1. Schizophrenia is an illness comprised of 3 symptom domains. Which domain is most responsive to antipsychotic treatment?
A. Positive symptoms (e.g., auditory hallucinations, paranoid delusions)
B. Negative symptoms (e.g., amotivation, decreased speech productivity)
C. Cognitive symptoms (e.g., decreased concentration, processing speed)
D. Mood symptoms (e.g., depressed mood, psychomotor retardation)
E. Unsure
2. When an individual with schizophrenia experiences an acute exacerbation of his illness, what would the minimum reduction in symptom severity need to be in order for him to be considered an antipsychotic responder?
A. 90%
B. 75%
C. 50%
D. 30%
E. Unsure
3. Which of the following is not a risk factor for relapse in schizophrenia?
A. Treatment non-adherence and adverse medication effects
B. Comorbid substance abuse and lack of caregiver support
C. No comorbid mood disorder and second-generation antipsychotic treatment
D. Mental illness stigma and poor therapeutic connection with treatment provider
E. Unsure
4. The Clinical Antipsychotic Trials of Intervention Effectiveness study reported that, by the end of 18 months, what percentage of the 1493 study participants had stopped their antipsychotic treatment?
A. 90%
B. 74%
C. 68%
D. 50%
E. Unsure
5. Which of the following first-generation antipsychotics is available in a long-acting form as a decanoate?
A. Loxapine
B. Fluphenazine
C. Perphenazine
D. Chlorpromazine
E. Unsure
6. Each of the following second-generation antipsychotics is available in a long-acting form except:
A. Paliperidone
B. Aripiprazole
C. Ziprasidone
D. Risperidone
E. Unsure
7. Which of the following statements about antipsychotic safety is true?
A. Prior to the first injection of any long-acting injectable antipsychotic, a 0.1-mL test dose should be administered to test for any unknown allergy
B. Neuroleptic malignant syndrome is a common adverse effect of both fluphenazine decanoate and haloperidol decanoate
C. Patients treated with long-acting aripiprazole injections (monohydrate and lauroxil forms) should be monitored for the development of restlessness, metabolic syndrome, and compulsive behaviors
D. Paliperidone palmitate is a cytochrome P450 (CYP) 2D6 substrate and dose reductions should be considered in patients who are also receiving a potent CYP2D6 inhibitor
E. Unsure
8. Which of the following statements is true regarding long-acting injectable antipsychotic (LAIA) administration services by community pharmacists?
A. Every state in the United States permits pharmacists to administer LAIAs
B. Community pharmacies should provide LAIA patient services in a stigma-free environment with access to a fully private space and the availability of a chaperone
C. All available LAIAs require the same method of intramuscular injection and are suspended in a sesame oil vehicle
D. Post-injection delirium/sedation syndrome is a risk for all LAIA injections and requires that patients be observed for 3 hours after each injection
E. Unsure
9. A 30-year-old patient with schizophrenia is successfully treated with oral paliperidone 12 mg daily. She is transitioning to long-acting injectable therapy and she received the standard intramuscular paliperidone palmitate loading dose of 234 mg on day 1. What intramuscular dose should be administered on day 8?
A. 234 mg
B. 156 mg
C. 117 mg
D. 78 mg
E. Unsure
10. A patient successfully treated with 20 mg of oral aripiprazole daily is initially prescribed aripiprazole monohydrate to be administered by the pharmacist. Which of the following is not necessary?
A. Prior to administering the injection, confirm the patient's identity and current medications
B. Educate the patient about aripiprazole's risk for hepatic toxicity, thrombocytopenia, and hyperammonemia
C. Administer 400 mg aripiprazole monohydrate intramuscularly (provided there are no interacting medications that should force a re-evaluation of the dose)
D. Inform the patient that, after the first intramuscular dose, he needs to continue to take his oral aripiprazole for 14 consecutive days and that he will receive his next injection in 4 weeks
E. Unsure
Evaluation Questions
11. How confident are you in your decision to treat your 30 year old patient with intramuscular paliperidone palmitate?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident