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Review Question - QID 205782

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QID 205782 (Type "205782" in App Search)
A 27-year-old male recently diagnosed with schizophrenia 6 months ago presents to your office for a check-up. Upon diagnosis, the patient was started on a single medication for his psychiatric symptoms. Today, he complains of 20 pound weight gain over the prior six months. Laboratory studies reveal that serum LDL cholesterol has increased significantly over the same time interval. The patient’s side effects are typical of which of the following drugs?

Haloperidol

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Fluphenazine

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Olanzapine

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Buspirone

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Duloxetine

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Olanzapine is an atypical antipsychotic with known side effects of dyslipidemia, significant weight gain, and diabetes mellitus.

Atypical antipsychotics act mainly on 5-H2A receptors. They improve positive and negative symptoms of schizophrenia and are less commonly associated with extrapyramidal symptoms than typical antipsychotics. Olanzapine is a versatile drug and can be used in the treatment of OCD, anxiety disorder, depression, mania, and Tourette’s syndrome.

Muench et al. review the side effects of antipsychotic medications, noting that weight gain from olanzapine does not appear to be dose-dependent within therapeutic ranges. Clozapine and olanzapine cause greater weight gain than other atypical antipsychotics, including aripiprazole and ziprasidone.

Hasnain et al. review weight gain and glucose dysregulation in patients taking olanzapine. Patients starting olanzapine should be monitored regularly for symptoms of diabetes. If significant weight gain occurs, another medication should be sought if possible.

Illustration A summarizes hyperlipidemia risk of major antipsychotics.

Incorrect Answers:
Answers 1-2: Haloperidol and fluphenazine are high-potency typical antipsychotics, a class of drugs more closely associated with extrapyramidal symptoms.
Answers 4-5: Buspirone and duloxetine are not used as primary agents in the treatment of schizophrenia. Buspirone is used to treat generalized anxiety disorder, while duloxetine is an antidepressant.

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