Psychiatry Clerkship Jeopardy: Test Your Knowledge in Antipsychotics
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is proud
is proud
to present
to present
And
Now
Here
Is
The
Host
.
.
.
Insert Name Here
The categories for today’s
Jeopardy will be:
Typical
Antipsychotics
Atypical
Antipsychotics
Side Effects
Mechanism of
Action
Miscellaneous
100
100
100
100
200
200
300
300
800
800
700
700
500
500
800
800
Typicals
Side
Effects
Miscellaneous
100
100
700
700
500
500
700
700
400
400
800
800
600
600
100
100
900
900
900
900
900
900
900
900
300
300
500
500
800
800
Mechanism
of action
100
100
900
900
500
500
400
400
300
300
200
200
300
300
400
400
600
600
800
800
200
200
300
300
600
600
200
200
500
500
400
400
700
700
600
600
200
200
400
400
700
700
600
600
Atypicals
Row 1, Col 1
Not only was this drug the first
antipsychotic, it was the first
psychotropic medication
of any kind
What is
chlorpromazine (Thorazine)?
1,2
Typical antipsychotics are divided into
these two categories which also
correlates to their D
2
receptor’s
binding affinity
What are
high potency & low potency
?
1,3
This typical antipsychotic is available
PO, IM, & IV; is commonly used to
treat agitated patients in
hospitals/ER’s; & can be used to
treat Tourette’s syndroms
What is
haloperidol (Haldol)?
1,4
Three anticholinergic medications
commonly used to counter EPS side
effects are:
trihexyphenidyl (artane),
benztropine (cogentin), &
this medication
What is
diphenhydramine (Benadryl)?
1,5
When used in their long acting
injectable form, these 2 FGA’s are
given IM every 2-4 weeks to treat
patients with chronic schizophrenia
What are
haloperidol (Haldol) & fluphenazine (Prolixin)?
1,6
This type of typical antipsychotic
is anti-cholinergic,
anti-histaminic, & an
α
1
adrenergic antagonist
What is
low potency antipsychotic?
Chlorpromazine (thorazine)
1,7
While prochlorperazine (Compazine)
is a D2 blocker it is more commonly
used for this than its
antipsychotic properties
What is
antiemetic properties?
1,8
This antipsychotic can also be
used to treat intractable hiccups
What is
chlorpromazine (Thorazine)?
1,9
This typical antipsychotic
has the greatest risk of
any antipsychotic for dose
dependent QTc prolongation,
torsades de pointes, and
cardiotoxicity
What is
thioridazine (Mellaril)
?
2,1
Even though its the most
efficacious antipsychotic, its side
effect profile prevents this drug
from consideration for first
line use
What is
Clozapine (Clozaril)?
2,2
This atypical is used to treat
psychosis in Lewy Body
Dementia & Parkinson’s Disease
due to its low likelihood of EPS
What is
quetiapine (Seroquel)?
2,3
These 2 atypicals are available in a
long acting injectable form &
have the highest risk among
atypicals of causing
prolactin elevation
What is
risperidone (Risperdal) &
paliperidone (Invega)
2,4
These two atypicals are most
likely to cause side effects of
significant sedation and
the metabolic syndrome
What is
olanzapine (Zyprexa) and clozapine (Clozaril)?
2,5
What is
ziprasidone (Geodon)?
Of all the SGA’s, this medication has
the highest risk of causing
QTc prolongation
2,6
This SGA is a partial dopamine
agonist & commonly has the
side effect akathisia
What is
aripiprazole (Abilify)?
2,7
This atypical is FDA approved for
adjunct treatment of major
depression
What is
aripiprazole (Abilify)?
2,8
Due to the risk of seizure induction,
slow dose titration must be done
for this atypical
What is
clozapine (Clozaril?)?
2,9
Lurasidone (latuda), asenapine
(saphris) & these two SGA’s are the
most metabolically “neutral”
What are
ziprasidone (geodone) & aripiprazole (abilify)?
3,1
More common with typical
antipsychotics, this side effect is
characterized by repetitive,
involuntary, purposeless
movements
What is
Tardive Dyskinesia?
3,2
Gradual taper Abrupt stop
----------------------------------
For a patient taking Clozapine
(Clozaril) this is done when the
WBC is <2,000 or the absolute
neutrophil count is <1,000
What is
abrupt stop?
(abrupt stop
→
rebound psychosis;
do gradual taper when possible)
3,3
Due to the risk of metabolic
syndrome, patients on atypicals
should have their weight, waist
circumference and these 2 labs
monitored regularly
What is
glucose & lipids?
3,4
The picture shows
a pt experiencing
this EPS side
effect
What is
dystonia?
3,5
Clozapine (clozaril), Quetiapine (seroquel),
Iloperidone (fanapt), Risperidone (risperdal)
Paliperidone (invega)
------------------------------------------------
All may cause dose dependent orthostatic
hypotension due to this
What is
α
1
adrenergic antagonism?
undesirable in elderly pts & pts at risk for falls
3,6
There is a blackbox warning for the
use of antipsychotics in elderly
dementia patients due to
increased risk of this
What is
sudden death (cardiovascular cause?)?
3,7
The antipsychotic side effect seen in this patient is this
What is oculogyric crisis?
3,8
The picture shows a
patient with this D
2
blocking medication
side effect
What is
gynecomasitia?
(From hyperprolactinemia)
3,9
This atypical may cause dry mouth
due to its anticholinergic
properties, but ironically it
may also cause excess
salivation
What is
clozapine (Clozaril)?
4,1
SGA’s work primary by blocking
these 2 receptors
What are
the D
2
& 5HT
2A
receptor?
4,2
The positive symptoms of
schizophrenia are due to
hyperactivity of what
dopamine tract?
What is
the Mesolimbic Pathway?
4,3
Excess blockade of this dopamine
tract may cause infertility,
galactorrhea, & osteopenia.
What is
the Tubuloinfundibular Pathway?
4,4
When switching to aripiprazole (abilify)
from a different antipsychotic, before
the other antipsychotic has washed
out, the aripiprazole (abilify)—at
least in theory— initially does this
at the D
2
receptors
What is
act as a dopamine agonist
?
When
switching
to abilify, need to switch slowly or
have a washout period
4,5
The percentage of D
2
occupancy necessary
for the antipsychotic effect is this
What is
60%?
4,6
This percentage of occupancy at D
2
is believed to be associated with
elevated prolactin and/or EPS
What is ~
80%?
4,7
While NMS is uncommon to rare
(incident rate 0.02-3%), its
cause is this
What is
dopamine antagonism?
4,8
Hypoactivity of this dopamine tract is
believed to be associated with the
development of negative symptoms
What is
the mesocortical pathway?
4,9
The SGA with
the unique mechanism of
action of partial dopamine
agonism is this
What is
aripiprazole (Abilify)?
5,1
Prochlorperazine (Compazine) Metoclopramide (Reglan)
Droperidol (Inapsine) Promethazine (Phenergan)
This antiemetic medication(s) is/are a D
2
blocker(s) and may cause EPS or TD
What is
all 4 of them?
5,2
About 75% of pts with schizophrenia
do this unhealthy activity which
also induces an
metabolic
rate
of antipsychotic medications
What is
cigarette smoking?
5,3
While not diagnostic for NMS
(it may be normal if there is not clearly
well developed rigidity),
this lab’s degree of abnormality
correlates with the disease
severity & prognosis
What is
creatine kinase?
5,4
Antipsychotics approved for the
treatment of bipolar depression are
olanzapine/fluoxetine (symbyax),
lurasidone (latuda), and this
What is
quetiapine (Seroquel)?
5,5
This atypical has a significant risk of
causing hyperprolactinemia, a
significant risk of sexual side effects,
and is the active metabolite of
risperidone (Risperdal)
What is
paliperidone (Invega)?
5,6
The 4 SGA’s that are available in
long acting injectable preparations are:
risperidone (Risperidal Consta),
olanzapine (Zyprexa Relprevv)
& these two medications
What are
paliperidone (Invega Sustenna) &
aripiprazole, (Abilify Maintena)
5,7
Antipsychotic side effects of sedation
& weight gain are likely due
to antagonist activity at
this receptor
What is
histamine (H1)?
5,8
Young or Elderly
Males or Females
This demographic is at the greatest
risk for dystonia from
antipsychotics
What is
young males?
5,9
While muscular rigidity,
hyperthermia, & autonomic
stability are all common symptoms
of NMS, most often this symptom
presents first
What is
mental status changes?
Dive into the world of psychiatry with this engaging Jeopardy game tailored for the Psychiatry Clerkship. Test your knowledge on typical and atypical antipsychotics, their side effects, mechanisms of action, and more. Challenge yourself with questions ranging from drug identification to treatment applications. Sharpen your skills in a fun and interactive way!
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Presentation Transcript
Jeopardy Jeopardy for the Psychiatry Clerkship
And Now Here Is The Host . . . is proud to present Insert Name Here
The categories for todays Jeopardy will be:
Typical Antipsychotics
Atypical Antipsychotics
Mechanism of Action
Typicals Miscellaneous Atypicals Side Effects Mechanism of action 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300 400 400 400 400 400 500 500 500 500 500 600 600 600 600 600 700 700 700 700 700 800 800 800 800 800 900 900 900 900 900
What is chlorpromazine (Thorazine)? Not only was this drug the first antipsychotic, it was the first psychotropic medication of any kind Row 1, Col 1
What are high potency & low potency? Typical antipsychotics are divided into these two categories which also correlates to their D2receptor s binding affinity 1,2
What is haloperidol (Haldol)? This typical antipsychotic is available PO, IM, & IV; is commonly used to treat agitated patients in hospitals/ER s; & can be used to treat Tourette s syndroms 1,3
What is diphenhydramine (Benadryl)? Three anticholinergic medications commonly used to counter EPS side effects are: trihexyphenidyl (artane), benztropine (cogentin), & this medication 1,4
What are haloperidol (Haldol) & fluphenazine (Prolixin)? When used in their long acting injectable form, these 2 FGA s are given IM every 2-4 weeks to treat patients with chronic schizophrenia 1,5
What is low potency antipsychotic? Chlorpromazine (thorazine) This type of typical antipsychotic is anti-cholinergic, anti-histaminic, & an 1 adrenergic antagonist 1,6
What is antiemetic properties? While prochlorperazine (Compazine) is a D2 blocker it is more commonly used for this than its antipsychotic properties 1,7
What is chlorpromazine (Thorazine)? This antipsychotic can also be used to treat intractable hiccups 1,8
What is thioridazine (Mellaril)? This typical antipsychotic has the greatest risk of any antipsychotic for dose dependent QTc prolongation, torsades de pointes, and cardiotoxicity 1,9
What is Clozapine (Clozaril)? Even though its the most efficacious antipsychotic, its side effect profile prevents this drug from consideration for first line use 2,1
What is quetiapine (Seroquel)? This atypical is used to treat psychosis in Lewy Body Dementia & Parkinson s Disease due to its low likelihood of EPS 2,2
What is risperidone (Risperdal) & paliperidone (Invega) These 2 atypicals are available in a long acting injectable form & have the highest risk among atypicals of causing prolactin elevation 2,3
What is olanzapine (Zyprexa) and clozapine (Clozaril)? These two atypicals are most likely to cause side effects of significant sedation and the metabolic syndrome 2,4
What is ziprasidone (Geodon)? Of all the SGA s, this medication has the highest risk of causing QTc prolongation 2,5
What is aripiprazole (Abilify)? This SGA is a partial dopamine agonist & commonly has the side effect akathisia 2,6
What is aripiprazole (Abilify)? This atypical is FDA approved for adjunct treatment of major depression 2,7
What is clozapine (Clozaril?)? Due to the risk of seizure induction, slow dose titration must be done for this atypical 2,8
What are ziprasidone (geodone) & aripiprazole (abilify)? Lurasidone (latuda), asenapine (saphris) & these two SGA s are the most metabolically neutral 2,9
What is Tardive Dyskinesia? More common with typical antipsychotics, this side effect is characterized by repetitive, involuntary, purposeless movements 3,1
What is abrupt stop? (abrupt stop rebound psychosis; do gradual taper when possible) Gradual taper ---------------------------------- For a patient taking Clozapine (Clozaril) this is done when the WBC is <2,000 or the absolute neutrophil count is <1,000 Abrupt stop 3,2
What is glucose & lipids? Due to the risk of metabolic syndrome, patients on atypicals should have their weight, waist circumference and these 2 labs monitored regularly 3,3
What is dystonia? The picture shows a pt experiencing this EPS side effect 3,4
What is1 adrenergic antagonism? undesirable in elderly pts & pts at risk for falls Clozapine (clozaril), Quetiapine (seroquel), Iloperidone (fanapt), Risperidone (risperdal) Paliperidone (invega) ------------------------------------------------ All may cause dose dependent orthostatic hypotension due to this 3,5
What is sudden death (cardiovascular cause?)? There is a blackbox warning for the use of antipsychotics in elderly dementia patients due to increased risk of this 3,6
What is oculogyric crisis? https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcR4wedhwZujBGMyrisURhc748ctGvGVhQNYgjoy4siAAcMuC4Fe The antipsychotic side effect seen in this patient is this 3,7
What is gynecomasitia? (From hyperprolactinemia) The picture shows a patient with this D2 blocking medication side effect 3,8
What is clozapine (Clozaril)? This atypical may cause dry mouth due to its anticholinergic properties, but ironically it may also cause excess salivation 3,9
What are the D2 & 5HT2A receptor? SGA s work primary by blocking these 2 receptors 4,1
What is the Mesolimbic Pathway? The positive symptoms of schizophrenia are due to hyperactivity of what dopamine tract? 4,2
What is the Tubuloinfundibular Pathway? Excess blockade of this dopamine tract may cause infertility, galactorrhea, & osteopenia. 4,3
What is act as a dopamine agonist? When switching to abilify, need to switch slowly or have a washout period When switching to aripiprazole (abilify) from a different antipsychotic, before the other antipsychotic has washed out, the aripiprazole (abilify) at least in theory initially does this at the D2 receptors 4,4
What is 60%? The percentage of D2 occupancy necessary for the antipsychotic effect is this 4,5
What is ~80%? This percentage of occupancy at D2 is believed to be associated with elevated prolactin and/or EPS 4,6
What is dopamine antagonism? While NMS is uncommon to rare (incident rate 0.02-3%), its cause is this 4,7
What is the mesocortical pathway? Hypoactivity of this dopamine tract is believed to be associated with the development of negative symptoms 4,8
What is aripiprazole (Abilify)? The SGA with the unique mechanism of action of partial dopamine agonism is this 4,9
What is all 4 of them? Prochlorperazine (Compazine) Metoclopramide (Reglan) Droperidol (Inapsine) Promethazine (Phenergan) This antiemetic medication(s) is/are a D2 blocker(s) and may cause EPS or TD 5,1
What is cigarette smoking? About 75% of pts with schizophrenia do this unhealthy activity which also induces an metabolic rate of antipsychotic medications 5,2
What is creatine kinase? While not diagnostic for NMS (it may be normal if there is not clearly well developed rigidity), this lab s degree of abnormality correlates with the disease severity & prognosis 5,3
What is quetiapine (Seroquel)? Antipsychotics approved for the treatment of bipolar depression are olanzapine/fluoxetine (symbyax), lurasidone (latuda), and this 5,4
What is paliperidone (Invega)? This atypical has a significant risk of causing hyperprolactinemia, a significant risk of sexual side effects, and is the active metabolite of risperidone (Risperdal) 5,5
