Safety Exam # 2 Scavenger Hunt modules 6 – 10

Safety Exam # 2 Scavenger Hunt modules 6 – 10

Questions 1 – 10 are from module 6 – Second Generation Antipsychotics

1. What differentiates SGAs from FGAs?
SGAs has “atypical” clinical properties
1G strong is to d2 antagonist
2G strong 5HT2a receptor antagonist, hence bind more weakly to d2R
1G – EPS, anticholinergic, weight gain and muscle stiffness
2G: It entails lipids, glucose, hyperprolactemia and metabolic side effects.
Aripiperazole is partial agonist to d2 receptor and some researcher believe that it should be
classified as 3G antipsychotic.

2. Which antipsychotic was one of the first found to have negligible
extrapyramidal side effects, however, associated with substantial risk of
The difference in D2 receptor occupancy is probably why Clozapine does not cause
Weekly WBC counts are indicated to monitor the patient for development of
3. What causes breast secretions while receiving perphenazine? Is this
typical with both FGAs and SGAs?
Perphenazine blocks dopamine 2 receptors in the pituitary, causing
hyperprolactinemia, which can cause galactorrhea.
Except for risperidone, SGAs do not elevate prolactin.
4. Which of the SGAs is most likely and which is least likely to worsen a
metabolic profile?
Most likely: olanzapine
-weight gain, metabolic risk
Least likely: ziprasidone
-weight neutral, lowers triglyceride levels
5. Describe a cross taper from risperidone to olanzapine (hint check out
Kaplan & Sadock pg 1031).
Taper the risperidone off over three weeks while simultaneously beginning
olanzapine at 10 mg per day

risperidone, quetiapine, and ziprazodone lack anticholinergic effects.

Abrupt transition from a DRA, olanzapine, or clozapine to one of these
agents may cause cholinergic rebound 6. What are some primary treatments for monotherapy used as treatment of
acute mania?
“All of the SDAs (except clozapine) are FDA approved for this.

Serotonin dopamine antagonist (SDAs)
risperidone (Risperdal), and olanzapine (Zyprexa), ziprasidone (Geodon)
7. Which medications are FDA-approved for use in bipolar depression?
quetiapine (Seroquel) is approved for bipolar depression.

A fixed combination of olanzapine and fluoxetine known as Symbyax is
approved as a treatment for acute bipolar depression
8. The FDA has added a new warning about which SGA cautioning
prescribers about potential prolongation of the QT interval when above-
recommended amounts of this drug are combined with specific drugs?
paliperidone (Invega) may cause an increase in QT interval and should be
avoided in combination with other drugs that may cause QT interval
9. Compared with persons with schizophrenia and schizoaffective disorder
treated with DRAs, persons treated with SDAs have what types of
outcomes? (Hint check out Kaplan & Sadock pg 1024)
SDAs have fewer relapses, require less frequent hospitalizations, fewer ER
visits, less phone contact to providers, less treatment in day programs
10. The presumed antipsychotic effects of the SDAs are blockade of D2
dopamine receptors. Where the SDAs differ from older antipsychotic drugs
is their higher ratio interactions with serotonin receptor subtypes, most
notably the?
5-HT2A subtype
Questions 11 – 20 are from module 7 – Substance Use

11. The major neurotransmitters possibly involved in developing substance
abuse and substance dependence are?
Dopamine, GABA, Opioid systems
12. What is the primary drug class used to control alcohol withdrawal
(Ativan, lorazepam, chlordiazeposide)
13. Review both alcohol-induced persisting amnestic disorder Wernicke’s
encephalopathy (a set of acute symptoms) and Korsakoff’s syndrome (a
chronic condition). In the early stages, Wernicke’s encephalopathy responds

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