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Therapeutics 3 Kappa Epsilon > Exam 3 - Schizophrenia (Watts/Ott) > Flashcards

Exam 3 - Schizophrenia (Watts/Ott) Flashcards

1
Q

what are the positive symptoms

A

hallucinations
delusions
bizarre behavior
thought disorders

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2
Q

what are the negative symptoms

A

blunted emotion
poor self care
social withdrawal
poverty in speech

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3
Q

Cognitive symptoms involve ______ receptors and _____ receptors

A

D1 receptors; Glutamate Receptors

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4
Q

what neurotransmitters are to be involved in schizophrenia

A

dopamine
serotonin
glutamate

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5
Q

do positive or negative symptoms respond better to drug therapy

A

positive!

negative has like no response

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6
Q

what 5HT receptor is known as the mediator for hallucinations

A

5HT 2A

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7
Q

5HT2A receptors modulate _______ release in the cortex, limbic region, and striatum

A

dopamine

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8
Q

5HT2A receptors modulate dopamine release in what area?

A

cortex, limbic region, and striatum

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9
Q

5HT2A receptors modulate _______ release and ______ receptors

A

glutamate; NMDA

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10
Q

what kind of agents can exacerbate symptoms of schizophrenia

A

dopaminergic

L-DOPA, Amphetamine, Bromocriptine

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11
Q

what is the major receptor antagonized by antipsyhchotics

A

dopamine!

MAINLY D2

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12
Q

newer antipsychotics also antagonize what receptor?

A

serotonin

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13
Q

what are other (aka minor) receptors that antipsychotics antagonize?

A

NE, ACh, Histamine

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14
Q

most antipsychotic drugs are (agonist, partial agonist, or antagonist?)

A

Antagonist!!

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15
Q

D1 or D2 receptors have more correlation b/w binding potency and clinical effectiveness

A

D2!!

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16
Q

when D2 antagonism occurs in the basal ganglia — what effects are seen?

A

EPS/motor effects

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17
Q

what are symptoms of EPS

A

dystonia
pseudoparkinsonism
tremor
aktahisia

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18
Q

what is akathisia

A

restlessness

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19
Q

what is dystonia

A

increase muscle tone

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20
Q

are EPS symptoms form antipsychotics reversible?

A

yes

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21
Q

when do EPS symptoms occur when an antipsychotic is started

A

days to weeks

early on!

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22
Q

what are symptoms of tardive dyskinesia?

A

rhythmic involuntary movements
irregular purposelessness
athetoid (worm like)
axial hyperkinesias (to and fro)

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23
Q

are tardive dyskinesia symptoms form antipsychotics reversible?

A

no!

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24
Q

when do tardive dyskinesia symptoms occur when an antipsychotic is started

A

later!

months to a year

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25
Q

what is NMS side effect from antipsychotic?

A

neuroleptic malignant syndrome
serious/rapid (fatality)
(EPS + Fever)

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26
Q

Antipsychotic drugs take about how long for effectiveness?

A

2- 3 weeks

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27
Q

Antipsychotic drugs take about how long for maximal effectiveness

A

6 weeks to 6 months…

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28
Q

ADE’s of Antipsychotics: Autonomic

when Muscarinic cholinoreceptors are blocked what are the manifestations?

A

dry mouth
difficulty urinating
constipation
loss of accommodation (eye)

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29
Q

ADE’s of Antipsychotics: Autonomic

when alpha adrenergic blockade occurs what are the manifestations?

A

orthostasis hypotension
impotence
failure to ejaculate

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30
Q

ADE’s of Antipsychotics: CNS

when dopamine receptor blockade occurs — what are the manifestations?

A

parkinson’s syndrome
aktahasia
dystonia

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31
Q

ADE’s of Antipsychotics: CNS

if supersensitvity of dopamine receptors occur — what is the manifestation?

A

tardive dyskinesia

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32
Q

ADE’s of Antipsychotics: CNS

if muscarinic blockade happens - what is the manifestation? (CNS!!*)

A

toxic - confusional state

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33
Q

ADE’s of Antipsychotics: CBS

if histamine receptors are blocked - what is the clinical manifestation?

A

sedation

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34
Q

ADE’s of Antipsychotics: Endocrine System

what is the manifestation when dopamine receptors are blocked (causing hypoerprolactonemia)

A

ameorrhea
galactorhea
infertility
impotence

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35
Q

ADE’s of Antipsychotics:

when combined H1 and 5HT(2C) blockade occurs — what is the manifestation

A

weight gain

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36
Q

which drug was the first typical antipsychotic?

A

chlorpromazine

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37
Q

Key Points for Chlorpromazine?

Watts Table

A

1st antipsychotic

antihistamine side effects

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38
Q

Key Points for Promethazine

Watts Table

A

antihistamine

antiemetic

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39
Q

Key Points for Thioridazine

Watts Table

A

Anticholinergic
sedation
sexual dysfunction
cardiovascular

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40
Q

Key Points for Fluephenazine

Watts Table

A

EPS

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41
Q

Key Points for Prochlorperazine

Watts Table

A

Antiemetic

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42
Q

Key Points for Perphenazine

Watts Table

A

CATIE Studies =

Combo w/ anticholinergic vs newer agents

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43
Q

Key Points for Thiothixene

Watts Table

A

modest EPS

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44
Q

Key points for haloperidol

Watts Table

A

EPS

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45
Q

Key Points for Molindone

Watts Table

A

moderate EPS

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46
Q

Key Points for Pimozide

Watts Table

A

used for tourette’s disease, suppress motor and vocal tics

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47
Q

what drug was the first atypical antipsychotic

A

clozapine

48
Q

biggest side effect with clozapine

A

agranulocytosis

49
Q

Clozapine & Agranulocytosis

occurs when?

A

1 -2 % get it first 6 mos

50
Q

why is aripiprazole’s MOA so different?

A

partial agonist at 5HT(1A) (and D2?)

aka a receptor involved in depression

51
Q

what drugs are partial D2/D3 agonist

A

Brexpiprazole

Cariprazine

52
Q

key points for clozapine (watts table)

A

1st atypical antipsychotic
agranulocytosis
risk of diabetes

53
Q

key points for Olanzapine (watts table)

A

weight gain

risk of diabetes

54
Q

key points for quetiapine (watts table)

A

metabolite w/ antidepressant activity
hypotension
sedation

55
Q

key points for risperdone (watts table)

A

5HT2A/D2 receptor antagonist

56
Q

key points for ziprasidone (watts table)

A

5HT2A/D2/alpha1 affinity

prolongs QT interval

57
Q

key points for Lurasidone (watts table)

A

5HT2A/D2
reduced metabolic effects
rapid titration

58
Q

key points for Aripiprazole (watts table)

A

high 5HT2A/D2 affinity

partial agonist activity

59
Q

Key Features that define psychotic disorders

A 
delusions
hallucinations
disorganized thinking
disorganized abnormal motor behavior
negative
60
Q

what drugs can hasten the onset of schizophrenia/exacerbate symptoms, AND reduce time to relapse

A

marijuana
cocaine
amphetamines

61
Q

oral antipsychotic therapy or IM depot drug treatment is first line?

A

oral is first line

62
Q

Aripiprazole: long or short half life?

A

long

63
Q

Aripiprazole - P450 interactions?

A

2D6 and 3A4 substrate

64
Q

T or F: LAIs of Aripriprazole need dosing adjustment if given with 2D6/3A4 inhibitors or 3A4 inducers

A

truuuue

65
Q

T or F: Aripiprazole does not need oral overlap with LAI?

A

FALSE!! need overlap the Ability Maintena and Aristada

66
Q

Aripiprazole Oral/LAI Overlap:
Abilify Maintena needs ______ overlap
and
Aristada needs _____ overlap

(how long of overlap?)

A

Maintena: 2 - weeks

Aristada: 3 - weeks

67
Q

Asenapine:

what formulation only?

A

sublingual

68
Q

Asenapine: P450 interaction?

A

1A2

69
Q

Asenapine: Clinical Considerations?

A

QT prolonging
metallic tasta/unit dose packaging
smoking decrease concentration
caffeine can increase concentration

70
Q

Brexpiprazole: once or twice daily dosing?

A

once

71
Q

Brexpiprazole or Aripiprazole?

which one has a higher incidence of akathisia

A

Aripiprazole

72
Q

Brexpiprazole: P450 interactions?

A

2D6 and 3A4 substrate

just like aripiprazole

73
Q

Brexpiprazole Clinical Considerations?

A

P450 2D6 or 3A4 substrates
once daily dosing
Max Dose 4 mg (or 3mg if severe hepatic dysfunction or CrCl < 60 mL/min)

74
Q

Cariprazine: P450?

A

3A4 substrate

75
Q

Cariprazine: Max dose?

A

6 mg QD

76
Q

Cariprazine: higher doses mean higher risk of _______ but not _______

A

akathisia risk increases

higher doses does NOT lead to more efficacy

77
Q

Cariprazine: dose adjustments?

A

not recommended in severe hepatic impairment or CrCl < 30 mL/min

78
Q

Side Effects of Clozapine?

A 
AGRANULOCYTOSIS
cardiomyopathy
hypersalivation
hypotension
metabolic syndrome
QT prolongation
constipation
sedation
79
Q

which drugs has to have REMS program

A

Clozapine

80
Q

what is the monitoring requirements for Clozapine

A

ANC weekly x 6 mos
ANC biweekly x 6 mos
then
every 4 weeks forever

81
Q

Iloperidone ADEs?

A

boxed warning for QT prolongation
orthostatic hypotension!!
slow dose titration

82
Q

Iloperidone: once or twice daily dosing?

A

TWICE Daily!!

83
Q

Iloperidone P450 interactions?

A

2D6 and 3A4 substrate

84
Q

Lurasidone: once or daily dosing?

A

once daily

85
Q

usual max dose of Lurasidone

A

160 mg

86
Q

for Lurasidone dosing: if moderate hepatic impairment or CrCl < 50 mL/min: max dose?

A

80 mg

87
Q

for Lurasidone dosing: if severe hepatic impairment what is the max dose?

A

40 mg

88
Q

Olanzapine: once or twice daily dosing?

A

both..

89
Q

Olanzapine: best time to take the medication?

A

bedtime — because sedation

90
Q

ADEs of olanzapine?

A

sedation
hyperglycemia/hyperlipidemia
metabolic syndrome
anticholinergic ADEs at higher doses

91
Q

P450 of Olanzapine?

A

1A2 substrate

92
Q

what two meds MUST be taken with food (to improve bioavailability)

A

Lurasidone

Ziprasidone

93
Q

what drugs are 1A2 substrates

A

Olanzapine
Asenapine
Clozapine

94
Q

which drugs have renal or hepatic dosing adjustments

A

brexpiprazole
cariprazine
lurasidone
(paliperidone - is renal only)

95
Q

what drug will have a ghost capsule?

A

Paliperidone

96
Q

Paliperidone — what are the IM formulations available?

A

Invega Sustenna

Invega Trinza

97
Q

Paliperidone —-
Invega Sustenna given IM every _____ weeks
Invega Trinza given IM every _____ weeks

A

sustenna: q 4 weeks
trinza: q 12 weeks

98
Q

Paliperidone —

can only do Invega Trinza if ???

A

patient has been stable Invega Sustenna 4 stable maintenance doses

99
Q

Risperidone: has higher risks of what?

A

EPS and hyperprolactinemia

100
Q

P450 interaction for risperdone?

A

2D6

101
Q

which drug has 2D6 interactions only?

A

risperidone

102
Q

Ziprasidone usually ______ dosing but can be ___

A

usually twice; can be once

103
Q

Clinical Considerations of Ziprasidone?

A

twice daily
MUST TAKE WITH FOOD
QT prolongation
Dress warning

104
Q

what is the drug Pimavanserin used for?

A

“antipsychotic” for parkinson patients having hallucinations

105
Q

ADEs for pimavanserin

A

peripheral edema
confusional states
nausea
rare angioedema

106
Q

Clozapine and REMS:

patients can start the drug if their ANC level is greater than ________

A

1500 /uL

107
Q

what IM drugs are oil based

A

Fluphenazine

Haloperidol

108
Q

what drug has to be refrigerated and reconstituted

A

Risperdal Consta

109
Q

what drug can have PDSS from IM injection

A

Zyprexa Relprevv

110
Q

what is PDSS

A

post dose delirium sedation syndrome

monitor for 3 hours after dose

111
Q

4 main types of EPS

A

Acute Dystonia
Drug Induced Parkinson’s
Akathisia
Tardive Dyskinesia (

112
Q

how to treat acute dystonia

A

IM anticholinergic now

can do 50 mg of benadryl

113
Q

who is at highest risk for acute dystonia

A

young, black, male

114
Q

how to treat akathisisa

A 
beta blocker (propranolol)
BZD - prn dosing
Oral anticholinergic (not too effective)
try to lower dose of antipsychotic if possible
115
Q

how to treat tardive dyskinesia

A

lower antipsychotic dose if possible,

DO NOT GIVE ANTICHOLINERGICS

Therapeutics 3 Kappa Epsilon (20 decks)

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