Exam 4 - Ott Schizophrenia Flashcards by Alton Adams

Key features of Schizophrenia (5)

positiveSx:
-delusions
-hallucinations
-disorganized thoughts and speech
-disorganized or abnormal motor behavior
negative Sx

How well did you know this?

Not at all

Perfectly

Typical disease course in schizophrenia (3)

onset in late adolescence to early adulthood
men-late teens, early 20s
women-late 20s, early 30s

How well did you know this?

Not at all

Perfectly

Marijuana, cocaine, and amphetamine use can _____ the onset of schizophrenia, exacerbate symptoms, and ______ time to relapse

hasten, reduce

How well did you know this?

Not at all

Perfectly

considerations with antipsychotic drug therapy (6)
-no step therapy

doses per day
SE
previous drug therapy
cost
concomitant disease drug therapy
need for monitoring: labs? weight? ECG?

How well did you know this?

Not at all

Perfectly

most common antipsychotic agent used

haloperidol (ruotine and prn use)
-typical antipsychotic

How well did you know this?

Not at all

Perfectly

Which agents, atypical or typical, cause more EPS?

more EPS seen in higher potency typicals

How well did you know this?

Not at all

Perfectly

which is more effective for treating positive Sx, typical or atypical?

typical, however, they are more likely to worsen negative and cognitive Sx

How well did you know this?

Not at all

Perfectly

partial agonists (aripiprazole, brexpiprazole, cariprazine) have ______ for akathisia (increased/decreased)

increased

How well did you know this?

Not at all

Perfectly

partial agonists (aripiprazole, brexpiprazole, cariprazine) are approved for adjunct tx in _____ and come with a boxed warning for ________

depression, suicidal thinking

How well did you know this?

Not at all

Perfectly

aripiprazole considerations (3)

2D6 and 3A4 substrate
moderate akathisia
low weight gain

How well did you know this?

Not at all

Perfectly

brexpiprazole considerations (3)

2D6 and 3A4 substrate
moderate akathisia
low-moderate weight gain

How well did you know this?

Not at all

Perfectly

cariprazine considerations (3)

3A4 substrate
moderate akathisia
low-moderate weight gain

How well did you know this?

Not at all

Perfectly

the “pine’s” considerations (asenapine, clozapine, olanzapine, quetiapine) (4)

more 5HT2A antagonism, less D2 antagonism
less EPS
more weight gains
smoking is not a CI but still warn pts to be cautious

How well did you know this?

Not at all

Perfectly

asenapine considerations (3)

patch (q24h, rotate sites) and SL tab
1A2 substrate
QTc prolongation

How well did you know this?

Not at all

Perfectly

clozapine substrate

1A2 substrate

How well did you know this?

Not at all

Perfectly

clozapine boxed warnings

bradycardia, syncope, seizures, myocarditis, cardiomyopathy

How well did you know this?

Not at all

Perfectly

clozapine SE

sedation, weight gain (most of all of pines), constipation, hypersalivation, dry mouth, QTc prolongation

How well did you know this?

Not at all

Perfectly

olanzapine

1A2 substrate
significant weight gain and sedation
high risk metabolic syndrome
DRESS warning

How well did you know this?

Not at all

Perfectly

quetiapine

3A4 substrate
QTc prolongation
weight gain and sedation
boxed warning for suicidal ideation

How well did you know this?

Not at all

Perfectly

clozapine monitoring timelines for ANC (absolute neutrophil count) due to risk of infection

monitoring timelines weekly x 6 months, biweekly x 6 months, then every 4 weeks

How well did you know this?

Not at all

Perfectly

normal ANC level on clozapine

1500 per microliter

How well did you know this?

Not at all

Perfectly

Samidorphan (olanzapine/samidorphan combo product) acts on ______ receptors and can cause _______

opioid, opioid withdrawal

How well did you know this?

Not at all

Perfectly

the “done’s” (iloperidone, lurasidone, ziprasidone, risperidone, paliperidone)

D2 and 5HT2A antagonists
variable EPS and metabolic effects

How well did you know this?

Not at all

Perfectly

iloperidone considerations

high risk for orthostasis and syncope
QTc prolongation
2D6 substrate

How well did you know this?

Not at all

Perfectly

lurasidone considerations

3A4 substrate higher risk for akathisia warning for suicidal thoughts - adjunct for bipolar depression take with FOOD (to increase bioavailability)

ziprasidone considerations

QTc prolongation (CI) DRESS warning take with FOOD (to increase absorption and bioavailability) 3A4 substrate (less worry for interactions)

risperidone considerations

2D6 substrate SE: EPS, hyperprolactinemia, weight gain, sedation, orthostasis

paliperidone considerations (3)

renally eliminated - dose adjustments in renal impairment SE: EPS, hyperprolactinemia, weight gain, sedation, orthostasis QTc prolongation

lumateperone considerations (3)

low risk for weight gain or metabolic SE low risk for EPS or akathisia 3A4 substrate

Pimavanserin considerations (3)

FDA approved for tx of hallucinations or delusions in a pt with PD MOA: inverse agonist and antagonist at the 5HT2A receptor 3A4 substrate

warnings for all antipsychotics (5)

boxed warning: increased risk of death in elderly patients treated with antipsychotics for dementia metabolic AE EPS increased risk of falls

Risperdal Consta (risperidone) considerations (1)

MUST supplment with oral risperidone for first few weeks of treatment (until 3rd injection)

Perseris (risperidone) considerations (2)

abdominal injection every 4 weeks with 3A4 inducers use 120mg or oral supplmentation

Rykindo (risperidone) considerations (2)

every 2 weeks IM injection oral overlap is 1 week (compared to 3 with Risperdal Consta)

Uzedy (risperidone) considerations (2)

ab or upper arm SQ injection once a month or once every 2 months

Invega Sustenna (paliperidone) considerations (4)

loading dose, then booster, then every 4 weeks initial loading and booster doses must be given in deltoid to improve absorption no oral overlap caution in renal impairment

Invega Trinza (paliperidone) considerations (3)

may only be initiated for a pt who has been on stable monthly IM injection of Invega Sustenna for 4 injections (this one given q3months) deltoid administration recommended DO NOT USE in CrCl <50

Invega Hafyera (paliperidone) considerations (2)

glute injection only may be initiated after stable Invega Sustenna for 4 months or Invega Trinza for 1 month

Zyprexa Relprevv (olanzapine) considerations (1)

PDSS - post dose delirium sedation syndrome

Abilify Maintena (aripiprazole) considerations (2)

MUST overlap with oral for 14 days deltoid or glute injection

Abilify Asimtufii (aripiprazole) considerations (3)

q2months dosing glute injection oral aripiprazole overlap for 2 weeks

Aristada (aripiprazole leuroxil) considertions (1)

overlap with oral for 3 weeks

Aristada Initio considerations (2)

developed to avoid need for 21 day oral overlap avoid in pts who are 2D6 poor metabolizers or strong 3A4 or 2D6 inhibitors

IR antipsychotic injections for emergencies (3 drugs)

haloperidol - most common chlorpromazine fluphenazine

olanzapine IM immediate release cannot be given with ________ due to boxed warning for respiratory depression

benzodiazapine immediate release injections

EPS seen in schizophrenia (4)

acute dystonia Drug-induced PD akathisia tardive dyskinesia

acute dystonia tx strategy

IM anticholinergic NOW (benztropine 2mg, diphenhydramine 50mg)

drug induced PD tx strategy

oral anticholinergic (benztropine, trihexyphenidyl, diphenhydramine)

akathisia tx strategy

propranolol is 1st line lorazepam 2nd line

tardive dyskinesia tx strategy

VMAT inhibitors

tetrabenazine (Xenazine) valbenazine (Ingrezza) deutetrabenazine (Austedo)

valbenazine (Ingrezza)

2D6/3A4 substrate QTc prolongation

deutetrabenazine (Austedo)

2D6 substrate QTc prolongation

Neuroleptic Malignant Syndrome

life threatening medical emergency caused by dopamine blockade from antipsychotics hyperpyrexia, tachycardia, labile BP muscle rigidity may use antipsychotics again in the future (not CI)

Metabolic AE

hyperglycemia, hyperlipidemia, hypertension weight gain

rank the atypical antipsychotics from most metabolic AE to least

clozapine = olanzapine > quetiapine = risperidone = paliperidone = asenapine = iloperidone = cariprazine = brexpiprazole > ziprazidone = lurasidone = aripiprazole

Metabolic Monitoring - personal or fam Hx

assess at baseline, then yearly

Metabolic Monitoring - weight (BMI)

at baseline, 4 weeks, 8 weeks, 12 weeks, every 3 months

Metabolic Monitoring - waist circumference

at baseline, then yearly

Metabolic Monitoring - BP

at baseline, 12 weeks, then yearly

Metabolic Monitoring - FPG/A1c

at baseline, 12 weeks, then yearly

Metabolic Monitoring - fasting lipids

at baseline, 12 weeks, then every 5 years