Chapter 64: Schizophrenia/Psychosis Flashcards
Schizophrenia cause is multifactorial and includes altered brain structure and chemistry, primarily involving _____, ____ and _____
DA
serotonin
and glutamine
Common symptoms of schizophrenia
Hallucinations
Delusions
Disorganized thinking/behavior
Negative Signs and Symptoms of schizophrenia according to the DSM-5 include
- 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)
Positive Signs and Symptoms of schizophrenia according to the DSM-5 include
- 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
Antipsychotics primarily bock which receptors
DA and serotonin
What drug class is used first line in schizophrenia & why
Second-generation antipsychotics; they have a lower risk of extrapyramidal symptoms
Medications/illicit drugs that can cause psychotic symptoms
- 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
FGAs have a high incidence of EPS, including ____, ______, ______, and _____
- painful dystonias (muscle contractions)
- dyskinesias (abnormal movements)
- tardive dyskinesias (repetitive, involuntary movements such as grimacing and eye blinking)
- akathisia (restlessness, inability to remain still)
Tardive dyskinesias (TD) can be irreversible; the drug causing the TD should be ____
discontinued
Which two drugs should not be given together (i.e., in an injection) d/t risk of excessive sedation and breathing difficulty
Olanzapine and benzodiazepines
There is an increased risk of mortality when antipsychotics are used for ____ in elderly with dementia-related psychosis
agitation control
Several antipsychotics also carry a warning for an increased risk of ____ in patients with dementia
stroke
First-generation antipsychotic MOA
work mainly by blocking dopamine-2 (D2) receptors
with minimal serotonin receptor blockade
Thioridazine boxed warning
QT prolongation
Which FGAs have a warning for QT prolongation
thioridazine
haloperidol
chlorpromazine
Besides QT prolongation, what are other warnings for FGAs
orthostasis/falls
anticholinergic effects
CNS depression
EPS
hyperprolactinemia
neuroleptic malignant syndrome (NMS)
Side effects of FGAs
Sedation, dizziness, anticholinergic effects, increased prolactin, EPS
What medication class can you give with FGAs to limit/avoid painful dystonic reactions
Anticholinergics (e.g., benztropine, diphenhydramine)
(higher or lower) potency drugs have ↑ sedation and ↓ EPS
Lower
(higher or lower) potency drugs have ↓ sedation and ↑ EPS
Higher
Haloperidol brand name
Haldol
Haldol Decanoate
Haldol Decanoate is given how often and via what route
IM monthly
Fluphenazine decanoate is given how often and via what route
IM every 2 weeks
Second generation antipsychotic MOA
work mainly by blocking dopamine-2 (D2) receptors
serotonin (5-HT2A) receptors
Aripiprazole brand name
Abilify
Abilify Maintena is an IM suspension given every ____
month
Aristada (Abilify) is an IM suspension given every ____
4-6 weeks
Clozapine brand name
Clozaril
Fazaclo ODT
Versacloz suspension
Clozapine is very effective and has ↓ risk of EPS/TD, but used no sooner than ___ line due to severe SE potential (metabolic effects, neutropenia)
3rd
Clozapine boxed warning
- Significant risk of potentially life-threatening neutropenia/agranulocytosis (REMS program)
- Myocarditis and cardiomyopathy: d/c if suspected
- Seizures