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A - NAPLEX > 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 drug class is used first line in schizophrenia & why

A

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

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7
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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8
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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9
Q

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

A

discontinued

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10
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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11
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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12
Q

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

A

stroke

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13
Q

First-generation antipsychotic MOA

A

work mainly by blocking dopamine-2 (D2) receptors

with minimal serotonin receptor blockade

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14
Q

Thioridazine boxed warning

A

QT prolongation

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15
Q

Which FGAs have a warning for QT prolongation

A

thioridazine

haloperidol

chlorpromazine

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16
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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17
Q

Side effects of FGAs

A

Sedation, dizziness, anticholinergic effects, increased prolactin, EPS

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18
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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19
Q

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

A

Lower

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20
Q

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

A

Higher

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21
Q

Haloperidol brand name

A

Haldol

Haldol Decanoate

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22
Q

Haldol Decanoate is given how often and via what route

A

IM monthly

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23
Q

Fluphenazine decanoate is given how often and via what route

A

IM every 2 weeks

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24
Q

Second generation antipsychotic MOA

A

work mainly by blocking dopamine-2 (D2) receptors

serotonin (5-HT2A) receptors

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25
Aripiprazole brand name
Abilify
26
Abilify Maintena is an IM suspension given every ____
month
27
Aristada (Abilify) is an IM suspension given every ____
4-6 weeks
28
Clozapine brand name
Clozaril Fazaclo ODT Versacloz suspension
29
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
30
Clozapine boxed warning
- Significant risk of potentially life-threatening neutropenia/agranulocytosis (REMS program) - Myocarditis and cardiomyopathy: d/c if suspected - Seizures
31
Clozapine side effects
Agranulocytosis seizures constipation metabolic syndrome (↑ weight, ↑ BG, ↑ lipids)
32
Abilify side effects
Akathisia (can’t sit still)
33
Which SGA requires REMS program
Clozapine
34
To start clozapine treatment, baseline ANC must be
>/= 1500/mm3
35
Clozapine therapy must be stopped if ANC falls below
1000/mm3
36
Lurasidone brand name
Latuda
37
lurasidone side effects
somnolence, EPS (dystonias), nausea ** Nearly weight, lipid and glucose neutral
38
Olanzapine brand name
Zyprexa Zyprexa Zydis ODT Zyprexa Relprevv injection
39
Zyprexa Relprevv injection suspension lasts ____
2-4 weeks
40
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)
3 hours
41
Olanzapine side effects
Somnolence metabolic syndrome (↑ weight, ↑ BG, ↑ lipids)
42
Paliperidone brand name
Invega Invega Sustenna Invega Trinza
43
How often is Invega Sustenna IM injection given
monthly
44
How often is Invega Trinza IM injection given and when should it be started
every 3 months start only after receiving Invega Sustenna x 4 months
45
Paliperidone side effects
- ↑ prolactin – sexual dysfunction, galactorrhea, irregular/missed periods - EPS, especially at higher doses - Metabolic syndrome (↑ weight, ↑ BG, ↑ lipids)
46
Quetiapine brand name
Seroquel
47
Quetiapine SE
- Somnolence, metabolic syndrome (↑ weight, ↑ BG, ↑ lipids) | - Low EPS risk- often used for psychosis in PD
48
When should Seroquel XR be taken and how
At night without food or with a light meal
49
Risperidone brand name
Risperdal Risperdal Consta
50
How often is Risperdal Consta IM injection given
every 2 weeks
51
Risperidone SE
- ↑ prolactin – sexual dysfunction, galactorrhea, irregular/missed periods - EPS, especially at higher doses - Metabolic syndrome (↑ weight, ↑ BG, ↑ lipids)
52
Ziprasidone brand name
Geodon
53
Should ziprasidone be taken with or without food
with food
54
Ziprasidone CI
QT prolongation: do not use with QT risk
55
What SGA comes as a sublingual tablet
Asenapine (Saphris)
56
Counseling for Asenapine (Saphris)
No food/drink for 10 min after dose
57
Asenapine (Saphris) side effect with SL tab
Tongue numbness
58
Which antipsychotics can cause increased prolactin, leading to painful gynecomastia
risperidone paliperidone
59
Which SGA can cause painful dystonia and tardive diskinesia
Haloperidol
60
Which SGAs have cardiac risk/QT prolongation
Ziprasidone haloperidol thioridazine chlorpromazine
61
Besides FGAs, which SGAs have high risk of EPS
Risperidone paliperidone (at high doses)
62
Which SGA should you give someone if they have history of movement disorder (e.g., Parkinson's Disease)
Quetiapine
63
Which SGAs worsen metabolic issues
olanzapine quetiapine
64
Which SGAs are preferred in overweight/metabolic risk (e.g., increased TG)
aripiprazole ziprasidone lurasidone (Latuda) asenapine (Saphris)
65
Which antipsychotics should be given in someone who has acute psychosis and refusing PO meds
Haloperidol IV or IM Alternatives: Ziprasidone IM Olanzapine IM
66
Which SGAs come as ODT
aripiprazole olanzapine risperidone
67
Which SGAs come as oral liquids
aripiprazole fluphenazine haloperidol risperidone
68
Which SGA comes as a patch
asenapine (Saphris)
69
Which SGAs can cause hyperglycemia and weight gain
olanzapine quetiapine risperidone paliperidone
70
Risperidone oral solution cannot be mixed with
Cola or tea
71
What is the first drug that has been approved for tardive diskinesia
Valbenazine (Ingrezza)
72
Valbenazine warnings
Somnolence
73
Deutetrabenzine, another drug approved for tardive diskinesia, has a CI for
Hepatic impairment
74
Neuroleptic malignant syndrome (NMS) is rare, but highly lethal. It occurs commonly with FGAs and is due to
D2 blockade
75
Signs of NMS include
- 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
76
How do you treat NMS
- 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

A - NAPLEX (83 decks)

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