Exam 3: Schizo Flashcards
Schizophrenia vs. Schizoaffective
Affective has a mood component
Schizophrenia dx
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
Which antipsychotics have a strong sedating effect?
First gen
- chlorpromazine
- thioridazine
Second gen
- clozapine
- quetiapine
Which antipsychotics are most likely to cause EPS?
First gen: all of them
- chlorpromazine
- fluphenazine
- haloperidol
- perphenazine
- thioridazine
- thiothixene
Second gen
- paliperidone
- risperidone
Which antipsychotics are the most anticholinergic?
First gen:
- chlorpromazine
- thioridazine
Second gen
- clozapine
Which antipsychotics are the most likely to cause orthostasis?
First gen:
- chlorpromazine
- thioridazine
Second gen
- clozapine
- iloperidone - avoid in old people
Which antipsychotics are the most likely to cause weight gain?
First gen:
- chlorpromazine
Second gen
- clozapine
- olanzapine
- quetiapine
Which antipsychotics are the most likely to cause an elevation in prolactin?
First gen: (all of them)
- chlorpromazine
- fluphenazine
- haloperidol
- perphenazine
- thioridazine
- thiothixene
Second gen
- paliperidone
- risperidone
Which antipsychotics are the most likely to cause CV AE?
First gen:
- chlorpromazine
- haloperidol
Second gen
- clozapine
- iloperidone
- ziprasidone
What is included in metabolic syndrome and which antipsychotics are most likely to cause metabolic syndrome
- hypertriglyceridemia
- hyperglycemia
- weight gain (waist circumfernce)
___ - clozapine
- olanzapine
- quetiapine (kinda)
Which antipsychotics are available as LAI
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
Which antipsychotics are available as short acting injections?
Second gen:
- olanzapine
- ziprasidone
Which antipsychotic is a NIOSH drug (much hazardous, needs full garbing)
ziprasidone
Which are the 2 highest potency antipsychotics?
fluphenazine
haloperidol
higher potency, higher risk for EPS
Antipsychotics as antidepressants
MUST BE IN CONJUNCTION WITH AN ACTUAL ANTIDEPRESSANTS
- aripiprazole
- brexipiprazole
- olanzapine (but must be with fluoxetine)
- quetiapine
Which antipsychotic has an APPROVED indication for agitation in Alzheimer’s patients?
Brexipiprazole
Clozapine missed dose >48 hrs
Must start the titrating process all over again
What is the benefit of olanzapine+samidorphan over olanzapine?
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
Which antipsychotic is available through the OROS delivery system and what are the implications of this?
Paliperidone PO
osmotic pump delivery, you’ll see the shell in your poo (dw, the med is working)
Which antipsychotic has NO DOPAMINE action, just serotonin?
Pimavavanserin
because it is just serotonin action, is only indicated for parkinson’s psychosis
EPS s/s and how to treat
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
Antipsychotics that can cause DRESS
- olanzapine
- ziprasidone
BBW for ALL antipsychotics
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
Which antipsychotic has opthalmic effects (cataracts AE)
Quetiapine
Clozapine special AE and DDI
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)
Which antipsychotics have the greatest QTc prolonging properties and after what point do we consider someone’s QTc prolonged?
450 mms
- chlopromazine
- thioridazine
- iloperidone
while these are the most prolonging, ALL antipsychotics are prolonging
General first gen antipsychotic AE
EPS
QTc prolongation
prolactin elevation
deramtologic
photosensitivity
blue-gray skin
orthostatic hypotension
altered thermoregulation
T/F: Second gen antipsychotic injections are better tolerated than first gen
True
the injectables for second gen are water based and hurt a lil less on injection
General second gen antipsychotic AE
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)
Aripiprazole formulations
- PO tab
- Soln
- initio inj (loading dose for LAI)
- LAI
Asenapine formulations
SL tab (do not eat/drink 10 min after taking)
topical patch
Brexiprzole formulations
PO tab - t1/2 of 91 hrs
Ariprazine formulations
PO cap
Which antipsychotics are associated with impulsivity?
Aripiprazole
Brexiprazole
Which antipsychotic is the gold standard for refractory illness (or soooner if suicidal risk)?
Clozapine
in most cases, clozapine isn’t ued untilafter 2 meds have already been trialed
Clozapine formulations
- PO tab
- ODT
- PO susp
Iloperidone formulations
PO tab
Lurasidone formulations
PO cap
Olanzapine formulations
PO tab
ODT
Short acting IM
LAI
Olanzapine+ samidorphan formulations
PO tab
Paliperidone formulations
PO tab (OROS delivery)
LAI
Pimvanserin formulatios
PO tab
Quetiapine formulations
PO tab (IR and XL)
Risperidone formulatiosn
- PO tab
- ODT
- Soln
- LAI
Ziprasidone formulations
- PO tab
- short acting inj
Approach to starting a pt on an LAI
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
Whcih antipsychotics are the more activating ones (least sedating)
Second gen:
- aripiprazole
- lurasidone
acute dystonias s/s
- 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)
pseudo-parkinsonism s/s
- bradykinesia
- tremmor
- pill rolling
- cogwheel rigidity
- postural and oral abnormalities
akathisia s/s
- restlessness
- pacing
- shuffling
- compulsion to stay in motion
- subjectie feelings of distress
tardive dyskinesia s/s
much stigma because it’s the face
- tongue thrusting, chewing
- lip smacking
- grimacing
- limb twisting
- rockign
neuroleptic maligant syndrome and antipsychotics and s/s
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
Smoking affects which antipsychotics?
- 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
Why do second gen antipsychotics have a greater chance of cardiometabolic AE?
has 5-HT2 effects (more so than dopamine)
fist gen is mostly D2
Which antipsychotics ahve the least weight gain
lurasidone
arirpiprazole
ziprasoidone
Which meds are most liekly to cause NMS
haloperidoel and flupheanzine (high dose FGAs
(tho all antipsychotics have a precaution for this)
