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*Pharmacotherapy 5270 > 1. Schizophrenia > Flashcards

1. Schizophrenia Flashcards

1
Q

list some key features associated with schizophrenia sprectrum & other psychotic disorders

A
  • delusions
  • hallucinations
  • disorganized thinking/speech
  • grossly disorganized or abnormal motor behaviour
  • negative symptoms
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2
Q

this is a syndrome which consists of a variety of potential symptoms which result in a loss of contact with reality (individual has trouble distinguishing between what is real and what is not).

note: it is not a disorder itself but a feature of several mental disorders and a defining feature of schizophrenia

A

psychosis

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3
Q

what are some symptoms of psychosis?

A

positive symptoms
- things are present that shouldn’t be (e.g. hallucinations, hearing voices)

negative symptoms
- things are missing (motivation, happiness)

note: we often associate schizophrenia with positive symptoms because its easier to see something that shouldn’t be there compared to looking for something that should be there

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4
Q

a negative symptom; inability to feel pleasure

A

anhedonia

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5
Q

a negative symptom; lowered levels of motivation or drive, lack of energy, decreased ability to start tasks, lack of spontaniety

A

avolition/apathy

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6
Q

a negative symptom; monotone & 1 syllable or general reduction in speech

A

alogia

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7
Q

a negative symptom; impressive face - little display of emotions

A

affective flattening

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8
Q

a negative symptom; lack of interest in other people, poor rapport, impaired relationships, detached

A

asocial

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9
Q

this is a complex disorder of brain function with heterogeneity in symptoms (alterations in perceptions, thoughts, mood, cognition & behaviour). characterized by positive symptoms, negative symptoms and often impairments in mood and cognition. there are significant disturbances in the ability to function in society on a daily basis

A

schizophrenia

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10
Q

this part of the brain is responsible for positive symptoms

A

mesolimbic

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11
Q

this part of the brain is responsible for negative symptoms

A

mesocortical

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12
Q

this part of the brain is responsible for cognitive symptoms

A

dorsolateral prefrontal cortec

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13
Q

this part of the brain is responsible for affective/mood symptoms

A

ventromedical prefrontal cortex

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14
Q

this part of the brain is responsible for aggressive symptoms

A

orbitofrontal cortec and amygdala

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15
Q

what are neurochemical imbalances that can lead to development of schizophrenia

A

if glutamate deficiency occurs than dopamine imbalance can happen

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16
Q

true or false: there is a genetic component to schizophrenia

A

true
general population - 1%
1 parent with schiz. - 10%
2 parents with shciz. - 40%
identical twin with schiz. - 30%

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17
Q

true or false: schizophrenia is more common in males

A

true

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18
Q

true or false: there is a high rate of individuals who experience first episode psychosis with good recovery and no further epidoses

A

false - only 10%

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19
Q

true or false: there is a high right of relapse in first episode patients within the first 5 years

A

true - 80%

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20
Q

true or false: every time someone has a psychotic break, they never fully recover and eventually experience burnout

A

true

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21
Q

true or false: leaving psychosis untreated does not change the prognosis

A

false - untreated psychosis the worse the outcome

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22
Q

what is the defintion of First Episode Psychosis (FEP)

A

a week or more of sustained positive symptoms

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23
Q

true or false: a high dose antipsychotic is usually started in a FEP patient

A

false - FEP patients are generally more responsive to beneficial effects and more sensitive to side effects of antipsychotic medications therefore usually use lower doses

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24
Q

what is the critical period for FEP patients recieving tx

A

first 5 years

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25
Q

which agent has demonstrated superiority in treatment resistant schizophrenia

A

clozapine

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26
Q

true or false: there is some evidence that atypical antipsychotics (SGA’s and TGA’s) are best for treating positive symptoms

A

false - FGA, SGA and TGA are all fair game

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27
Q

true or false: there is some evidence that atypical antipsychotics (SGA’s and TGA’s) are best for treating negative symptoms

A

true

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28
Q

order the antipsychotics associated with movement disorders from greatest risk to lowest risk

A

HP-FGA’s > FGA’s > others > CLZ

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29
Q

order the antipsychotics associated with metabolic effects (weight gain, dyslipidemia, T2DM) from greatest risk to lowest risk

A

CLZ-OLZ > QTP > others

*if a multiple choice and both OLZ and CLZ are options: choose CLZ

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30
Q

order the antipsychotics associated with sedation from greatest risk to lowest risk

A

LP-FGA’s (thus have HP for H1), CLZ, OLZ, QTP > others

*take dose/biggest part of dose at bedtime

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31
Q

order the antipsychotics associated with seizures from greatest risk to lowest risk

A

CLZ > LP-FGA > others

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32
Q

order the antipsychotics associated with hyperprolactemia from greatest risk to lowest risk

A

HP-FGA, PAL, RSP > others > ARP

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33
Q

this medication is SL tablet and cannot have food/drink for 10 mins after dose to ensure all medication is absorbed buccally

A

asenapine

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34
Q

these two antipsychotics are available in ODT

A

risperiode and olanzapine

35
Q

which two antipsychotics have a drug interaction with smoking?

A

clozapine and olanzapine

people who smoke need a higher dose of these medications because smoking induces CYP 1A2; if they stop smoking, clozapine level will be way too high and the risk of having a seizure is increased

36
Q

which antipsychotics should be avoided in patients with diabetes?

A

those with high risk of metabolic effects
CLZ-OLZ > QTP > others

37
Q

which antipsychotics should be avoided in patients with dementia

A

those with anticholinergic side effects
LP-FGA’s (thus have HP for M1), CLZ, OLZ, QTP > others

38
Q

true or false: when deciding which dose to recommend for an antipsychotic, the highest dose should be used to optimize therapy

A

false - lowest effective dose should be used to establish treatment acceptance and minimize adverse effects

39
Q

how long might it take for plasma concentrations to reach steady state for someone using a long-acting injection (LAI)

A

2-4 months

40
Q

this antipsychotic needs to be taken with a minimum of 500 kcal meal otherwise bioavailability will be 1/2

A

Ziprasidone

41
Q

this antipsychotic needs to be taken with a small meal (min 350 kcal required) as absorption can be decreased by up to 50% if taken on an empty stomach

A

Lurasidone

42
Q

in a patient experiencing FEP, if there is no response after this amount of time after starting tx and tolerability is good, the dose can be increased

A

2 weeks (2/52)

43
Q

this antipsychotic requires TDM in order to monitor efficacy

A

clozapine

44
Q

what is an adequate trial for most oral antipsychotics

A

4-6 weeks
(clozapine = 8-12 weeks)

45
Q

explain the washout/start method for switching antipsychotics

A

taper, stop and washout (4-5 half-lives) initial antipsychotic, then start new antipsychotic

46
Q

what is a benefit of the washout/start method

A

minimizes withdrawal reaction

47
Q

what is a disadvantage of the washout/start method

A

may increase risk of relapse (therefore often not clinically practical if patient is not well)

48
Q

explain the stop/start method for switching antipsychotics

A

stop first AP on day 1 and start new antipsychotic on day 2

49
Q

in what situation is the stop/start method most commonly used

A

if there is a serious/significant ADR to the first AP

50
Q

what are the two disadvantages of the stop/start method

A

increase risk of relapse and withdrawal reactions

51
Q

explain the cross taper method

A

taper down the first AP while simultaneously adding & increasing the dose of the second AP
most common method

52
Q

why is the cross taper method the most common?

A

thought to minimize risk of relapse and withdrawal symptoms

53
Q

what are the disadvantages of cross taper

A
  • two drugs at once therefore increase ADR’s
  • risk of long term poly pharmacy
  • if doses are too low may increase risk of relapse
54
Q

explain the delayed withdrawal method for switching antipsychotics

A

establish patient on a therapeutic dose of second AP before tapering/dc the first AP

55
Q

in what situation is the delayed withdrawal method most commonly used

A

when switching from an FGA/SGA to a TGA

56
Q

what is a benefit of delayed withdrawal method

A

decrease risk of relapse b/c patient is on established dose of second agent before even starting to taper the first agent

57
Q

what is a disadvantage of delayed withdrawal method

A

risk on long term poly pharmacy and increase ADR’s

58
Q

what are some factors that may exacerbate an acute exacerbation of psychosis

A
  • adherence
  • substance abuse (cannabis and stimulants are precipitants of episodes of psychosis)
59
Q

what can you do if a patient is having an acute exacerbation of psychosis and they are on a long acting injections (LAI)?

A

top up with a little bit of oral formulation

60
Q

what can you do if a patient is experiencing psychotic ex’s ~ 1 week before their injection?

A

prob breakthrough therefore try a shorter interval (e.g. q 3 weeks instead of q 4 weeks)

61
Q

this is known as a poor response to adequate trials of at least 2 antipsychotics

A

treatment resistance schizphrenia

62
Q

what is the recommended medication for treatment resistant schizophrenia

A

clozapine

63
Q

what is an adequate trial of clozapine

A

8-12 weeks

64
Q

how long should treatment continue for FEP?

A

no less than 18 months following remission

65
Q

how long should treatment continue for someone who has had multiple episodes

A

2-5 years or long term treatment
*AP’s reduce the risk of relapse to less than 30% a year

66
Q

if discontinuing an AP, what is the suggested timeline for doing this

A

6-24 months

67
Q

what are the 7 possibilities for managing side effects

A
  1. stop the drug
  2. do nothing… provide reassurance
  3. change the dose
  4. alter the dosing schedule
  5. add a non drug tx
  6. add a drug tx
  7. switch the drug
68
Q

when is a patient most likely to experience s/e

A

at tx start and after dose increase

69
Q

true or false: tolerance usually develops to s/e after a few weeks

A

true

70
Q

true or false: if a patient is experiencing urinary retention after being started on a AP such as CLZ, they can stay on the current dose as they may develop tolerance to this in a few weeks

A

false
urinary retention = stop drug

71
Q

true or false: tolerance does not develop for hyperprolactemia due to dopaminergic block

A

true

72
Q

true or false: hyperprolacetmia may occur in a patient taking risperidone

A

true
-less common in other SGA’s

73
Q

true or false: hyperprolactemia may occur in a patient taking aripiprazole

A

false - less common in TGA’a

74
Q

true or false: EPS occurs early and TD occurs later

A

true

75
Q

true or false: dystonia (posture/muscle spasms), akathisia (restlessness) & Parkinsonism (tremor, rigidly & bradykinesia) are more likely to occur in LP-FGA’s

A

false - HP-FGA’s!!

76
Q

true or false: Benzotropine can be used to treat dystonia, akathisia & Parkinsonism

A

false - used to treat dystonia & Parkinsonism
- propranolol and lorazepam used to treat akathisia/restlessness

77
Q

true or false: akathisia can occur in TGA’s

A

true

78
Q

true or false: tar dive dystonia, dyskinesia and akathisia are reversible

A

false - these are often irreversible

79
Q

this side effect is an abrupt onset in muscle rigidly, fever, autonomic instability; not as common, more common in the older AP’s

A

neuroleptic malignant syndrome (NMS)

80
Q

true or false: if a patient experiences NMS with an AP, they can never use that AP again

A

false - NMS usually resolves once the drug is stopped

81
Q

true or false: all AP’s lower seizure threshold

A

true

82
Q

which AP has the highest risk of agranulocytosis

A

CLZ
*As RPh need to check bloodwork & watch for any signs of infection!
do not use if WBC’s < 3000
blood work is constant (weekly for first 6 months and then bi-weekly)

83
Q

what is the first line for anti-psychotic induced weight gain after healthy lifestyles?

A

metformin

84
Q

based on side effects, what are some baseline parameters that should be collected and followed up on when starting AP’s

A
  • weight + waist circumference
  • fasting lipid profile
  • WBC’s
  • FBG

*Pharmacotherapy 5270 (7 decks)

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