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NAPLEX 2023 > Chapter 64: Schizophrenia/Psychosis > Flashcards

Chapter 64: Schizophrenia/Psychosis Flashcards

1
Q

Schizophrenia cause is multifactorial and includes altered brain structure and chemistry, primarily involving _____, ____ and _____

A

DA, serotonin, and glutamine

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2
Q

Common symptoms of schizophrenia

A

Hallucinations
Delusions
Disorganized thinking/behavior

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3
Q

Negative Signs and Symptoms of schizophrenia according to the DSM-5 include

A
  • Loss of interest in everyday activities
  • Lack of emotion (apathy)
  • Inability to plan or carry out activities
  • Poor hygiene
  • Social withdrawal
  • Loss of motivation (avolition)
  • Lack of speech (alogia)
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4
Q

Positive Signs and Symptoms of schizophrenia according to the DSM-5 include

A
  • Hallucinations: can be auditory (hearing voices), visual or somatic
  • Delusions: beliefs held by the patient that are without a basis in reality
  • Disorganized thinking/behavior
  • Difficulty paying attention
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5
Q

Antipsychotics primarily bock which receptors

A

DA and serotonin

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6
Q

What are dystonias?

treatment/ppx?

A

prolonged contractions of muscels during drug initiation
life-threatening if airway is compromised

centrally acting anticholinergics (diphenhydramine/benztropine)

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7
Q

What is akathisia?

how to treat

A

restlessness wth anxiety and an inability to remain still

treated iwth BZD or propranolol

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8
Q

What is parkinsonism?

how to treat

A

looks like parkisons (tremors, abnormal gait, bradykinesia)

treat with anticholinergics or propranolol (for tremor)

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9
Q

What is tardive dyskinesias?

treatment

A

abnormal facial movements (tongue/mouth)
can be irreversible

STOP drug, replace with SGA with lower EPS risk (quetiapine / clozapine)

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10
Q

What are dyskinesias?

A

abnormal movements
common with dopamine replacement in parkinson disease

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11
Q

What drug class is used first line in schizophrenia & why

A

Second-generation antipsychotics (SGA); they have a lower risk of extrapyramidal symptoms

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12
Q

Medications/illicit drugs that can cause psychotic symptoms

A
  • Anticholinergics (centrally-acting, high doses)
  • Dextromethorphan
  • DA or DA agonists (e.g., Requip, Mirapex, Sinemet)
  • Interferons
  • Stimulants
  • Systemic steroids
  • Illicit drugs include bath salts, cannabis, cocaine, LSD, methylphenidate/ice/crystal, PCP
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13
Q

FGAs have a high incidence of EPS, including ____, ______, ______, and _____

A
  • painful dystonias (muscle contractions)
  • dyskinesias (abnormal movements)
  • tardive dyskinesias (repetitive, involuntary movements such as grimacing and eye blinking)
  • akathisia (restlessness, inability to remain still)
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14
Q

Tardive dyskinesias (TD) can be irreversible; the drug causing the TD should be ____

A

discontinued

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15
Q

Which two drugs should not be given together (i.e., in an injection) d/t risk of excessive sedation and breathing difficulty

A

Olanzapine and benzodiazepines

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16
Q

There is an increased risk of mortality when antipsychotics are used for ____ in elderly with dementia-related psychosis

A

agitation control

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17
Q

use of antipsychotics in elderly patietns with dementia-related psychosis can lead to

A

increased risk of mortality –> CV conditions

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18
Q

Several antipsychotics also carry a warning for an increased risk of ____ in patients with dementia

A

stroke

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19
Q

First-generation antipsychotic MOA

A

work mainly by blocking dopamine-2 (D2) receptors, with minimal serotonin receptor blockade

many are in phenothiazine class = “azine” ending

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20
Q

Thioridazine boxed warning

A

QT prolongation

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21
Q

Which FGAs have a warning for QT prolongation

A

thioridazine, haloperidol, chlorpromazine

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22
Q

Besides QT prolongation, what are other warnings for FGAs

A

orthostasis/falls, anticholinergic effects, CNS depression, EPS, hyperprolactinemia, neuroleptic malignant syndrome (NMS)

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23
Q

Side effects of FGAs

A

Sedation, dizziness, anticholinergic effects, increased prolactin, EPS

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24
Q

What medication class can you give with FGAs to limit/avoid painful dystonic reactions

A

Anticholinergics (e.g., benztropine, diphenhydramine)

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25
Q

(higher or lower) potency drugs have ↑ sedation and ↓ EPS

A

Lower

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26
Q

(higher or lower) potency drugs have ↓ sedation and ↑ EPS

A

Higher

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27
Q

Haloperidol brand name

A

Haldol

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28
Q

Haldol Decanoate is given how often and via what route

A

IM monthly

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29
Q

what class is haloperidol in structurally?

A

butyrophenone

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30
Q

Fluphenazine decanoate is given how often and via what route

A

IM every 2 weeks

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31
Q

Second generation antipsychotic MOA

A

work mainly by blocking dopamine-2 (D2) receptors & serotonin (5-HT2A) receptors

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32
Q

Aripiprazole brand name

A

Abilify

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33
Q

Abilify Maintena is an IM suspension given every ____

A

month

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34
Q

Aristada (Abilify) is an IM suspension given every ____

A

4-8 weeks

35
Q

Clozapine brand name

A

Clozaril

36
Q

Clozapine is very effective and has ↓ risk of EPS/TD, but used no sooner than ___ line due to severe SE potential (metabolic effects, neutropenia)

A

3rd

37
Q

Clozapine boxed warning

A
  • Significant risk of potentially life-threatening neutropenia/agranulocytosis (REMS program)
  • Myocarditis and cardiomyopathy: d/c if suspected
  • Seizures
38
Q

Clozapine side effects

A

Agranulocytosis, seizures, constipation, metabolic syndrome (↑ weight, ↑ BG, ↑ lipids), hypersalivation

39
Q

Abilify side effects

A

Akathisia, activating

40
Q

Which SGA requires REMS program

A

Clozapine

41
Q

To start clozapine treatment, baseline ANC must be

how often to check ANC

A

≥ 1500/mm3

baseline, qweek x 6 months, q2weeks x 6 months, then monthly

42
Q

Clozapine therapy must be stopped if ANC falls below

A

< 1000/mm3

43
Q

Lurasidone brand name

A

Latuda

44
Q

Lurasidone side effects

A

Somnolence, EPS (dystonias), nausea

- Nearly weight, lipid and glucose neutral

45
Q

Olanzapine brand name

A

Zyprexa

46
Q

Zyprexa Relprevv injection suspension lasts ____

A

2-4 weeks

47
Q

Zyprexa Relprevv injection can cause sedation (including coma) and delirium following injection & must be administered in a registered healthcare facility. Patients must be monitored for ____ post-injection (REMS program requirements)

A

3 hours

48
Q

Olanzapine side effects

A

Somnolence, metabolic syndrome (↑ weight, ↑ BG, ↑ lipids)

49
Q

Paliperidone brand name

A

Invega, Invega Sustenna (monthly), Invega Trinza (q3mo), Hafyera (q6mo)

50
Q

How often is Invega Sustenna IM injection given

A

monthly

51
Q

How often is Invega Trinza IM injection given and when should it be started

A

every 3 months; start only after receiving Invega Sustenna x 4 months

tri = three

52
Q

How often is Invega Hafyera IM injection given?

A

every 6 months

hafyera = Half a year

53
Q

Paliperidone side effects

A
  • ↑ prolactin – sexual dysfunction, galactorrhea, irregular/missed periods
  • EPS, especially at higher doses
  • Metabolic syndrome (↑ weight, ↑ BG, ↑ lipids)
54
Q

Quetiapine brand name

A

Seroquel

55
Q

Quetiapine SE

A
  • Somnolence, metabolic syndrome (↑ weight, ↑ BG, ↑ lipids)

- Low EPS risk- often used for psychosis in PD

56
Q

When should Seroquel XR be taken and how

A

At night, without food or with a light meal

57
Q

Risperidone brand name

A

Risperdal, Risperdal Consta (q2weeks)

58
Q

How often is Risperdal Consta IM injection given

A

every 2 weeks

59
Q

Risperidone SE

A
  • ↑ prolactin – sexual dysfunction, galactorrhea, irregular/missed periods
  • EPS, especially at higher doses
  • Metabolic syndrome (↑ weight, ↑ BG, ↑ lipids)
60
Q

Ziprasidone brand name

A

Geodon

61
Q

Should ziprasidone be taken with or without food

A

with food

Zip past the pantry and get some food before taking

62
Q

Ziprasidone CI

A

QT prolongation: do not use with QT risk

63
Q

What SGA comes as a sublingual tablet

A

Asenapine (Saphris)

64
Q

Counseling for Asenapine (Saphris)

A

No food/drink for 10 min after dose
may cause tong numbness

65
Q

Which antipsychotics can cause increased prolactin, leading to painful gynecomastia

A

Risperidone, paliperidone

66
Q

Which SGA can cause painful dystonia and tardive diskinesia

A

Haloperidol

67
Q

Which SGAs have cardiac risk/QT prolongation

A

Ziprasidone, haloperidol, thioridazine, chlorpromazine

68
Q

Which SGAs have high risk of EPS

A

Risperidone, paliperidone (at high doses)

69
Q

Which SGA should you give someone if they have history of movement disorder (e.g., Parkinson’s Disease)

A

Quetiapine

70
Q

Which SGAs worsen metabolic issues

A

Olanzapine, quetiapine

71
Q

Which SGAs are preferred in overweight/metabolic risk (e.g., increased TG)

A

Aripiprazole, Ziprasidone, lurasidone, and asenapine

72
Q

Which antipsychotics should be given in someone who has acute psychosis and refusing PO meds

A

Haloperidol IV or IM

Alternatives:
Ziprasidone IM
Olanzapine IM

73
Q

Which SGAs come as ODT

A

Aripiprazole, olanzapine, risperidone

74
Q

Which SGAs come as oral liquids

A

Aripiprazole, fluphenazine, haloperidol, risperidone

75
Q

Which SGA comes as a patch

A

Asenapine

76
Q

Which SGAs can cause hyperglycemia and weight gain

A

Olanzapine, quetiapine, risperidone, and paliperidone

77
Q

Risperidone oral solution cannot be mixed with

A

Cola or tea

78
Q

What is the first drug that has been approved for tardive diskinesia

A

Valbenazine (Ingrezza)

79
Q

Valbenazine warnings

A

Somnolence

80
Q

Deutetrabenzine, another drug approved for tardive diskinesia, has a CI for

A

Hepatic impairment

81
Q

Neuroleptic malignant syndrome (NMS) is rare, but highly lethal. It occurs commonly with FGAs and is due to

A

D2 blockade

82
Q

Signs of NMS include

A
  • Hyperthermia
  • Extreme muscle rigidity (called “lead pipe” rigidity), which can lead to respiratory failure
  • Mental status changes
  • Other signs can include tachycardia, tachypnea, and BP changes
83
Q

How do you treat NMS

A
  • Taper off the antipsychotic quickly and consider another choice (quetiapine or clozapine)
  • Provide supportive care
  • Cool the pt down
  • Muscle relaxation with BZDs or dantrolene is sometimes used, as some cases may require a DA agonist such as bromocriptine

NAPLEX 2023 (88 decks)

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