11 - Psychoses

Question 1

List some low potency FGAs

Answer 1

chlorpormazine or methotrimeprazine

Question 2

List some intermediate potency FGAs

Answer 2

loxapine or perphenazine

Question 3

List some high potency FGAs

Answer 3

haloperidol or fluphenazine

Question 4

What s/e are low potency FGAs more likely to cause?

Answer 4

have increased rates of sedation, CV effects, anticholinergic s/e and weight gain

Question 5

What s/e are high potency FGAs more likely to cause?

Answer 5

higher rates of EPS, NMS, and increased prolactin levels

Question 6

_____ is for tx-resistant schizophrenia

Answer 6

clozapine

Question 7

What is an adequate trial for antipsychotics?

Answer 7

4-8 weeks @ therapeutic dose

Question 8

How long should you treat for?

Answer 8

min 1-2 years

For those with 2 or more episodes, treat for 5 years (stable and disease recurrence-free for 5 years)

Question 9

Key counselling points for:

Aripiprazole (SGA)

Answer 9

• given in morning as it can cause insomnia

- changes in dosage should be made no more frequently than every 14 days due it’s uniquely long half life

Question 10

Key counselling points for:

Asenapine (SGA)

Answer 10

• given SL
• can cause hypoesthesia and paresthesia, usually resolve within 1 hour
• can cause hypersensitvity reactions

Question 11

Key counselling points for:

Brexpiprazole (SGA)

Answer 11

low risk of akathisia and EPS, weight gain and metabolic complications

Question 12

Key counselling points for:

Lurasidone (SGA)

Answer 12

• need to take with food (min 350 calories)

- can cause significant nausea! (give dose HS or ginger or peppermint may be helpful)

Question 13

Key counselling points for:

Paliperidone (SGA)

Answer 13

• active metabolite of risperidone

- can cause insomnia so give in morning

Question 14

Key counselling points for:

Ziprasidone (SGA)

Answer 14

• need to take with food (min 500 calories)

- only agent to show improvement in weight and metabolic parameters following a switch from another SGA

Question 15

Smoking induces metabolism of which antipsychotics

Answer 15

clozapine

olanzapine

Question 16

How long should you taper for before discontinuing?

Answer 16

• gradually reduce the dose by < 20% every 2-4 weeks
• reduce over a period of 6-12 months for first episode patients and 6-24 months if patients have experienced 2 or more episodes

Question 17

What is NMS syndrome?

Answer 17

muscle rigidity, fever, autonomic disturbance, labile (easily changed) blood pressure, fluctuating levels of consciousness and elevated levels of CK and WBC

Question 18

What is a risk factor for NMS?

Answer 18

dehydration

Question 19

What antipsychotics cause sedation?

Answer 19

low potency FGAs, clozapine, olanzapine, quetiapine

Question 20

____ can cause a dulling effect

Answer 20

FGAs

Question 21

What is the major advantage of using SGAs over FGAs?

Answer 21

less incidence of EPS

Question 22

What is tardive dyskinesia?

Answer 22

repetitive, involuntary choreoathetoid movements usuallly involving the buccal-oral-lingual musculature, face, trunk, extremeties, or respiratory muscles and can be permanent and disabling

Question 23

____ may improve existing TD

Answer 23

clozapine

Question 24

What drugs can cause dyslipidemia?

Answer 24

clozapine, olanzapine and quetiapine

*can manage this by switching to ziprasidone

Question 25

What drugs can cause QT prolongation?

Answer 25

• ziprasidone
• haloperidol
• chlorpromazine, pimozide

Question 26

____ can cause myocarditis

Answer 26

clozapine

Question 27

_____ can cause DRESS

Answer 27

olanzapine