bipolar and schizophrenia

Question 1

schiz positive sx

Answer 1

Presence of abnormal behaviors: delusions, hallucinations, disorganized thinking
or speech, grossly disorganized or catatonic behavior

Question 2

schiz negative sx

Answer 2

Absence of appropriate behaviors: blunted affect, social withdrawal, lack of
motivation or interest, speech poverty

Question 3

class:
o Low potency:
§ Chlorpromazine
§ Thiordazine
o High potency:
§ Haloperidol
§ Droperidol
§ Fluphenazine

Answer 3

1st gen /typical antipsychotics

Question 4

class:
Clozapine
o Risperidone
o Olanzapine
o Aripiprazole
o Quetiapine
o Ziprasidone

Answer 4

2nd gn antipsychotics

Question 5

which gen of antipsychotics is more effective against hegative sx

Answer 5

2nd

Question 6

ch gen of antipsycothics is more liekly to have metabjolic abnormalities like metabolic syndrome

Answer 6

2nd

Question 7

which antispychotics come in long acting IM?

Answer 7

haloperidol, fluphenazine, risperidone, olanzapine, aripiprazole

Question 8

MOA:
o Block D2 receptors

Answer 8

1st gen antipsychotics

Question 9

AEs:
o Non-motor effects:
§ Sedation
§ Anticholinergic effects
§ Orthostatic hypotension
EPS

Answer 9

1st gen antip

Question 10

how to treat dystonia EPS

Answer 10

benztropine or diphenhydramine

Question 11

how to treat akathisia

Answer 11

cautious reduction of dose if possible
o Beta blockers (propranolol) to treat – first line
o Benztropine (Cogentin) second line

Question 12

how to treat pseudo parkinsonism EPS

Answer 12

cautious reduction of dose if possible
o Benztropine or amantadine daily to decrease

Question 13

how to treat tardive dyskinesia EPS

Answer 13

change to quetiapine or clozapine if possible

Question 14

main SEs of chlorpromazine

Answer 14

very sedating, blood dycrasias (agranulocytosis)

Question 15

main SE of thiordazine

Answer 15

sedation

Question 16

thiordazine BBW

Answer 16

PRO-ARRHYTHMIC EFFECTS (QT PROLONGATION)

Question 17

AEs: marked EPS, hyperprolactinemia, sedation, anxiety, weight gain, milder antimuscarinic, QT prolongation

Answer 17

haloperidol

Question 18

give what w/ haldol to prevent EPS

Answer 18

benztropine or diphenhydramine

Question 19

haldol cautions

Answer 19

Use extreme caution in patient w/ possible electrolyte abnormality
§ Avoid in any withdrawal or seizure history
§ Beer’s List – continuous EKG monitoring and cut dose by half

Question 20

main 2nd gen SEs

Answer 20

Glucose dysregulation
o Dyslipidemia

Question 21

clozapine BBW

Answer 21

BBW: agranulocytosis (neutropenia) à monitor CBC every week, orthostatic
hypotension, cardiomyopathy, seizures

Question 22

which 2nd gen AP has lowest risk for EPS?

Answer 22

clozapine

Question 23

AEs:
§ Sedation, weight gain, metabolic syndrome (worst of all SGAs)
§ Low risk of EPS and hyperprolactinemia

Answer 23

olanzapine

Question 24

olanzapine DI

Answer 24

cipro (will raise concentrations)

Question 25

worst AP for metabolic syndrome

Answer 25

olanzapine

Question 26

which APs have lowest risk of metabolic syndrome?

Answer 26

aripiprazole, ziprasidone

Question 27

tell pt to take quetiapine when?

Answer 27

at night due to sedation

Question 28

qutiapine main SEs

Answer 28

sedation, prolonged QT

Question 29

ziprasidone main SEs

Answer 29

seizures,, SJS and DRESS

Question 30

pt counseling for lurasidone

Answer 30

Take w/ at least 350 calories for maximum absorption

Question 31

tx for acute manic episode

Answer 31

Mood stabilizers (lithium OR valproic acid) AND a second-generation antipsychotic

Question 32

tx for more manic pts

Answer 32

Mood stabilize w/ lithium OR anticonvulsants (valproic acid)

Question 33

tx for more depressed pts

Answer 33

First line: quetiapine or lurasidone o Second line: cariparzine, olanzapine-fluoxetine

Question 34

1st line for bipolar 1

Answer 34

lithium

Question 35

lithium consieraions

Answer 35

renal elimination - anything altering GFR will alter clearance of Lithium Narrow therapeutic index § Should only prescribe if you have ability to monitor serum levels § Dosed in micrograms

Question 36

o AEs: § Rash/psoriasis – discontinue § Tremor – reduce dose, add BB § CNS toxicity (agitation/confusion) – reduce dose § GI (N/V/D) – reduce dose, try XR, split dose, take w/ food § Hypothyroidism – discontinue, or initiate levothyroxine § Polydipsia/polyuria (nephrogenic diabetes insipidus) – reduce dose, manage fluid intake, try amiloride or HCTZ (will ­ lithium levels, decrease dose by 30-50%) § Interstitial fibrosis/glomerulosclerosis – keep dose at lowest effective concentrations, avoid dehydration § Teratogenicity – avoid during 1st trimester if possible

Answer 36

lithium

Question 37

lithium monitoring

Answer 37

EKG if pre-existing cardiac dz or >40 § CBC, BMP (renal function, electrolytes), dematologic exams

Question 38

lithium DIs

Answer 38

Thiazide diuretics, furosemide, NSAIDs, ACEI - ­lithium, avoid use to reduce toxicity § Theophylline - ¯lithium concentration § Neuromuscular blockers – lithium prolongs action § Neuroleptics – lithium may potentiate EPS § Carbamazepine – increase CNS toxicity

Question 39

other potential 1st line med for bipolar 1

Answer 39

valproic acid

Question 40

main SEs of VPA

Answer 40

thrombocytopenia Hepatotoxicity – hepatic necrosis * Severe pancreatitis

Question 41

o AEs: § Common: * Drowsiness, dizziness, ataxia, lethargy, confusion, GI upset * Hyponatremia (may induce SIADH) * Hepatotoxicity § Mildly toxic levels: * Diplopia, dysarthria § Rare, serious * Agranulocytosis, aplastic anemia § BBW: TEN, SJS – related to HLAB1502

Answer 41

carbamazepine

Question 42

how long to see if bipolar meds work?

Answer 42

2 wks