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BCPS > General Psychiatry > Flashcards

General Psychiatry Flashcards

1
Q

What are the different types of schizophrenia symptoms?

A

Positive (presence of something normally not there), negative (absence of something that should be there), Cognitive (dysfunctions of higher level thinking).

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2
Q

What order of symptoms can medications treat for schizophrenia?

A

Positive–> Negative–>Cognitive

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3
Q

What is the response rate of symptoms to treatment?

A

Top 3: Combativeness, Tension and hyperactivity,hallucinations–>Bottom 3: Realistic planning, judgment, insight (anosognosia).

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4
Q

What to know about FGAs?

A

Binds to D2 receptor, Movement disorders (acute dystonias, akathisia, pseudo-parkinsonism (EPS), Tardive dyskinesias. Also off-target binding (more common in low potency agents)–> Anticholinergic, histaminergic (sedation, orthostasis:alpha-blockade).

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5
Q

What to know about SGAs?

A

Activity at 5-Ht receptors in addition to dopaminergic activity. Side effect profile more heterogenous, Less EPS. Increased risk of metabolic effects, weight gain, diabetes mellitus, dyslipidemias.

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6
Q

Which SGAs have the highest weight gain potential?

A

Clozapine and Olanzapine, then FGAs, then Quetiapine.

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7
Q

Which SGAs have the lowest weight gain potential?

A

Lurasidone, Aripiprazole, Cariprazine.

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8
Q

Which SGAs affect glucose intolerance most?

A

Clozapine and Olanzapine, asenapine, iloperidone, aripiprazole is lowest.

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9
Q

Which SGAs have the highest movement disorder risk?

A

Cariprazine, Aripiprazole, Lurasidone, Risperidone

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10
Q

Which SGAs have the lowest movement disorder risk?

A

Clozapine, Quetiapine, Brexpiprazole

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11
Q

Which SGAs have the highest sedation risk?

A

Clozapine, Olanzapine, Quetiapine

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12
Q

Which SGAs have the lowest sedation risk?

A

Aripirazole, Brexipiprazole, Cariprazine

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13
Q

What SGA is associated with Agranulocytosis?

A

Clozapine

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14
Q

Which SGAs have DRESS (drug related eosinophila and systemic symptoms)?

A

Olanzapine, Ziprasidone

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15
Q

Which SGAs cause hyperprolactinemia?

A

Paliperidone, Risperidone

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16
Q

Which SGAs cause hypersentivity reactions?

A

Asenapine, Cariprazine

17
Q

Which SGAs cause pathological gambling and compulsive behavior?

A

Aripiprazole, Brexpiprazole

18
Q

Which SGAs cause seizures?

A

Cariprazine, Clozapine

19
Q

Which SGAs cause dose-dependent decrease in thyroid hormone levels?

A

Quetiapine

20
Q

What are the treatment guidelines for schizophrenia?

A

1st line- most prefer SGAs (some exclude olanzapine due to metabolic effects, some include FGAs)

2nd line - SGA or FGA (only an FGA if an SGA was tried first), some include clozapine

3rd line - Clozapine is 3rd line (exception if patient is suicidal), this is good for treatment resistant

21
Q

What to know about Clozapine?

A

1st SGA considered to be Atypical. Indicated to reduce suicidal thoughts, preferred in treatment resistant schizophrenia, intensive monitoring program required. Agranulocytosis–> Every week for 1st 6 months, ANC <1000, interrupt treatment, ANC <500, stop, don’t rechallenge.

22
Q

What are the long acting injectables?

A

Aripiprazole, Fluphenazine, Haloperidol, Olanzapine (REMS drug), Paliperidone, Risperidone.

23
Q

Which SSRI has the longest half life?

A

Fluoxetine

24
Q

Which SSRIs is activating?

A

Fluoxetine, sertraline

25
Q

Which SSRI is sedating?

A

Paroxetine

26
Q

Which SSRIs are neutral?

A

citalopram, escitalopram

27
Q

Which SSRI are 2D6 inhibitors?

A

fluoxetine, paroxetine

28
Q

Which SSRI is a QTC pprolongation risk?

A

Citalopram at 40 mg

29
Q

Which SSRI is category D in pregnancy?

A

Paroxetine

30
Q

What to know about buproprion?

A

Activating and weight decrease

31
Q

What to know about desvenlafaxine?

A

Neutral on sleep and weight gain

32
Q

What to know about Vilazodone?

A

Activating and Neutral on weight gain but must be taken with food

33
Q

Which Anti-depressants help counteract weight loss?

A

Mirtazapine, paroxetine, TCAs

34
Q

Which anti-depressants help counteract weight gain?

A

bupropion, duloxetine, SSRIs (besides paroxetine), venlafaxine

35
Q

Which antidepressants help counteract insomnia?

A

mirtazapine, TCAs, paroxetine, trazodone

36
Q

Which antidepressants help counteract hypersomnia?

A

Bupropion, duloxetine, fluoxetine, sertaline, vilazodone

37
Q

Which antidepressants help counteract suicidal ideation?

A

NOT TCAs, avoid bupropion, use SSRIs

38
Q

Which antidepressants help with neuropathic pain?

A

duloxetine, TCAs (amitriptyline, desipramine, nortriptyline)

39
Q

Which antidepressants help in pregnancy?

A

SSRIs (fluoxetine, sertraline) NOT paroxetine

BCPS (21 decks)

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