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Pharmacological Management of Schizophrenia

Evaluation

1. All patients presenting with significant psychotic symptoms require a complete history and physical, as well as basic laboratory studies.

A. True

B. False


2. Positive symptoms are all of the following, except for:

A. Bizarre, dramatic, and unsettling to both the observer and the patient.

B. The most accessible to assessment.

C. Not very responsive to antipsychotic medications.

D. All of the above describe positive symptoms.


3. Which type of symptoms are remarkably similar to, and sometimes indistinguishable from, symptoms of depression and antipsychotic medication side effects?

A. Positive symptoms

B. Negative symptoms

C. Both (A) and (B)

D. None of the above


4. Cognitive impairments, such as problems with _____, appear to be an integral part of chronic psychotic disorders, especially schizophrenia.

A. Attention

B. Memory

C. Executive function

D. All of the above


5. Treatment of anxiety early in the course of the psychotic disorder may reduce patient suffering and promote compliance.

A. True

B. False


Treatment Issues and Challenges

6. Which of the following is a common issue or challenge related to treating patients with psychotic disorders?

A. Establishing and maintaining a reasonable level of rapport with the patient.

B. Responding to patients with impaired reality testing.

C. Maintaining a conscious awareness of the patient’s cognitive impairments.

D. All of the above.


7. When a patient refuses treatment, the treatment cannot be provided even in an emergency.

A. True

B. False


Antipsychotic Medication

8. The current understanding of the therapeutic action of antipsychotic medications is that they affect various neurotransmitters in the brain, but primarily the _____ receptors.

A. Dopamine

B. Serotonin

C. Histamine

D. Norepinephrine


9. There is evidence to support that at least one SGA, _____, may actually improve tardive dyskinesia.

A. Risperidone

B. Clozapine

C. Olanzapine

D. Quetiapine


10. Many patients require multiple trials of different medications prior to obtaining maximal benefit.

A. True

B. False


11. All of the following were found to have greater efficacy that FGAs, except for:

A. Quetiapine

B. Clozapine

C. Olanzapine

D. Risperidone


12. In terms of relative efficacy, SGAs have no predictable advantage over FGAs, and both classes of drugs seem to be similarly efficacious.

A. True

B. False


13. Current evidence shows that FGAs are more likely than SGAs to cause neuroleptic malignant syndrome.

A. True

B. False


14. In general, the more potent the first-generation antipsychotic:

A. The greater the anticholinergic side effects.

B. The greater the extrapyramidal side effects.

C. Both (A) and (B).

D. None of the above.


15. All of the following are indications for the use of FGAs, except for:

A. Patient preference

B. History of excellent response in a highly symptomatic patient

C. Chronic symptoms requiring rapid effect

D. Need for a long-acting injectable medication


16. For maintenance treatment with FGAs, low-potency agents are preferable to high- or medium-potency medications.

A. True

B. False


17. Of all the available antipsychotic medications, _____ is considered the gold standard for the treatment of schizophrenia.

A. Clozapine

B. Risperidone

C. Olanzapine

D. Quetiapine


18. Which of the following medications need to be combined with food to be effective?

A. Clozapine

B. Risperidone

C. Ziprasidone

D. All of the above


19. Polypharmacy, or the use of multiple antipsychotic medications without previous therapeutic trials of single agents, is generally poor practice and can:

A. Unnecessarily contribute to excessive costs

B. Increase side effects

C. Increase risk of drug-drug interactions

D. All of the above


Adjunctive Medications

20. Due to the inevitable development of physiological dependence, short-acting benzodiazepines such as alprazolam should be prescribed.

A. True

B. False


21. Discontinuation of benzodiazepines after _____ or more should occur only under close clinical supervision.

A. One week

B. Three weeks

C. Two months

D. Six months


22. Under which situation would benzodiazepines be inappropriate for inmates with chronic psychotic disorders?

A. When the patient has a comorbid anxiety disorder requiring long-term treatment.

B. When the patient has a history of substance abuse.

C. When there are underlying syndromes contributing to the anxiety.

D. All of the above.


Medications to Treat Antipsychotic Side Effects

23. Which EPS symptom requires immediate treatment with parenteral medication?

A. Dystonia

B. Pseudoparkinsonism

C. Akathisia

D. All of the above


Appendix 8: Neuroleptic Malignant Syndrome

24. All of the following are risk factors for the development of the potentially fatal NMS condition that can occur in any patient taking antipsychotic medication, except for:

A. Initiation or increased dose of an antipsychotic medication

B. Dehydration

C. Young, female patient

D. High ambient temperature / humidity


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