Chapter 64: Schizophrenia/Psychosis Flashcards
Dystonias
Prolonged contraction of muscles during drug initiation, including painful muscle contraction; life-threatening if airway is compromised.
Diphenhydramine and benztropine can be used for prophylaxis or treatment
Akathisia
Restlessness with anxiety and an inability to remain still;
Treated with benzodiazepines or propranolol
Parkinsonism
Looks similar to Parkison disease, with tremors, abnormal gait, and bradykinesia.
Treat with anticholinergics or propranolol if tremor is the main symptom
Tardive dyskinesia
Abnormal facial movements, primarily in the tongue or mouth; TD can be irreversible.
Must stop drug and replace with an SGA with low EPS risk (quetiapine, clozapine)
Dyskinesias
Abnormal movements, more common with dopamine replacement for Parkinson disease
Medications That Can Cause Psychotic Symptoms
Anticholinergic Dextromethorphan Dopamine or dopamine agonists (requip, mirapex, sinemet) Interferons Stimulants (e.g amphetamines) Systemic steroids
Illicit Drugs That Can Cause Psychosis
Bath salts (synthetic cathinones, MDPV) Cannabis Cocaine Lysergic acid diethylamide (LSD) Meth, Ice, Crystal Phencyclidine (PCP)
Thioridazine Boxed Warnings
QT prolongation
1st Gen Antipsychotics Boxed Warning
Elderly patients with demetia-related psychosis have increased risk of death from antipsychotics
Haloperidol Class
butyrophenone
Haloperidol Decanoate
IM Q Monthly
1st gen Antipsychotics Warnings
- QT prolongation (thioridazine, haloperidol, chlopromazine), orthostasis/falls
- Anticholinergic effects
- CNS depression
- Extrapyramidal Symptoms
- Hyperprolactinemia
- Neuroleptic malignant syndrome
1st Gen Antipsychotics SE
- Sedation
- Dizziness
- Anticholinergic Effects
- EPS
Aripiprazole SE
Abilify Akathisia Activating Lower risk of weight gain Some QT prolongation EPS (in children)
Abilify Long-Acting
Maintena: IM Q month
Aristada: IM q4-8 weeks
Clozapine Boxed Warnings
Neutropenia/Agranulocytosis
Myocarditis and cardiomyopathy
Seizures
Clozapine SE
Agranulocytosis Seizures Constipation Metabolic Syndrome (Weight gain, increased BG, increased lipids) Hypersalivation
Clozapine REMS
To start TX ANC must be >1,500 Check ANC weekly for 6 months; Then every 2 weeks for 6 months; Then Monthly STOP if ANC <1,000
Lurasidone SE
Latuda Somnolence EPS (dystonias) Nausea Almost weight, lipid and BG neutral
Olanzapine SE
Zyprexa
Somnolence
Metabolic Syndrome (increased weight, BG and Lipids)
Zyprexa Relprev
Lasts 2-4 weeks
Boxed warnings: must be monitored for 3 hours after injection (REMS program)
Paliperidone SE
Invega
Increased prolactin
EPS (especially at higher doses)
Metabolic syndrome (increased weight, bg, lipids)
Invega sustenna
IM Q monthly
Invega Trinza
IM Q3 months
Start only after receiving sustenna for 4 months
