54 - Pharmacotherapy of schizophrenia and psychotic disorders (Ott) Flashcards
Key features that define psychotic disorders
- ___ - fixed false beliefs that are not amenable to change even with conflicting evidence
- ___ - perception-like experiences that occur without an external stimulus (usually ___ , but can be visual, tactile, or olfactory)
- disorganized thinking and speech
- disorganized or abnormal motor behavior
- negative symptoms
- delusions
- hallucinations, auditory
Disease Course in Schizophrenia
onset late adolescence to early adulthood
men - late ___, early ___
women - late ___ , early ___
teens, 20s
20s, 30s
Link to Substance Use
- more than 75% of people with schizophrenia use tobacco
smoking is associated with induction of CYP ___ due to hydrocarbons inhaled.
- decreases serum concentrations of ___ substrate antipsychotics (olanzapine, asenapine, clozapine, loxapine)
1A2
1A2
Link to Substance Use
- longer illness goes untreated, more likely it is that the patient will missuse a substance
- marijuana, cocaine, and amphetamine use can hasten ___ of schizoprenia, reduce time to ___, and exacerbate symtoms
- substance use treatment and mental health treatment should be undertaken at the same time
onset, relapse
T or F: all antipsychotics are considered to be equally effective in clinical trials and in generally equivalent doses in a large population . (Except clozapine - most effective)
True
antipsychotic drug selection
1st line) ___ antipsychotic drug therapy
- unless patient presents with reasons to consider IM depot drug therapy first
oral
changing injection perception to convienence and not punishment
typical antipsychotics
older agents - primarily ___ receptor antagonists
efficacy for positive symptoms similar to ___ antipsychotics (except ___)
examples: (6)
D2
atypical, clozapine
- haloperidol
- chlorpromazine
- fluphenazine
- perphenazine
- loxapine
- thioridazine
typical antipsychotics clinical pearls
- ___ - most commonly used (routine and prn)
- ___ is rarely used due to a black box warning for QTc prolongation
- more ___ with higher potency typicals - and atypical antipsychotics risperidone and paliperidone
- are very effective for treating ___ symptoms, but are likely to worsen ___ and cognitive symptoms
- haloperidol
- thioridazine
- EPS
- positive, negative
atypical antipsychotics
- ___ and ___ antagonism
- less ___ than typicals; more ___ side effects
(13)
- D2, 5HT2A
- EPS, metabolic
partial agonists
- stabilized ___ transmission - not too much, not too little
- associated with more ___ than other antipsychotics
- approved for adjunct treatment in depression so all have boxed warnign for ___ thoughts/behavior
- dopamine
- akathisia
- suicidal
partial agonists
aripiprazole
- D2 partial agonist and 5HT2A antagonist
- ___ and ___ substrate
- moderate ___
- ___ weight gain
- 2D6, 3A4
- akathisia
- low
partial agonists
brexpiprazole
- D2 partial agonist and 5HT2A antagonist
- ___ and ___ substrate
- moderate ___
- ___ weight gain
- 2D6, 3A4
- akathisia
- low-moderate
partial agonist
cariprazine
- ___ / ___ partial agonist and 5HT2A antagonist
- ___ substrate
- moderate ___
- ___ weight gain
- D2/D3
- 3A4
- akathisia
- low-moderate
the “pines”
- less ___ antagonism, more ___ antagonism
- significantly less ___
- ___ weight gain than other agents
- D2, 5HT2A
- EPS
- higher
the “pines”
asenapine
- ___ and ___ formulations
- metalic taste
- ___ substrate
- ___ prolongation
- sublingual, patch
- 1A2
- QTc
