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PHM701 > Exam 3 - Schizophrenia > Flashcards

Exam 3 - Schizophrenia Flashcards

1
Q

What are indications for clozapine as a schizophrenia treatment? (2)

A

treatment resistance or suicidal

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2
Q

What antipsychotic is approved for sleep in non-psychiatric conditions?

A

NONE

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3
Q

Explain effect of dopamine antagonism of the nigrostriatal pathway?

A

movement disorders

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4
Q

Explain effect of dopamine antagonism of the mesolimbic pathway?

A

relief of psychosis

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5
Q

Explain effect of dopamine antagonism of the mesocortical pathway? (2)

A

akathisia, relief of psychosis

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6
Q

explain effect of dopamine antagonism of the tuberoinfundibular pathway?

A

increased prolactin

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7
Q

What are first generation antipsychotics? (6)

A

chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), perphenazine (Trilafon), thioridazine (Mellaril), thiothixene (Navane)

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8
Q

What are class related side effects of first generation antipsychotics? (5)

A

extrapyramidal symptoms (EPS), QTc prolongation, prolactin elevation, photosensitivity/tinged skin (blue-gray), orthostatic hypertension

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9
Q

What is a boxed warning for first and second generation antipsychotics?

A

dementia-related psychosis

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10
Q

What are second generation antipsychotics? (13)

A

aripiprazole (Abilify), asenapine (Saphris), brexiprazole (Rexulti), cariprazine (Vraylar), clozapine

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11
Q

Which SGAs are partial dopamine agonists? (2)

A

aripiprazole (Abilify) and brexiprazole (Rexulti)

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12
Q

What are AEs of aripiprazole (Abilify)? (3)

A

insomnia, akathisia, impulsivity

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13
Q

What formulations are available for aripiprazole (Abilify)?

A

tablet, solution, Mycite (app), initio injection, LAI

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14
Q

What are AEs of asenapine (Saphris)? (3)

A

QTc prolongation, anaphylaxis, skin reactions

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15
Q

What formulations are available for asenaphine (Saphris)?

A

SL tab, patch

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16
Q

Which SGAs have long half-lives (91hrs)? (2)

A

brexiprazole (Rexulti) and cariprazine (Vraylar)

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17
Q

What are AEs of brexiprazole (Rexulti)? (2)

A

akathisia, impulsivity

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18
Q

What formulations are available for brexiprazole (Rexulti)?

A

tablet

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19
Q

What are AEs for cariprazine (Vraylar)? (2)

A

metabolite accumulation, akathisia

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20
Q

What formulations are available for cariprazine (Vraylar)?

A

capsule

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21
Q

What are AEs for clozapine (Clozaril, Fazaclo)? (4)

A

metabolic, blood dyscrasias (REMS), QTc prolongation, seizure

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22
Q

What formulations are available for clozapine (Clozaril, Fazaclo)?

A

tablet, ODT, suspension

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23
Q

What are AEs for iloperidone (Fanapt)? (4)

A

orthostatic HTN, priapism, QTc prolongation, CYP inhibitor interactions

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24
Q

What formulations are available for iloperidone (Fanapt)?

A

tablet

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25
Q

What are AEs for lurasidone (Latuda)? (1)

A

neurologic ADRs (sedation), NO METABOLIC PROBLEMS

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26
Q

What formulations are available for lurasidone (Latuda)?

27
Q

What are AEs for olanzapine (Zyprexa)? (5)

A

metabolic, post injection delirium/sedation (PDSS; REMS) with LAI, DRESS, QTc prolongation, anticholinergic effects

28
Q

What formulations are available for olanzapine (Zyprexa)?

A

tablet, ODT, short acting IM, LAI

29
Q

What are AEs for olanzapine + samidorphan (Lybalvi)? (2)

A

same as olanzapine, risk of opioid withdrawal

30
Q

What formulations are available for olanzapine + samidorphan (Lybalvi)?

31
Q

What are AEs for paliperidone (Invega)? (6)

A

QTc prolongation, GI obstruction, priapism, thrombotic thrombocytopenic purpura (TTP), antiemetic effects, tablet shells in feces

32
Q

What formulations are available for paliperidone (Invega)?

A

tablet, LAI

33
Q

What is the indication for pimavanserin (Nuplazid)?

A

hallucinations/delusions in Parkinson’s Disease

34
Q

What are AEs for pimavanserin (Nuplazid)? (2)

A

renal function, QTc prolongation

35
Q

What formulations are available for pimavanserin (Nuplazid)?

36
Q

What are AEs for quetiapine (Seroquel)? (6)

A

metabolic, sedating (off-label use for insomnia INAPPROPRIATE), cataracts, hypothyroidism, QTc prolongation, anticholinergic effects

37
Q

What formulations are available for quetiapine (Seroquel)?

38
Q

What are AEs for risperidone (Risperidal)? (5)

A

prolactin elevation, EPS, priapism, thrombotic thrombocytopenic purpura (TTP), antiemetic effects

39
Q

What formulations are available for risperidone (Risperidal)?

A

tablet, ODT, solution, LAI

40
Q

What are AEs for ziprasidone (Geodon)? (4)

A

DRESS, SJS, QTc prolongation, priapism

41
Q

What formulations are available for ziprasidone (Geodon)?

A

tablet, short acting injection

42
Q

What is the treatment for individuals with first-break schizophrenia? (3)

A

aripiprazole (Abilify), risperidone (Risperidal), ziprasidone (Geodon)

43
Q

What is the treatment for individuals restarting medications for schizophrenia?

A

any antipsychotic except clozapine or previously tried APS that worked poorly

44
Q

What are indications for early use of clozapine? (3)

A

severely suicidal, EPS, history of violence/substance abuse

45
Q

When may clozapine be considered for use as a monotherapy regularly?

A

Patients that fail other APS

46
Q

Which FGAs have the lowest and highest EPS risk, respectively?

A

lowest = thioridazine (Mellaril) and chlorpromazine (Thorazine), highest = haloperidol (Haldol) and fluphenazine (Prolixin)

47
Q

Which FGAs have the lowest and highest anticholinergic risk, respectively?

A

lowest = haloperidol (Haldol) and fluphenazine (Prolixin), highest = thioridazine (Mellaril) and chlorpromazine (Thorazine)

48
Q

What is the indication for dexmedetomidine (Igalmi)?

A

acute agitation in adults with schizophrenia and bipolar disorders

49
Q

What is the MOA for dexmedetomidine (Igalmi)?

A

alpha-2 adrenergic receptor agonist

50
Q

What are the LAI FGAs? (2)

A

fluphenazine (Prolixin), haloperidol (Haldol)

51
Q

What are the LAI SGAs? (4)

A

aripiprazole (Abilify), risperidone (Risperidal), paliperidone (Invega), olanzapine (Zyprexa)

52
Q

Which SGAs are most likely to cause weight gain? (3)

A

olanzapine (Zyprexa), quetiapine (Seroquel), and clozapine (Clozaril, Fazaclo)

53
Q

Explain acute dystonias?

A

painful prolonged muscle contractions, involuntary facial and oculogyric movements, may involve back or legs

54
Q

Explain pseudo-parkinsonism?

A

bradykinesia, tremors, cogwheel rigidity and pill rolling, postural abnormalities

55
Q

Explain akathisia?

A

restlessness, pacing/shuffling, complusitory motions, subjective feelings of distress

56
Q

Explain tardive dyskinesia?

A

tongue thrusting, chewing, lip smacking, grimacing, limb twisting, rocking

57
Q

What is the treatment for acute dystonia?

A

anticholinergics, IM benzodiazepines

58
Q

What is the treatment for pseudo-parkinsonism?

A

anticholinergics

59
Q

What is the treatment for akathisia?

A

beta blockers

60
Q

What is the treatment for tardive dykinesia?

A

prevention

61
Q

What is the treatment for neuroleptic malignant syndrome (NMS)?

A

discontinue offending APS and give dopamine agonists

62
Q

What is the MOA of VMAT2s?

A

reversible reductions in dopamine release and availability to hypersensitive postsynaptic receptors

63
Q

What are the VMAT2s? (2)

A

valbenazine (Ingrezza) and deutetrabenazine (Austedo)

PHM701 (14 decks)

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