • ​loss of memory

​Schizophrenia Overview

• ​Most common in late teens and early 20s.

  Progressive pattern (difficulties with work, school or family, more eccentric behavior, finally psychotic events).

• Significant genetic link

• Environmental factors (famine, interuterine virus exposure, urban birth, parental age).

​

​Brain Characteristics

• ​Loss of Grey Matter

• ​Decreased dendrite and axon processes and arborations

• ​NO inflammation, glialosis (NOT a CNS degenerative disease)

Multiple Choice

Why is the non-compliance rate so high w/ antipsychotic regimens?

• Pts don't like how the medications make them feel

• These drugs cause Euphoria, acting like the highly addictive drugs

• Work to increase DA activity in the brain, which helps the pt to feel some relief

• Both A and C

• All of the above are correct in regards to non-compliance rates

Fill in the Blank

There are five different types of DA receptors (D1-5), yet the antagonists used as antipsychotics primarily mediate from only one... which receptor facilitates w/ antipsychotic action? 

hint: D_ (# only) 

Multiple Choice

w/ the D2 receptor being blocked by antagonists, this induces unwanted motor and endocrine side effects due to the DA Blockade within the basal ganglia.... w/ there being too little DA available, which of the following disease state signs/symptoms are increasingly likely?

• Hyper-prolactinemia

• Parkinson's Disease

• Mania

• Both A and B

• All of the above

Fill in the Blank

Based on the Dopaminergic Hypothesis, which class of drugs are indirect DA agonists and can induce Psychosis?

Multiple Choice

Serotonin also plays a role in psychotic behavior... Although there are more than a dozen 5HT receptors, which of the following has a significant role in Psychosis?

These antagonist also act as antipsychotic agents

• 5HT_1A

• 5HT_2A

• 5HT₃

• 5HT_2A-C

Multiple Select

Most antipsychotic drugs take long to accumulate in compartments of the body and generally have a long duration of action... This is b/c?

Select all that apply

• highly lipid soluble

• highly polar

• protein bound

• free form

Multiple Select

Most antipsychotic drugs are which type of antagonists?

Select all that apply

• D1

• D2

• 5HT_1A

• 5HT_2A

Multiple Choice

Which of the following classes does not block D2 receptors?

• Atypical

• Phenothiazine

• Butyrophenone

• Thioxanthine

Fill in the Blank

T/F: Regarding Atypical antipsychotic drugs... they reduce 5HT activity more than DA, but by doing so, increase the incidence of EPS or TD.

Multiple Choice

Drugs such as fluphenazine, Haldol, and Thiothixene have antipsychotic effects, but come with a higher/lower risk of EPS/TD

• Higher: DA block

• Lower: DA block

• Higher: 5HT block

• Lower: 5HT block

• No effect on either

Multiple Choice

Drugs such as Abilify, olanzapine, and Risperdal  have antipsychotic effects, but come with a higher/lower risk of EPS/TD

• Higher: DA block

• Lower: DA block

• Higher: 5HT block

• Lower: 5HT block

• No effect on either

Multiple Choice

Drugs such as chlorpromazine, thioridazine, and clozapine  have antipsychotic effects, but also affect which receptors causing an increase in systemic ADE?

• D₂

• 5HT_2A

• Histamine

• α - Adrenergic

• Cholinergic

Multiple Choice

Drugs such as chlorpromazine, thioridazine, and clozapine  have antipsychotic effects, but also affect which receptors causing an increase in the risk of Cardiovascular Collapse?

• D₂

• 5HT_2A

• Histamine

• α - Adrenergic

• Cholinergic

Multiple Choice

Drugs such as chlorpromazine, thioridazine, and clozapine  have antipsychotic effects, but also affect which receptors causing an increase in sedative affects?

• D₂

• 5HT_2A

• Histamine

• α - Adrenergic

• Cholinergic

Fill in the Blank

Which drug was developed in the 50's to reduce anxiety and later as an antipsychotic, but is now obsolete b/c of the high level of EPS?

Multiple Choice

Which of the following pertain to the following statement: high dose drugs, less extrapyramidal side effects, also display antimuscarinic action?

Analogs of the drug include: Thioridazine & Mesoridazine

• Chlorpromazine

• Piperidine

• Piperazine

• All of the above

Multiple Choice

Which of the following pertain to the following statement: low dose drugs (5-40 mg/day), most potent antipsychotic agents, but also induce great extrapyramidal side effects?

Analogs of the drug include: Fluphenazine, Trifluoperazine, & Perphenazine

• Chlorpromazine

• Piperidine

• Piperazine

• All of the above

​Phenothiazines: Main Points

1. Main action is to block weird behavior and hallucinations.

2. Take weeks to take effect.

3. Very common side effects, dry mouth, constipation, visual disturbances and sedation (anti-histamine and anti-cholinerigic action).

4. EPS very common and gynecomastia in males (anti-dopamine

action).

​

​Phenothiazines EPS Adverse Effects

• ​Dystonia: muscle spasms, twitching, facial grimacing, torticollis (twisting of the head)

• ​Akathisia: continuous body movement (jittery)

• ​Parkinsonism: rigidity, tremors, dyskinesia

• ​Tardive Dyskinesia: seen after long-term antipsychotic therapy... involves involuntary movements of lips, jaw, tongue, and the extremities. Often seen when therapy is stopped... Progressive and WORSENS w/ time

• ​Neuroleptic Malignant Syndrome: hyperthermia, muscular rigidity, and catatonia

Fill in the Blank

Butyrophenones... such as ? primarily block D2 more than 5HT_2A and less anti-

cholinergic, adrenergic and histaminic action, but very bad EPS. It is also good for manic and agitated patients, works well in Gilles de la Tourettes syndrome patients; a neurological disorder characterized by tics, involuntary, rapid, sudden movements or vocalizations (corprolalia or echolalia) that occur repeatedly in the same way.

Multiple Choice

Which drug class primarily blocks D2 but also some 5HT, adrenergic, and histamine receptors. Action similar to phenothiazines, but less sedation and less anti-cholinergic and anti-adrenergic side effects. Drugs in this class have very high tardive dyskinesia (extrapyramidal) side effects.

• Butyrophenones

• Phenothiazines

• Thiozanthenes

• All of the above

Multiple Choice

Which of the following is NOT a drug within the thiozanthene drug class?

• Fluphenazine

• Chlorprothixene

• Thiothixene

• Flupenthixol

Multiple Select

Which of the following drugs have primarily more anti-5HT_2A activity than anti-D2 activity. As such, much lower EPS side effects. However, use is associated with weight gain, elevated triglycerides, and increased risk of diabetes.

• Ziprasidone

• Aripiprazole

• Seroquel

• Risperidone

Multiple Choice

Which Atypical Antipsychotic drug acts on BOTH D2 and 5HT_2A receptors.... Having side effects that include, dizziness, headache, constipation, anxiety, and sleep disturbances (blocks Serotonin) and can also decrease sweating and increase body temperature and fever, especially during physical exertion.

• Quetiapine

• Clozapine

• Aripiprazole

• Ziprasidone

Multiple Choice

Which Atypical Antipsychotic drug has a low incidence of EPS, higher incidence of sedation, seizures, weight gain, and agranulocytosis? Agranulocytosis is a decrease in WBC, and related in increased infections.

High anticholinergic and postural hypotension side effects.

Because of high side effects, other atypical antipsychotics are preferred.

• Quetiapine

• Clozapine

• Aripiprazole

• Ziprasidone

Multiple Choice

Which Atypical Antipsychotic drug is a high potency drug with more anti-5HT_2A versus D2 receptor antagonism.

ADE include mild sedation with low EPS (dose-dependent), postural hypotension and weight gain can occur.

Can be given via IM injection.

• Quetiapine

• Risperidone

• Aripiprazole

• Ziprasidone

Multiple Choice

Which Atypical Antipsychotic drug has been found to be effective in the treatment of acute mania and bipolar disorder while having low EPS side effects?

• Quetiapine

• Olanzapine

• Aripiprazole

• Ziprasidone

Multiple Choice

Which Atypical Antipsychotic drug has been found to be effective in the treatment of schizophrenia, bipolar disorder, & major depression while having low EPS side effects?

• Quetiapine

• Olanzapine

• Aripiprazole

• Ziprasidone

Multiple Choice

Which Atypical Antipsychotic drug has been found to be effective in the treatment of schizophrenia & bipolar disorder while having EPS side effects which are common?

This drug somewhat inhibits reuptake of serotonin and norepinephrine, but not dopamine.

• Quetiapine

• Olanzapine

• Aripiprazole

• Ziprasidone

Fill in the Blank

Augmentation of GABA activity with what 2 classes of drugs may increase the effectiveness of antipsychotic drugs?

Multiple Choice

By blocking DA and 5HT, we can treat which of the following problems?

• N/V

• alcoholic hallucinosis

• hiccups

• All of the above

​Antipyschotics & Schizophrenia

​Nickelson

​Objectives

• ​The student will be able to list or recognize the core symptoms of Schizophrenia.

• The student will be able to identify or recommend appropriate initial drug treatment options.

• The student will be able to differentiate drug treatment options based on pharmacology and/or adverse effect profile.

• Given patient specific information, the student will be able to recommend appropriate drug treatment or treatment strategy.

Multiple Choice

What can be said about Psychosis NOT being pathognomonic?

• Psychosis does not mean that you are schizophrenic

• Psychosis means that you also have been diagnosed schizophrenic

• Psychosis is a hallmark feature of schizophrenia

• Other medical disorders must be ruled out

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Fill in the Blank

State the term for the following definition: Periods of psychosis w/o significant affective symptoms but may have mood disturbances

Multiple Choice

When dealing w/ the positive symptoms of Schizophrenia, what is the most common results found?

• Resolution of symptoms

• Reduction of symptoms

• Reduction of symptom intensity

• Psychosis diagnosis

• All of the above

​Rating Scales for Psychosis

• ​Try to bring objectively to things that are subjective

• ​Generally, no labs or biologic measures in psychiatry

• ​Used in the medical literature to evaluate different therapies, including drugs

• ​Be familiar w/ what each scale is used for or what it measures

Multiple Choice

Which of the following scales is true to this statement: Psychosis efficacy scale

• PANSS

• BPRS

• SANS

• AIMS

• SAS

Multiple Choice

Which of the following scales is true to this statement: Evaluates positive, negative, as well as all other symptoms associated w/ schizophrenia

• PANSS

• BPRS

• SANS

• AIMS

• SAS

Multiple Choice

Which of the following scales is true to this statement: Specific to Negative symptoms

• PANSS

• BPRS

• SANS

• AIMS

• SAS

Multiple Choice

Which of the following scales is true to this statement: most commonly used for assessment of Tardive

• PANSS

• BPRS

• SANS

• AIMS

• SAS

Multiple Choice

Which of the following scales is true to this statement: referred to as the Extrapyramidal Side Effect scale

• PANSS

• BPRS

• SANS

• AIMS

• SAS

Open Ended

The effects of Dopamine Blockade when pertaining to the Tuberinfundibular dopamine pathway... which controls prolactin secretion. What could be some effects we see in both males & females?

Multiple Choice

T/F: Dystonia is associated w/ the spasms of involuntary muscles commonly found within the head/neck and upper extremities

• True

• False

Multiple Choice

Which of the following prophylactic tx's of Dystonias is not true?

• do not use prophylaxic tx w/ 2^nd generation antipsychotics (Atypical)

• prophylaxic tx is indicated w/ 1^st generation antipsychotics (Typical)

• prophylaxic tx is indicated w/ 2^nd generation antipsychotics due to less ADE (Atypical)

• prophylaxic tx is indicated w/ 1^st generation

  high-potency antipsychotics (Typical)

Multiple Choice

Which of the following is not a tx option for Dystonias?

• Cogentin

• haloperidol

• trihexyphenidyl (Artane)

• lorazepam

• diphenhydramine

Multiple Choice

Which of the following is TRUE in regards to Pseudoparkinsonism Tx?

• Reduce dose of antipsychotic

• Change to antipsychotic w/ lower risk

  (same efficacy?)

• Use of oral anticholinergics such as benztropine & trihexyphenidyl

• All of the above

Multiple Select

How can we determine if a pt is presenting w/ Akathisia?

Select all that apply

• restlessness or anxiety

• aggressive

• fidget & pacing

• Rocking back and forth

Fill in the Blank

T/F: Akathisia typically responds to anticholinergic or antiparkinson tx options

Multiple Choice

What is the first-line tx option associated w/ Akathisia?

Discussion: Which pt population would this medication be CI'd in?

• lorazepam

• Propranolol

• Klonopin

• Cogentin

Fill in the Blank

What disease state is associated w/ abnormal, involuntary movements of any part of the body... repetitive movements of the lips (smacking), tongue movements, leg movements, etc.

Multiple Select

Select all that apply: What are the main drugs used currently for the treatment of TD?

• clonazepam

• Botox

• tetrabenazine

• valbenazine (Ingrezza)

• deutrabenazine (Austedo)

Multiple Choice

Which of the following drugs is classified as a low-potency 1^st generation antipsychotic?

• chlorpromazine

• haloperidol

• loxapine

• fluphenazine

• all of the above

Multiple Select

Which of the following drugs is/are classified as a high-potency 1^st generation antipsychotic(s)?

• chlorpromazine

• haloperidol

• loxapine

• fluphenazine

• all of the above

Multiple Select

Which of the following drugs is/are classified as atypical 2^nd generation antipsychotic(s)?

• thioridazine

• haloperidol

• quetiapine

• lumateperone (Caplyta)

• all of the above

Multiple Choice

T/F: an advantage of Typical Antipsychotics is that they are as effective for positive symptoms as Atypicals, some are even available as IM injection

• True

• False

Multiple Choice

What are some disadvantages associated w/ First Generation Antipsychotics?

• highest risk of parkinsonism

• highest risk of EPS and TD

• cognitive impairment

• anticholinergic side effects w/ low-potency agents

• all of the above

Multiple Select

Which psych medication(s) would you choose if you are wanting to avoid metabolic concerns?

• Aripiprazole

• Olanzapine

• Haloperidol

• Propranolol

Multiple Select

Which psych medication(s) would you choose if you are wanting to avoid EPS or TD?

• Aripiprazole

• Risperidone

• Haloperidol

• Propranolol

Multiple Select

Even though Atypical antipsychotics have a better ADE profile, such as ↓ risk of EPS, TD... Which two drugs are exceptions when it comes to the "↓ risk" of prolactin elevation and should be avoided in certain patients?

• Abilify

• Haldol

• Risperidone

• Palpiperidone

Fill in the Blank

T/F: Atypical antipsychotics have less issues related to weigh gain and metabolic problems, but do have a ↓ incidence of TD and EPS.

Multiple Select

Which of the following statements is true in regards to Clozapine?

• ↑ risk of EPS or TD

• effective for patients refractory to conventional antipsychotics

• ↑ risk of agranulocytosis and must be monitored

• ↑ seizure risk at high doses

• significant weight gain is probable

Multiple Choice

Which of the following statements is true in regards to Risperidone?

• ↑ risk of EPS (high dose relation)

• may cause prolactin elevation

• TDD: 4-6 mg/day

• Has the highest rates of EPS of all atypicals

• All of the above

Multiple Choice

Case: A pt comes into clinic complaining of signs/symptoms associated w/ schizophrenia (w/ aggression)... This is their first presenting noticeable episode... Viewing the pt profile, we see NKDA, and everything else checks out to be normal... What drug would we potentially choose as a tx option for Mr. Doe?

hint: this drug can be dosed QD, ODT, liquid formulations (good for cheekers), minimal effects on QTc interval, as well as ↓ weight gain

• Haloperidol

• Latuda

• Risperidone

• Quetiapine

Multiple Choice

Which of the following medications was the first Atypical antipsychotic to get an indication for Bipolar disorder? It does present w/ a high risk of weight gain, as well as the introduction to Diabetes/DKA.

• Aripiprazole

• Haloperidol

• Paliperidone

• Olanzapine

Multiple Choice

Severely ill pts may benefit from higher doses of olanzapine (Zyprexa) than what is typically recommended... What dose would we be reaching?

• 10 mg/day

• >15 mg/day

• 30-40 mg/day

• 800 mg/day

Fill in the Blank

Which drug is associated w/ the lowest incidence of EPS in the Atypical class?

This drug also has indications for the tx of Bipolar Disorder... Also indicated for adjunct tx to antidepressant in MDD... and it may be the preferred antipsychotic in Parkinson’s. This drug also is not likely to cause weight gain.

Multiple Choice

How is quetiapine (Seroquel) dosed in the tx of acute schizophrenia?

• 200 mg

• 400 mg

• 600-800 mg 

• 25 mg

Multiple Choice

Which of the following Atypical antipsychotics are indicated in the tx of psychosis and mania, with little weight gain... but QTc prolongation is the most prominent ADE

• Risperidone

• Aripiprazole

• Rexulti

• Ziprasidone

Multiple Choice

Which of the following Atypical antipsychotics are a D2 partial agonist? Associated w/ no weight gain, but may cause insomnia and GI effects

• Risperidone

• Aripiprazole

• Rexulti

• Ziprasidone

Multiple Choice

If we have a D2 partial agonist, dealing w/ a hyperactive state... Will it ↑ or ↓ the amount of Dopamine present?

• ↑

• ↓

• neither

Multiple Choice

If we have a D2 partial agonist, dealing w/ a hypoactive state... Will it ↑ or ↓ the amount of Dopamine present?

• ↑

• ↓

• neither

Multiple Choice

Iloperidone (Fanapt), which is a new Atypical antipsychotic, is a 5HT_2A & D2 antagonist... it is also a potent antagonist of α-1. When it comes to dosing, why must we start low and titrate up?

• Risk of confusion/cognitive impairment

• Risk of orthostasis

• Risk of more Gi associated ADE

• All of the above

Multiple Choice

What are some common side effects for Iloperidone?

• Insomnia

• Anxiety

• Aggravated schizophrenia

• All of the above

Multiple Select

Asenapine, which is a new Atypical antipsychotic, is a 5HT_2A & D2 antatonist... it is also a potent antagonist of 5HT_2C. When it comes to dosage form, how is this drug taken? Any time constraints worth mentioning?

• ODT (good for cheekers) 

• QD dosing

• avoid food and/or drink for 10 minutes post administration

• Secuado is a transdermal QD patch

Multiple Select

Lurasidone (Latuda), which is a new Atypical antipsychotic, is a 5HT_2A & D2 antatonist... it is also a partial agonist of 5HT_1A. What pt population may benefit from this drug?

• indicated for the tx of schizophrenia and Bipolar depression

• may be used in pregnant patients

• adjunct tx for those w/ Parkinson's

• all of the above

Open Ended

What are some side effects associated w/ Latuda?

Multiple Select

Which of the following drugs are part of the partial agonist class of Atypical antipsychotics?

hint: relatives to Abilify

• cariprazine (Vraylar)

• lumateperone (Caplyta)

• quetiapine (Seroquel)

• brexpiprazole (Rexulti)

• all of the above

Multiple Choice

Olanzapine has been added w/ the formulation of ___________, which is an opioid receptor antagonist. By doing so, weight gain and the metabolic effects associated w/ olanzapine have been decreased.

• Dextromethorphan

• Samidorphan

• Endorphan

• Epinephrine

Multiple Select

Which of the following is/are long-acting antipsychotics?

hint: Haloperidol is one

• Invega sustenna, trinza, hafyera

• Fluphenazine

• Risperdal Consta

• Aripiprazole Aristada & Maintenna

• Zyprexa Relprevv

Open Ended

Discussion: How are Invega Sustenna, Trinza, and Hafyera dosed?

Open Ended

Discussion: What is an important note when dealing w/ Zyprexa Relprevv?

Fill in the Blank

When treating Refractory pts, we typically use Augmentation. What would we introduce first?

Answer choices: Depakote, Lithium, Benzos, Dual antipsychotics, or Antidepressants

Multiple Select

Which of the following are IM agents that can be used for acute agitation?

Often times, combined w/ benzos or other things... which may be inappropriate

• Haloperidol

• Geodon (ziprasidone)

• Zyprexa (olanzapine)

• Abilify

Fill in the Blank

Is the use of Haldol w/ Benadryl indicated as a combo tx for Acute Agitation?

Parkinson's / Movement Disorders​ Medicinal Chemistry

El Sayed​

​Objectives

• Analyze and importance of enzymes involved in synthesis of L-DOPA and dopamine from L-tyrosine (in particular enzymes, COMT, MAO, decarboxylase).

• Explain why only small amount of L-DOPA reaches brain when administered? Methods to improve L- DOPA efficacy in vivo.

  Describe and identify metabolism of dopamine and dopamine agonists.

  Describe SAR and metabolism of MAO inhibitors.

  Analyze the SAR and metabolism of COMT inhibitors.

  Identify and analyze SAR and metabolism of non-dopaminergic agonists.

  Analyze the SAR and metabolism of muscarinic and histamine antagonists.

  Describe physicochemical properties and metabolism of skeletal muscle relaxants.

Multiple Choice

What is important to note for the following interaction?

• DOPA gets decarboxylated via decarboxylase to form Dopamine

• The aromatic ring provides stability when being hydroxylated

• The amine group undergoes N-methyl transferase

Open Ended

Discussion: Why is the decarboxylation of DOPA a critical step in the formation of Dopamine?

Multiple Choice

Which of the following cause major metabolism of Dopamine?

This is why we want inhibitors to maximize the time Dopamine is in the brain... for the treatment of Parkinson's 

• COMT

• MAO-B

• Decarboxylation

• all of the above

Multiple Choice

When dealing w/ Levodopa, select the molecule that will undergo Phase II Conjugation via COMT and ultimately become inactivated. 

Multiple Choice

When dealing w/ Levodopa, select the molecule that will undergo oxidative de-amination. 

Multiple Choice

Which of the following molecules is associated w/ potentially causing neuro-degeneration?

Multiple Choice

The mechanism of carbidopa when used in combo w/ L-Dopa is to...

• Induce L-amino acid decarboxylase

• Inhibit L-amino acid decarboxylase

• Form drug-drug complex, enhancing BBB penetration

• Act as polyvalent metal chelator, increasing L-Dopa access to BBB

Multiple Choice

Why can't Pyridoxine (vitamin B6) be used in adjunct w/ L-Dopa?

• co-factor and inducer for

  L-aromatic amino acid decarboxylase

• reverses therapeutic effects of L-Dopa

• Increases peripheral decarboxylase activity

• All of the above

Multiple Choice

Which of the following molecules is considered the most active?

Multiple Choice

When presented w/ Semirigid structures, which of the following molecules is considered the least active?

Multiple Choice

Which of the following apomorphine rotamers will have the best dopamine receptor binding based on the main pharmacophore geometry?

• Apomorphine

• 1,2 - Dihydroxy-

  aporphine

• Isoapomorphine

• All of the above are equivalent

Multiple Choice

What is important to note about Bromocriptine?

• attachment via amide bond

• metabolically is hydrolyzed in the liver and becomes inactive

• eliminated mainly in bile

• all of the above

Multiple Select

What type of interactions could we expect w/ Pramipexole?

Select all that apply

• N-dealkylation

• Sulfa-oxidation

• Decarboxylation

• Hydroxylation

Fill in the Blank

T/F: Rotigotine, both the free base and conjugate acid, are lipophilic and may cross the BBB

Multiple Choice

Tolcapone has a relatively longer duration of action (8-12 h) and acts both in the brain and periphery, whereas entacapone has a shorter duration of action (2 h) and acts mostly in the periphery. Why?

• Tolcapone causes liver failure

• Entacapone is metabolically deactivated by

  N-dealkylation

• Different properties

• Tolcapone is metabolically deactivated by

  N-dealkylation

Multiple Choice

Comparing the potential metabolism of Tolcampone and Entacapone, why does the latter have a shorter duration of activity versus the former?

• Entacapone is better substrate for COMT unlike Tolcapone

• Entacapone has a nitrile group that can be extensively metabolized and inactivated

• Entacapone amide carbonyl can be a good substrate for keto reductase

• Entacapone can be first-pass dealkylated and inactivated

Multiple Select

Which of the following drugs utilize the lipophilic cage (ansa)-like structure, which increases their lipophilicity & precludes their catabolism by oxidative enzymes. Lipophilicity facilitates their entry into brain despite the protonation

• Amantadine

• Famotadine

• Memantine

• Seroquel

​Parkinsonism

​Sylvester

​Objectives

• Understand the role that the Pyramidal and Extra-pyramidal motor pathways play in voluntary and involuntary movement. Include anatomical areas and connections with other parts of the nervous system.

• Describe the hallmark symptoms and characteristics of Parkinson’s Disease.

• Understand the role of specific neurotransmitters in the pathology of Parkinson’s Disease.

• Understand the mechanism of action of drugs used to treat Parkinson’s Disease.

• Know the neuropathology of the other diseases associated with the extrapyramidal motor pathway (Huntington’ Disease, Ballism, Tardive dyskinesia)

​

Fill in the Blank

Voluntary movement is initiated in the ______, which sends descending motor neurons efferent fibers down the spinal cord in 2 separate and distinct motor pathways.

1. Pyramidal Pathway

2. Extrapyramidal Pathway

Fill in the Blank

The Pyramidal Pathway may also be known as the _____________ tract.

​Pyramidal Pathway

• Also known a the corticospinal tract, fibers from pyramidal neurons (primary motor neurons) in the motor cortex run uninterrupted from cortex to all levels of the spinal cord, and finally end on or near the fast conducting, myleinated A-motor neurons (secondary motor neurons) in the cord that then send fibers out the ventral root of the spinal cord to the skeletal muscles.

  Primary motor neuron axons travel caudally from cortex, through the basal ganglia, midbrain and medulla. In the medulla this tract forms the “pyramids”.

• In the spinal cord most fibers cross to the contra-lateral side of the cord and form the lateral corticospinal tract, synapse with secondary motor neurons and leave the cord via the ventral horn and innervate limbs and distal muscles. Associated with fine finger and toe movements (typing and tap dancing).

• Fibers that remain on the ipso-lateral side form the anterior corticospinal tract, synapse with A-motor neurons and are associated with innervating the muscle of the trunk (push ups and hula hooping).

​

Multiple Choice

Injury to the Pyramidal Pathway (stroke) is associated w/ which of the following?

• loss of fine, delicate, skilled movements

• slow reflexes

• difficulty holding objects for a prolonged period of time

• all of the above

​Extrapyramidal Pathway

• The extrapyramidal motor system is a highly complex system of major ganglia and tracts responsible for the control of involuntary muscle excitation.

  ​Includes the brain stem, motor nuclei, and all motor pathways not part of the pyramidal system

• This system includes the rubrospinal, vestibulospinal, reticulospinal, and tectospinal tracts

• These motor pathways are complex and multisynaptic, and regulate:

  • Axial muscles that maintain balance and posture

  • Muscles controlling coarse movements of the proximal portions of limbs

  • Head, neck, and eye movement

​Remember that w/ Parkinson's Disease, the patient will undoubtably have NO facial expressions

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Multiple Choice

Which of the following locations of the brain are associated w/ the initiation of Dopamine receptors by either causing excitatory (D1) or inhibitory (D2) actions

• Globus Pallidus

• Substantia Nigra

• Thalmus

• Cortex

​In a normal person, dopamine works by inhibiting GABA and also turns on the Cortex. This in turn ignites the excitatory neurotransmitters, which ultimately lead to movement.

​In Parkinson's, more GABA is present, leading to more inhibition, which creates less excitation from neurotransmitters, ultimately decreasing the amount of movement

Multiple Choice

The ascending tract of the spinal cord is associated w/ which of the following pathways?

• Pyramidal

• Extrapyramidal

• Sensory

• Motor

Multiple Select

The descending tract of the spinal cord, dealing w/ involuntary movements, is associated w/ which of the following pathways?

• Pyramidal

• Extrapyramidal

• Sensory

• Motor

Multiple Select

Which of the following are hallmark signs of Parkinson's?

• Bradykinesia

• Tremor

• Rigidity

• Postural Defects

• Micrography

Multiple Choice

Which of the following is not a suspected cause of Parkinson's?

• Genetics (formation of Lewy Bodies)

• Creation of MPTP from incorrect synthesis of meperidine (Environmental)

• Oxidation Stress (free radical formation)

• Use of NSAIDs in the tx of inflammation

• All of the above are correct

Multiple Select

Which of the following do not cross the BBB?

Se

• Levodopa

• Carbidopa

• Dopamine

• Benserazide

• All of the above

Open Ended

What is the main purpose of dopa decarboxylase inhibitors, such as carbidopa or benserazide?

Multiple Choice

Levodopa is CI'd in pts w/ which of the following disease states?

• Psychosis

• Ulcers

• Narrow angle glaucoma

• All of the above

Multiple Choice

Dopamine stimulates the emetic center of the brain, as such, Levodopa (taken alone) will cause which of the following in at least 80% of patients?

• Postural Hypotension

• Vivid dreams

• N/V

• AFib

• Dyskinesis

Open Ended

ADEs of Levodopa include but are not limited to...

Multiple Choice

Which of the following Dopamine-like drugs is a D1 agonist, associated w/ having the most side effects?

• Pergolide

• Ropinirole

• Pramipexole

• Apomorphine

Multiple Choice

Which of the following Dopamine-like drugs is a D2 agonist & weak D1 agonist, associated w/ having less ADE like vomiting and vasopressor activity?

• Pergolide

• Ropinirole

• Pramipexole

• Apomorphine

• Bromocriptine

Multiple Select

Which of the following Dopamine-like drugs is/are a D2 agonist & D3 agonist, associated w/ having less ADE since there is no D1 activity?

Select all that apply

• Pergolide

• Ropinirole

• Pramipexole

• Apomorphine

• Bromocriptine

Multiple Select

Apomorphine is an agonist for which of the following Dopamine receptors?

This drug is used as "off" therapy, but is associated with more N/V

Select all that apply

• D1

• D2

• D3

• D4

• All of the above

Multiple Select

Which of the following drugs are COMT Inhibitors, which prevent the metabolism of L-dopa in the periphery and the metabolism of Dopamine in the CNS to ultimately increase the t^1/2 of these compounds? 

Select all that apply

• Alcapone

• Tolcapone

• Pramipexole

• Apomorphine

• Entacapone

Fill in the Blank

When dealing w/ Tolcapone, what is a major ADE that must be monitored due to it's long duration of action?

Multiple Choice

Which of the following MAO_B inhibitors slows down disease progression, but also provides some neuroprotection?

• Selegiline

• Carbidopa

• Rasagiline

• Procyclidine

Multiple Choice

Which of the following drug classes has little to no effect on bradykinesia, which is the slowness of movement, but is very good at ↓ rigidity and tremor at rest?

• Muscarinic receptor antagonist

• MAO_B inhibitors

• COMT inhibitors

• Dopamine-like drugs

• L-dopa

Fill in the Blank

Let's see the big picture... What kind of ADEs are typically associated w/ the use of muscarinic receptor antagonists?

Multiple Choice

Which of the following drugs is NOT a muscarinic receptor antagonist?

Remember those anticholinergic ADE 😉

• Benztropine mesylate

• Benadryl

• Amantadine

• Trihexyphenidyl

Fill in the Blank

What class of medications does Amantadine fall under?

This drug helps enhance the responsiveness of NMDA receptors and increases movement in those w/ Parkinson's Disease... It is less potent than l-dopa, and tolerance develops quickly. However, it is very safe and virtually free of side effects.

Multiple Choice

Which of the following statements is not true?

• Pallidotomy is a neuro surgery that results in decreased rigidity and tremor

• Deep brain stimulation of subthalamic N. increases movement

• Gene therapy is now used to increase DA activity

• Stem cell implantation has helped pts to recover from the disease rapidly

• All of the above are correct

​General Comments of Parkinsonism

​The benefits of l-dopa therapy often seem to diminish with time and certain adverse effects may complicate long term treatment. Nevertheless, evidence is accumulating that DA therapy at a relatively early stage may be most effective in alleviating symptoms of P and may also favorably affect the mortality rate due to the disease. Pharmacological treatment is probably best avoided until there is some degree of disability or until the symptoms begin to have a significant impact on the patient life style. When treatment begins, l- dopa is usually given in combination with carbidopa and antimuscarinic drugs may optimize the benefit. Long-term adverse effects of l-dopa can be minimized if dose is kept low and combined with bromocriptine. Physical therapy is helpful in improving mobility.

​

​

Goal: Delay disease progression

Multiple Choice

Parkinson's, along w/ Huntington's, Ballism, and Tardive are diseases associated w/ which part of the brain?

• Basal Ganglia

• Thalamus

• Cortex

• Cerebellum

• These diseases affect the brain as a whole

Fill in the Blank

What disease state is associated w/ progressive motor dysfunction and cognitive decline, due to a loss of GABA neurons in the striatum?

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Parkinson's Disease​

​Nickelson

​Objectives

• ​Be able to list or identify the core symptoms of Parkinson's Disease

• ​Be able to identify or recommend appropriate drug therapy options

• ​Be able to differentiate drug treatment options based on pharmacology and/or ADE profile

Multiple Choice

Which of the following drugs/classes may cause drug-induced Parkinson's Disease?

Select all that apply

• antipsychotics

• metoclopramide

• anticonvulsants

• all of the above

Fill in the Blank

What are some sensory complaints that are usually the starting clinical signs associated w/ Parkinson's?

Multiple Choice

Which of the following is not a classical symptom of Parkinson's Disease?

• Resting tremor

• Rigidity

• Bradykinesia

• Slurred spe

• All of the above are correct

Multiple Choice

Which of the following drugs is the most effective in treatment of Parkinson's?

• Carbidopa

• Levodopa

• Tolcapone

• Selegiline

• All of the above are equivalents

Open Ended

What are some disadvantages w/ the use of Levodopa?

Multiple Select

Levodopa is generally reserved for use when? (select one)

It is also preferred in which pt population? (select one)

• later in the course of the disease

• at onset of disease

• elderly

• newly diagnosed pts > 50 yrs old

Open Ended

Simemet (carbidopa-levodopa) is dosed 25mg/100mg TID; why is it important that the doses are spaced out evenly over waking hours?

Fill in the Blank

What drug is a MAO_B inhibitor, which is selective for DA, and may have drug interactions/diet concerns at doses > 10 mg/day? This drug is good in that when used in adjunct w/ L-dopa, it extends its duration of action, but on the other hand, this worsens psych symptoms...

Multiple Choice

Which of the following is a irreversible MAO_B inhibitor that recently had its dietary restrictions lifted?

• Selegiline

• Bromocriptine

• Rasagiline

• None of the above

Fill in the Blank

Dopamine agonists bind to the (presynaptic/postsynaptic) D2 receptors

Multiple Choice

Dopamine agonists may be considered as initial therapy to delay the initiation of which of the following regimens?

• Pergolide

• Rasagiline

• Levodopa

• Carbidopa

Multiple Select

What is of significance to note about Bromocriptine?

Select all that apply

• ↓ ADE profile w/

  L-dopa

• ↑ ADE profile

• Stops lactation in post-pardum mothers

• ↑ lactation in

  post-pardum mothers

Multiple Select

Which of the following Dopamine Agonists are ergot derivatives?

Discuss: what is of significance about ergot derivatives?

Select all that apply

• Bromocriptine

• Pramipexole

• Ropinirole

• Pergolide

Multiple Select

Which of the following Dopamine Agonists is/are selective for D2 receptors?

• Bromocriptine

• Pramipexole

• Ropinirole

• Pergolide

Multiple Choice

Tolcapone is no longer used in practice mainly due to which of the following major ADE?

• Renal failure

• Hepatotoxicity

• Gynecomastia

• Blindness

Fill in the Blank

T/F: Entacapone is a COMT inhibitor that can be taken as mono-therapy

​F A L S E

Fill in the Blank

Entacapone (Comtan) is associated w/ what kind of side effects?

Fill in the Blank

Anticholinergic agents are useful in the management of what?

Caution/avoid in the elderly

Multiple Choice

Which anticholinergic agent do we see used most often?

• Benztropine (Cogentin)

• Biperiden (Akineton)

• Diphenhydramine (Benadryl)

• Trihexyphenidyl (Artane)

Multiple Choice

Istradefylline (Nourianz) is a selective adenosine A_2A receptor agonist that has been approved for which of the following?

• Mono-therapy for Parkinson's

• Adjunct therapy w/ carbidopa-levodopa for "on" periods

• Adjunct therapy w/ carbidopa-levodopa for "off" periods

• SL dosing

Multiple Choice

Opicapone (Ongentys) is a COMT inhibitor that has been approved for which of the following?

• Mono-therapy for Parkinson's

• Transdermal administration

• Adjunct therapy w/ carbidopa-levodopa

• SL dosing

Multiple Choice

Safinamide (Xadago) is a MAO_B inhibitor that has been approved for which of the following?

• Mono-therapy for Parkinson's

• Transdermal administration

• Adjunct therapy for Parkinson's

• SL dosing

Multiple Choice

Rotigotine (Neupro) is a DA agonist that has been approved for which of the following?

• Mono-therapy for Parkinson's

• Transdermal administration

• Adjunct therapy for Parkinson's

• SL dosing

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Multiple Choice

T/F: DA Agonists are not effective in pts w/ no response to Levodopa

• True

• False

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Fill in the Blank

Is the following statement true or false?

Anti-Parkinson drugs increase dopa activity, and conventional psych meds block dopamine tightly and can worsen movement disorders in Parkinson's

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Multiple Select

Pimavanserin (Nuplazid) is indicated for the tx of what that is associated w/ Parkinson's Disease Psychosis?

Select all that apply

• Aggression

• Forgetfulness

• Hallucinations

• Delusions

• All of the above

Multiple Choice

Pimavanserin (Nuplazid) comes w/ a BBW for which of the following?

• Aggression

• Forgetfulness

• Dementia

• Parkinson's

• Huntington's

Multiple Choice

Pimavanserin (Nuplazid) may cause QT prolongation, thus should be avoided/monitored for patients taking which of the following?

• CYP3A4 inducers

• CYP3A4 inhibitors

• QTC prolonging agents

• Both A & C

• All of the above

Alzheimer's Disease​

Nickelson​

​Objectives

• ​Identify warning signs and risk factors for AD

• ​Differentiate among the three stages of AD

• ​Discuss differences among pharmacologic agents commonly used for the tx of AD

Multiple Choice

Which stage of AD is this pt currently in?

"Patients are aware of the loss of cognitive function, can still participate in decision making process, and benefit from counseling, but they cannot care for themselves"

• Stage I

• Stage II

• Stage III

Multiple Choice

Which stage of AD is this pt currently in?

"Patient is still physically intact, w/ some behavioral problems, fall hazards, but the level of care has changed... The pt is having difficulties doing ADLs"

• Stage I

• Stage II

• Stage III

Multiple Choice

Which stage of AD is this pt currently in?

"This pt is completely dependent on caretaker for their daily needs, usually bedridden and may begin having lethal complications"

• Stage I

• Stage II

• Stage III

Open Ended

What are some standard "work-up" items in regards to Dementia?

Multiple Choice

Drugs that typically interfere w/ _____________ can worsen or induce delirium

Drugs that increase this activity may protect cognition and memory

• Cholinesterase

• Ach

• ADLs

• All of the above

Multiple Choice

Which of the following is not a cholinesterase inhibitor?

• Tacrine

• Donepezil

• Rivastigmine

• Galantamine

• Fluoxetine

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Fill in the Blank

Cholinesterase inhibitors primarily have __ ADEs

These typically include what?

Multiple Choice

Which of the following is the most common cholinesterase inhibitor?

• Tacrine

• Donepezil

• Rivastigmine

• Galantamine

• Fluoxetine

Fill in the Blank

One advantge of Donepezil is that it has the lowest incidence of __ upset

Multiple Select

If tolerated, Galantamine (Razadyne) must be titrated upwards every _ weeks, but not to exceed a max dose of __ mg/day

• 2 weeks

• 4 weeks

• 16 mg

• 24 mg

• 50 mg

Multiple Choice

Which of the following statements is not true?

• Rivastigmine is available in transdermal patch

• less GI effects associated w/ Rivastigmine than others in the class

• little to no DD interactions

• Must be taken w/ food

• If stopped for period of time, titration must be started at baseline

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Multiple Choice

Which of the following medications reduce the formation of beta-amyloid plaques but at the cost of $56,000 per year?

• Aducanumab

• Biktegravir

• Amantadine

• Namenda

Fill in the Blank

Antipsychotics may be needed to address other problematic behaviors such as psychosis, agitation, and aggression. Note however, a BBW for increased _________ in dementia patients with all antipsychotics

​

​

​R E V I E W

Multiple Choice

Which of the following drugs is worse on EPS?

• Risperdal

• Seroquel

• Olanzapine

• Ziprasidone

Multiple Choice

Which of the following drugs has the worse prolactin elevation?

• Risperdal

• Seroquel

• Olanzapine

• Ziprasidone

Multiple Choice

Which of the following drugs is associated w/ metabolic problems and weight gain?

• Risperdal

• Seroquel

• Olanzapine

• Ziprasidone

Multiple Choice

Which of the following drugs is associated w/ least likely having metabolic problems?

• Risperdal

• Seroquel

• Olanzapine

• Ziprasidone

Multiple Choice

Which of the following drugs is associated w/ an increased risk of QT prolongation?

• Risperdal

• Seroquel

• Olanzapine

• Ziprasidone

Multiple Choice

Which of the following drugs is associated w/ bipolar depression and being used in pregnancy?

• Risperdal

• Seroquel

• Olanzapine

• Lurasidone