Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Integrated Drug Structure, Action, and Therapeutics > Dr. Aebi's Schizophrenia and Bipolar Disorder > Flashcards

Dr. Aebi's Schizophrenia and Bipolar Disorder Flashcards

1
Q

TAP

A

typical antipsychotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

FGA

A

first generation antipsychotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the treatment goals of schizophrenia treatment?

A
  • Decrease symptoms
  • increase quality of life (minimize adverse effects from treatment)
  • encourage adherence
  • decrease hospitalizations/health care $
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Out of the FGAs, what reduces positive symptoms the best?

A

All FGAs reduce positive symptoms at equivalent doses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How the FGAs handle negative symptoms?

A

Do not reduce negative symptoms well.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the general positives and negatives to FGA treatment?

A

EPS is a higher risk, as well as anticholinergic SEs

Lower risk for metabolic syndrome/weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do SGAs handle positive and negative symptoms of schizophrenia?

A

Handles positive symptoms well (but not as good as FGAs) and has moderate efficacy at reducing negative symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the benefits in using SGAs over FGAs?

A
  • Possible effect on increasing cognition (hits serotonin receptors: 5HT7 Lurasidone)
  • Less EPS because of 5HT2 antagonism in nigrostriatal dopamine pathway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the disadvantage in using SGAs over FGAs?

A

Higher risk for weight gain/metabolic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some negative symptoms in schizophrenia?

A

Depression, apathy, anhedonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is D2 affinity related to potency in FGAs?

A

The higher the D2 affinity, the more potent the drug is.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the range for effectiveness in affinity of the drug for dopamine receptor?

A

60% to see effectiveness. higher than 80% you start seeing AEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How are FGAs dosed?

A

Dosed based on chlorpromazine equivalents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the normal range of CPZ equivalents?

A

300-1000mg CPZ equivalents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In the FGAs, what do the drugs with low mg strength also have?

A

Higher potency, higher D2 affinity, high EPS, low sedation, and low anticholinergic effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In FGAs, what do the drugs with the high mg strength also have?

A

lower potency, lower EPS risk, lower D2 affinity, higher sedation, higher anticholinergic SEs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What drugs have lower mg strength?

A

Haloperidol, Fluphenazine, trifluoroperazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What drugs have high mg strength?

A

Thioridazine, chlorpromazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What drug is used for tourette’s?

A

pimozide and delusional parasitosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Out of the SGAs, which has the lowest risk of EPS?

A

clozapine and quetiapine. Also, olanzasine, ziprasidone, and asenapine have low risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which has the highest sedation of the SGAs?

A

also clozapine and quetiapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which has the highest hypotension risks? The lowest hypotension risks?

A

Clozapine has the highest hypotension risk, lurasidone and ziprasidone the least.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which has the most weight gain SE’s of the SGAs? The least?

A

most: clozapine and olanzapine
least: aripiprazole, asenapine, risperidone, and ziprasidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which SGA has the lowest sedation?

A

Aripiprazole, lurasidone, paliperidone, risperidone, ziprasidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which SGAs have QT prolongation problems?

A

paliperidone, olanzapine, quetiapine, risperidone, ziprasidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which SGA’s do not have many QT problems?

A

asenapine, lurasidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which SGAs increase prolactin levels the most?

A

olanzapine, paliperidone, risperidone, lurasidone, and ziprasidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the best way to reduce side effects?

A

Start low, titrate slowly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the main long-term side effects to watch out for?

A

Metabolic syndrome
QT prolongation
Prolactin increase
EPS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When do EPS show up in FGAs? SGAs?

A

FGAs: 6-12 months
SGAs: 1.5-2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When do you use clozapine?

A

After failing 2 previous antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Treatment guidelines: What is recommended with first episode psychosis?

A

SGA: risperidone, quetiapine, aripiprazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Treatment guidelines: What is recommended with acute severe psychosis? (positive symptoms)

A

Haldol: FGA - good for positive symptoms
Olanzapine: SGA - strong M, H1 receptors for sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Treatment guidelines: What meds do you choose for lifelong maintenance if you are younger? Why?

A

SGA (less EPS, less sedation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Treatment guidelines: What meds do you choose for lifelong maintenance if you are middle-aged?

A

SGA or FGA (more weight gain, diabetes in SGA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Treatment guidelines: treatment resistant? What drug?

A

FGA or clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Treatment guidelines: Pregnancy?

A

clozapine or lurasidone: category B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the special considerations with Lurasidone and ziprasidone?

A

Must be taken with a full meal (350-500 calories)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the special considerations with cardiac concerns? What should you avoid?

A

Ziprasidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the most common EPS symptom with SGAs?

A

Akathisia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What happens if you reach risperidone doses of higher than 6mg?

A

Increased EPS risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is akathisia?

A

A movement disorder characterized by the need to be in constant motion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What follow-up do you need if you are taking clozapine?

A

Weekly lab draws
REMs
Baseline WBC/ANC levels must be met prior to administration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is neutropenia?

A

An abnormally low number of neutrophils. <1500uL (whites) or <1200 (middle east)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What has a risk of neutropenia?

A

Clozapine has a high risk of this and agranulocytosis, as well as all FGAs and SGAs. Usually seen 4 weeks to 4 months of use.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is considered leukopenia?

A

WBC < 4000/uL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How long does it take to classify someone as a non-responder?

A

4-6 weeks

12 weeks for clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How long does it take to see the full effects of antipsychotics?

A

12 weeks

up to 6 months for clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

When would you switch meds sooner?

A

If there was acute relapse danger

50
Q

How often should you check HbAlc and blood glucose on SGAs?

A

Quarterly

51
Q

How is clozapine metabolized?

A

Using CYP 1A2, 3A4 ( and 2D6)

52
Q

What non-drug habits can interfere with CYP 1A2?

A

cigarette smoking is a strong 1A2 inducer. So is caffeine

53
Q

What is the main benefit of injectable APs?

A

They can improve adherence to medications

54
Q

What is the main adverse effect of AP injectables?

A

If there is an adverse effect, you cannot retrieve the drug out of the body.

55
Q

What is preferred, oral or injectable?

A

Oral first.

56
Q

What is the preferred route in AP injectables?

A

Gluteal usually over deltoid

57
Q

long-acting medication: what two decanoate medications are there?

A

Fluphenazine and haloperidol

58
Q

What meds are Maintenna and Aristada?

A

Abilify

59
Q

What is the longest dosing interval?

A

6 weeks at 882mg for ability Aristada

60
Q

What medication is Consta?

A

Risperidone Consta

61
Q

What medication is Sustenna?

A

Paliperidone

62
Q

What tablets are used to test if paliperidone Sustenna is is tolerated?

A

risperidone

63
Q

What medical conditions may precipitate mania?

A 
Stroke
Traumatic Brain Injury
Epilepsy
HIV/AIDS
Lupus
B12 deficiency
Cushing's
Sleep deprivation
Light exposure
Extreme Stress
Wilson's Disease
64
Q

Drugs which may precipitate mania in a bipolar patient

A 
alcohol
bronchodilators
caffeine
cocaine
stimulants
steroids
TCAs
hallucinogens
Dopamine agonist
Pseudo ephedrine
Interferon
65
Q

What is bipolar I?

A

Manic and depressive episodes, classic bipolar.

66
Q

What is bipolar II?

A

Less severe manic episodes than I, same depressive episodes.

67
Q

What is cyclothymia?

A

chronic but milder form of bipolar disorder, characterized by episodes of hypomania and depression that last for at least two years.

68
Q

What are mixed episodes?

A

Where mania and depression occur simultaneously. may feel hopeless and depressed yet energetic and wanting to participate in risky behaviors.

69
Q

When are destructive times for patients?

A

Either in mania or depressive phase.

70
Q

What is rapid-cycling?

A

Bipolar individuals experience four or more episodes of mania, depression, or both within one year.

71
Q

What is classified as a manic phase?

A

At least 7 days of abnormally or persistently elevated or irritable mood. May alternate back and forth between the two.

72
Q

What symptoms may be part of a manic episode?

A 
Inflated self-esteem
Decreased need for sleep
Intensified speech
Rapid ideas
Distractibility
Increased goal-pursuit
Involvement in pursuits of pleasure with high risks of consequences
73
Q

What is a hypomanic episode?

A

A less intense manic episode.
Only required to be present for 4 days
impacts function
Observable by others

74
Q

What is valproate indicated for?

A

Mania or mixed

75
Q

What is carbamazepine indicated for?

A

Mania and mixed

76
Q

What is lamotrigine indicated for?

A

maintenance and depression

77
Q

What is lithium indicated for?

A

Mania and maintenance

78
Q

What is aripiprazole indicated for?

A

Mania, mixed, and maintenance

79
Q

What is quetiapine indicated for?

A

Mania and depression

80
Q

What is risperidone indicated for?

A

Mania and mixed

81
Q

What is olanzapine indicated for?

A

mania, mixed, maintenance

82
Q

What is olanzapine and fluoxetine indicated for?

A

depression

83
Q

what is ziprasidone indicated for?

A

mania and mixed

84
Q

What is step 1 for bipolar disorder?

A

Li, VPA, or SGA

Li or VPA + SGA

85
Q

What is step 2 for bipolar disorder?

A

Switch to another 1st line agent

Combination of any two: Li, VPA, or SGA

86
Q

What is step 3 for bipolar disorder?

A

Combination of any two: Li, VPA, SGA (not 2 SGAs or Cloak) CBZ, FGA, OXC

87
Q

What is the best treatment for hypomania/mania or psychotic mania?

A

Lithium, vaproate, aripirazole, quetiapine, risperidone or ziprasidone

88
Q

What is the best treatment for dysphoric or mixed episodes?

A

Divaproex, risperidone, aripiprazole or ziprasidone

89
Q

Secondary options for mania?

A
  • carbamazepine (many drug interactions)

- olanzapine (metabolic syndrome risk)

90
Q

What would be the most sedating if one wanted to quickly slow down a manic person threatening to cause harm?

A

Valproate

91
Q

Which has the best overall evidence for acute euphoric mania?

A

quetiapine

92
Q

If someone had a past history of cardiac myopathy or QT prolongation, which one(s) would you stay away from?

A

Stay away from quetiapine, risperidone, ziprasidone

93
Q

What has the best evidence for treating Bipolar II or severe bipolar I and depression?

A
  • If on lithium, add lamotrigine or quetiapine, then olanzapine with fluoxetine
  • If not on lithium, then add lamotrigine or QTP + antimanic
  • If not on lithium and has not had a recent or severe manic episode, may try lamotrigine by itself
  • May add on olanzasine or olanzasine + fluoxetine
94
Q

What drug interaction do you want to watch out for?

A

valproic acid plus lamotrigine

95
Q

What is wrong with antidepressants in mono therapy for bipolar disorder?

A

Not recommended in BPD I, and could cause a mania switch. Possibly appropriate in BPD II with mood stabilizer on board (lithium or lamotrigine), but evidence of improved stability is lacking.
- SSRI, SNRI, MAOI (phenelzine) suggested. No TCAs

96
Q

Later stages of bipolar disorder, or resistance treatment:

A
  • oxcarbazepine: watch for hyponatremia (na+)
  • Clozapine (treatment resistant cases only)
  • ECT - highly effective for acute mania
  • inhaled loxapine: indicated to treat acute agitation in bipolar I
97
Q

What is lithium indicated for?

A

Acute mania

Maintenance in BPD I and II

98
Q

What should serum levels be for lithium?

A

0.5-1 mEq/L

99
Q

What are prophylactic benefits of lithium useful for?

A

Episodes of mania rather than depression recurrence

100
Q

How does the suicide rate decrease with lithium use?

A

5-fold decrease in suicide rate compared with placebo

101
Q

What direct illness-modifying effect does lithium have?

A

A neuroprotective effect

102
Q

What are the adverse effects of lithium?

A 
Cognitive dulling
Tremor
Memory impairments
Weight gain
Polyuria
Hypothyroidism (30% longterm patients) - cause of Breakthrough depression
Leukocytosis: increases WBC
Pregnancy category D - cardiac malformations 1st trimester
103
Q

What do NSAIDs and lithium cause?

A

They cause increase lithium levels

104
Q

What other drugs cause increased lithium levels?

A

ACE inhibitors, thiazide diuretics

105
Q

What drug causes encephalopathy with lithium?

A

Haloperidol

106
Q

At what serum level does lithium toxicity occur?

A

At higher than 1.2, but symptoms can occur within normal range

107
Q

What symptoms occur with lithium toxicity?

A

GI upset, N&V, diarrhea, tremor, dystonia, hyperreflexia, ataxia, cardiac dysrhythmias, neurotoxicity, nephrotoxicity, dehydration

108
Q

At what lithium levels is dialysis required?

A

> 4 mEq/L

109
Q

If a person is on lithium and is dehydrated, what is the worry?

A

Lithium toxicity. Either way on the water can cause toxicity.

110
Q

What does taking haldol and lithium together increase the risk of?

A

Neurological disorders, especially encephalopathy

111
Q

What are some symptoms of encephalopathy?

A

weakness, fever, tremor, lethargy, fluctuating cognition, delirium, ataxia, rigor in extremities, akinesia.

112
Q

What test would you do to determine neurological impairment?

A

An EEG

113
Q

What would you do if neurologic impairment was an issue?

A

Usually stopping the medications will reverse the symptoms.

114
Q

What is the role of a pharmacist in lithium monitoring?

A
  • have patient go in for labs (low therapeutic index)
  • counseling: well hydrated, but avoid polydipsia, light snack with dose if cause, do not restrict sodium intake. Do not take NSAIDs, COX2 inhibitors, ACEs, or diuretics w/o telling MD. May experience light hand tremor, may go away.
  • Don’t stop taking med or interrupt therapy w/o MD
  • Notify MD if diarrhea, vomiting, unsteady gait, excessive urination, weak muscle onset, significant tremor, confusion, ataxia, slurred speech
  • don’t start antidepressant w/o psychiatrist
115
Q

Valproate: IR form, DR form, ER form

A

IR form: valproic acid TID
DR form: Divalproex BID
ER form: divalproex QD

116
Q

What are the therapeutic ranges of valproate?

A

50-125 mpg/L

117
Q

What are the side effects of valproate in acute and maintenance patients?

A
  • Increased sedation, nausea, vomiting, dizziness in acutely manic patients
  • Weight gain, reduced platelets and WBC, increased ammonia levels and alopecia in maintenance
118
Q

Lamotrigine:

  • usefulness
  • often used with?
  • Should not be used if…
  • Warnings:
A
  • bipolar disorder, limited anti-mania efficacy
  • often used with lithium
  • should not be used if history of severe or recent mania w/o antimanic on board
  • start low, go slow. Go slower with valproate.
  • SJS skin reaction, aseptic meningitis
119
Q

Olanzasine + fluoxetine:

  • Indications?
  • AE’s?
  • Take at what time of day?
A
  • Bipolar I associated depression and treatment resistant depression
  • AE’s: Hypotension, weight gain
  • Dosed at bedtime due to olanzapine sedation
120
Q

How can you treat hyperammonemic encephalopathy?

A

With lactulose, the gut can be cleared of ammonia before it is absorbed.

Integrated Drug Structure, Action, and Therapeutics (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions