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701 > Exam 3: Schizo > Flashcards

Exam 3: Schizo Flashcards

1
Q

Schizophrenia vs. Schizoaffective

A

Affective has a mood component

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2
Q

Schizophrenia dx

A

Two or more of the following must be present for a significant portion of time during a 1 mo. period

  • Delusions
  • Hallucinations
  • Disorganzied speech
  • Grossly disorganzied
  • Negative symptoms - diminished emotional expression or avolition
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3
Q

Which antipsychotics have a strong sedating effect?

A

First gen
- chlorpromazine
- thioridazine

Second gen
- clozapine
- quetiapine

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4
Q

Which antipsychotics are most likely to cause EPS?

A

First gen: all of them
- chlorpromazine
- fluphenazine
- haloperidol
- perphenazine
- thioridazine
- thiothixene

Second gen
- paliperidone
- risperidone

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5
Q

Which antipsychotics are the most anticholinergic?

A

First gen:
- chlorpromazine
- thioridazine

Second gen
- clozapine

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6
Q

Which antipsychotics are the most likely to cause orthostasis?

A

First gen:
- chlorpromazine
- thioridazine

Second gen
- clozapine
- iloperidone - avoid in old people

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7
Q

Which antipsychotics are the most likely to cause weight gain?

A

First gen:
- chlorpromazine

Second gen
- clozapine
- olanzapine
- quetiapine

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8
Q

Which antipsychotics are the most likely to cause an elevation in prolactin?

A

First gen: (all of them)
- chlorpromazine
- fluphenazine
- haloperidol
- perphenazine
- thioridazine
- thiothixene

Second gen
- paliperidone
- risperidone

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9
Q

Which antipsychotics are the most likely to cause CV AE?

A

First gen:
- chlorpromazine
- haloperidol

Second gen
- clozapine
- iloperidone
- ziprasidone

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10
Q

What is included in metabolic syndrome and which antipsychotics are most likely to cause metabolic syndrome

A
  • hypertriglyceridemia
  • hyperglycemia
  • weight gain (waist circumfernce)
    ___
  • clozapine
  • olanzapine
  • quetiapine (kinda)
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11
Q

Which antipsychotics are available as LAI

A

First gen
- fluphenazine
- haloperidol

Second gen:
- aripiprazole
- olanzapine - only admin if there is life support near by d/t post injection delirum/sedation syndrome (PDSS); monitor for 3 hrs
- paliperidone
- risperidone

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12
Q

Which antipsychotics are available as short acting injections?

A

Second gen:
- olanzapine
- ziprasidone

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13
Q

Which antipsychotic is a NIOSH drug (much hazardous, needs full garbing)

A

ziprasidone

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14
Q

Which are the 2 highest potency antipsychotics?

A

fluphenazine
haloperidol

higher potency, higher risk for EPS

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15
Q

Antipsychotics as antidepressants

A

MUST BE IN CONJUNCTION WITH AN ACTUAL ANTIDEPRESSANTS

  • aripiprazole
  • brexipiprazole
  • olanzapine (but must be with fluoxetine)
  • quetiapine
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16
Q

Which antipsychotic has an APPROVED indication for agitation in Alzheimer’s patients?

A

Brexipiprazole

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17
Q

Clozapine missed dose >48 hrs

A

Must start the titrating process all over again

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18
Q

What is the benefit of olanzapine+samidorphan over olanzapine?

A

Samidorphan is an opioid system modulator (like naltrexone so don’t give in pts who need opioids) and is supposed to help reduce METABOLIC (weight, TGs, glucose, NOT EPS) effects of olanzapine

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19
Q

Which antipsychotic is available through the OROS delivery system and what are the implications of this?

A

Paliperidone PO

osmotic pump delivery, you’ll see the shell in your poo (dw, the med is working)

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20
Q

Which antipsychotic has NO DOPAMINE action, just serotonin?

A

Pimavavanserin

because it is just serotonin action, is only indicated for parkinson’s psychosis

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21
Q

EPS s/s and how to treat

A

dystonias - muscle contractions
- anticholinergics IV/IM (benadryl and benztropine) and IM benzos can help - want fast acting
- decrase dose or dc med

pseudo-parkinsonisms
- anticholinergics can help
- decrase dose or dc med

akathisia - anx and restlessness
- PO propranolol can help

tardive dyskinesia - permanent and hard to mask/hide
- dc med
- may try -benazines (VMAT2)
- do NOT use anticholinergics - will mask s/s delaying dx

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22
Q

Antipsychotics that can cause DRESS

A
  • olanzapine
  • ziprasidone
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23
Q

BBW for ALL antipsychotics

A

Dementia related psychosis, increased all cause mortality in pts with dementia

UNLESS the primary indication for usage is for an approved psychiatric use (e.g. schizophrenia), then ok to use
- would still avoid lurasidone though d/t increase ADR in pts with dementia/Lewy bodies/Parkinson’s

24
Q

Which antipsychotic has opthalmic effects (cataracts AE)

A

Quetiapine

25
Q

Clozapine special AE and DDI

A

AE
- salivation (despite it being very very very anticholinergic effects) - try scopolamine patches behind the ear to help reduce
- fatal constipation (because it is very very very anticholinergic)

DDI
- benzos - respiratory depression
- carbamazepine - will lower ANC (the lab value we monitor in REMS for clozapine)

26
Q

Which antipsychotics have the greatest QTc prolonging properties and after what point do we consider someone’s QTc prolonged?

A

450 mms

  • chlopromazine
  • thioridazine
  • iloperidone
    while these are the most prolonging, ALL antipsychotics are prolonging
27
Q

General first gen antipsychotic AE

A

EPS
QTc prolongation
prolactin elevation
deramtologic
photosensitivity
blue-gray skin
orthostatic hypotension
altered thermoregulation

28
Q

T/F: Second gen antipsychotic injections are better tolerated than first gen

A

True

the injectables for second gen are water based and hurt a lil less on injection

29
Q

General second gen antipsychotic AE

A

metabolic syndrome
- hypertriglyceridemia
- hyperglycemia
- weight gain (waist circumfernce)
QTc prolongation
blood dyscarsia/neutropenias → increased risk of infection (not dose related; clozapine is a big offender here)
lowers seisure threshold (pt more likely to have sezure)
anticholinergic effects
sedation
prolactin elevation (d/t dopamine blockade)

30
Q

Aripiprazole formulations

A
  1. PO tab
  2. Soln
  3. initio inj (loading dose for LAI)
  4. LAI
31
Q

Asenapine formulations

A

SL tab (do not eat/drink 10 min after taking)
topical patch

32
Q

Brexiprzole formulations

A

PO tab - t1/2 of 91 hrs

33
Q

Ariprazine formulations

A

PO cap

34
Q

Which antipsychotics are associated with impulsivity?

A

Aripiprazole
Brexiprazole

35
Q

Which antipsychotic is the gold standard for refractory illness (or soooner if suicidal risk)?

A

Clozapine

in most cases, clozapine isn’t ued untilafter 2 meds have already been trialed

36
Q

Clozapine formulations

A
  1. PO tab
  2. ODT
  3. PO susp
37
Q

Iloperidone formulations

A

PO tab

38
Q

Lurasidone formulations

A

PO cap

39
Q

Olanzapine formulations

A

PO tab
ODT
Short acting IM
LAI

40
Q

Olanzapine+ samidorphan formulations

A

PO tab

41
Q

Paliperidone formulations

A

PO tab (OROS delivery)
LAI

42
Q

Pimvanserin formulatios

A

PO tab

43
Q

Quetiapine formulations

A

PO tab (IR and XL)

44
Q

Risperidone formulatiosn

A
  • PO tab
  • ODT
  • Soln
  • LAI
45
Q

Ziprasidone formulations

A
  1. PO tab
  2. short acting inj
46
Q

Approach to starting a pt on an LAI

A

start them on the PO and estbalish tolerability of PO efore staretig LAI
- for paliperidone, since it is a metabolite of risperidone, can challenge with risperidone

47
Q

Whcih antipsychotics are the more activating ones (least sedating)

A

Second gen:
- aripiprazole
- lurasidone

48
Q

acute dystonias s/s

A
  • painful prolonged muscle contractions
  • involuntary
  • buccal and facial muscles, may involve back, arms, and legs
  • oculogyric (eyes roll into back of head and don’t unroll)
49
Q

pseudo-parkinsonism s/s

A
  • bradykinesia
  • tremmor
  • pill rolling
  • cogwheel rigidity
  • postural and oral abnormalities
50
Q

akathisia s/s

A
  • restlessness
  • pacing
  • shuffling
  • compulsion to stay in motion
  • subjectie feelings of distress
51
Q

tardive dyskinesia s/s

A

much stigma because it’s the face

  • tongue thrusting, chewing
  • lip smacking
  • grimacing
  • limb twisting
  • rockign
52
Q

neuroleptic maligant syndrome and antipsychotics and s/s

A

possible with all antipsychotics but is really most common with the high potency ones

s/s
- hyperpyrexia (fever)
- labile bp (autonomic dysfuntcion, change in hr, bp, rr)
- conufusion
- increased muscle tone

pts are at higher riks if dehdyrated or orgnaic mental disorder

53
Q

Smoking affects which antipsychotics?

A
  • olanzapine
  • clozapine

d/t CYP1A2 being induced from the smoke -> induces metabolism of olanzapine and clozapine -> higher dose of clozapine and olanzapine needed if pt smokes

54
Q

Why do second gen antipsychotics have a greater chance of cardiometabolic AE?

A

has 5-HT2 effects (more so than dopamine)

fist gen is mostly D2

55
Q

Which antipsychotics ahve the least weight gain

A

lurasidone
arirpiprazole
ziprasoidone

56
Q

Which meds are most liekly to cause NMS

A

haloperidoel and flupheanzine (high dose FGAs

(tho all antipsychotics have a precaution for this)

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