Exam 3 - Schizophrenia Flashcards
What are indications for clozapine as a schizophrenia treatment? (2)
treatment resistance or suicidal
What antipsychotic is approved for sleep in non-psychiatric conditions?
NONE
Explain effect of dopamine antagonism of the nigrostriatal pathway?
movement disorders
Explain effect of dopamine antagonism of the mesolimbic pathway?
relief of psychosis
Explain effect of dopamine antagonism of the mesocortical pathway? (2)
akathisia, relief of psychosis
explain effect of dopamine antagonism of the tuberoinfundibular pathway?
increased prolactin
What are first generation antipsychotics? (6)
chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), perphenazine (Trilafon), thioridazine (Mellaril), thiothixene (Navane)
What are class related side effects of first generation antipsychotics? (5)
extrapyramidal symptoms (EPS), QTc prolongation, prolactin elevation, photosensitivity/tinged skin (blue-gray), orthostatic hypertension
What is a boxed warning for first and second generation antipsychotics?
dementia-related psychosis
What are second generation antipsychotics? (13)
aripiprazole (Abilify), asenapine (Saphris), brexiprazole (Rexulti), cariprazine (Vraylar), clozapine
Which SGAs are partial dopamine agonists? (2)
aripiprazole (Abilify) and brexiprazole (Rexulti)
What are AEs of aripiprazole (Abilify)? (3)
insomnia, akathisia, impulsivity
What formulations are available for aripiprazole (Abilify)?
tablet, solution, Mycite (app), initio injection, LAI
What are AEs of asenapine (Saphris)? (3)
QTc prolongation, anaphylaxis, skin reactions
What formulations are available for asenaphine (Saphris)?
SL tab, patch
Which SGAs have long half-lives (91hrs)? (2)
brexiprazole (Rexulti) and cariprazine (Vraylar)
What are AEs of brexiprazole (Rexulti)? (2)
akathisia, impulsivity
What formulations are available for brexiprazole (Rexulti)?
tablet
What are AEs for cariprazine (Vraylar)? (2)
metabolite accumulation, akathisia
What formulations are available for cariprazine (Vraylar)?
capsule
What are AEs for clozapine (Clozaril, Fazaclo)? (4)
metabolic, blood dyscrasias (REMS), QTc prolongation, seizure
What formulations are available for clozapine (Clozaril, Fazaclo)?
tablet, ODT, suspension
What are AEs for iloperidone (Fanapt)? (4)
orthostatic HTN, priapism, QTc prolongation, CYP inhibitor interactions
What formulations are available for iloperidone (Fanapt)?
tablet
What are AEs for lurasidone (Latuda)? (1)
neurologic ADRs (sedation), NO METABOLIC PROBLEMS
What formulations are available for lurasidone (Latuda)?
capsule
What are AEs for olanzapine (Zyprexa)? (5)
metabolic, post injection delirium/sedation (PDSS; REMS) with LAI, DRESS, QTc prolongation, anticholinergic effects
What formulations are available for olanzapine (Zyprexa)?
tablet, ODT, short acting IM, LAI
What are AEs for olanzapine + samidorphan (Lybalvi)? (2)
same as olanzapine, risk of opioid withdrawal
What formulations are available for olanzapine + samidorphan (Lybalvi)?
tablet
What are AEs for paliperidone (Invega)? (6)
QTc prolongation, GI obstruction, priapism, thrombotic thrombocytopenic purpura (TTP), antiemetic effects, tablet shells in feces
What formulations are available for paliperidone (Invega)?
tablet, LAI
What is the indication for pimavanserin (Nuplazid)?
hallucinations/delusions in Parkinson’s Disease
What are AEs for pimavanserin (Nuplazid)? (2)
renal function, QTc prolongation
What formulations are available for pimavanserin (Nuplazid)?
tablet
What are AEs for quetiapine (Seroquel)? (6)
metabolic, sedating (off-label use for insomnia INAPPROPRIATE), cataracts, hypothyroidism, QTc prolongation, anticholinergic effects
What formulations are available for quetiapine (Seroquel)?
tablet
What are AEs for risperidone (Risperidal)? (5)
prolactin elevation, EPS, priapism, thrombotic thrombocytopenic purpura (TTP), antiemetic effects
What formulations are available for risperidone (Risperidal)?
tablet, ODT, solution, LAI
What are AEs for ziprasidone (Geodon)? (4)
DRESS, SJS, QTc prolongation, priapism
What formulations are available for ziprasidone (Geodon)?
tablet, short acting injection
What is the treatment for individuals with first-break schizophrenia? (3)
aripiprazole (Abilify), risperidone (Risperidal), ziprasidone (Geodon)
What is the treatment for individuals restarting medications for schizophrenia?
any antipsychotic except clozapine or previously tried APS that worked poorly
What are indications for early use of clozapine? (3)
severely suicidal, EPS, history of violence/substance abuse
When may clozapine be considered for use as a monotherapy regularly?
Patients that fail other APS
Which FGAs have the lowest and highest EPS risk, respectively?
lowest = thioridazine (Mellaril) and chlorpromazine (Thorazine), highest = haloperidol (Haldol) and fluphenazine (Prolixin)
Which FGAs have the lowest and highest anticholinergic risk, respectively?
lowest = haloperidol (Haldol) and fluphenazine (Prolixin), highest = thioridazine (Mellaril) and chlorpromazine (Thorazine)
What is the indication for dexmedetomidine (Igalmi)?
acute agitation in adults with schizophrenia and bipolar disorders
What is the MOA for dexmedetomidine (Igalmi)?
alpha-2 adrenergic receptor agonist
What are the LAI FGAs? (2)
fluphenazine (Prolixin), haloperidol (Haldol)
What are the LAI SGAs? (4)
aripiprazole (Abilify), risperidone (Risperidal), paliperidone (Invega), olanzapine (Zyprexa)
Which SGAs are most likely to cause weight gain? (3)
olanzapine (Zyprexa), quetiapine (Seroquel), and clozapine (Clozaril, Fazaclo)
Explain acute dystonias?
painful prolonged muscle contractions, involuntary facial and oculogyric movements, may involve back or legs
Explain pseudo-parkinsonism?
bradykinesia, tremors, cogwheel rigidity and pill rolling, postural abnormalities
Explain akathisia?
restlessness, pacing/shuffling, complusitory motions, subjective feelings of distress
Explain tardive dyskinesia?
tongue thrusting, chewing, lip smacking, grimacing, limb twisting, rocking
What is the treatment for acute dystonia?
anticholinergics, IM benzodiazepines
What is the treatment for pseudo-parkinsonism?
anticholinergics
What is the treatment for akathisia?
beta blockers
What is the treatment for tardive dykinesia?
prevention
What is the treatment for neuroleptic malignant syndrome (NMS)?
discontinue offending APS and give dopamine agonists
What is the MOA of VMAT2s?
reversible reductions in dopamine release and availability to hypersensitive postsynaptic receptors
What are the VMAT2s? (2)
valbenazine (Ingrezza) and deutetrabenazine (Austedo)