General Psychiatry Flashcards
What are the different types of schizophrenia symptoms?
Positive (presence of something normally not there), negative (absence of something that should be there), Cognitive (dysfunctions of higher level thinking).
What order of symptoms can medications treat for schizophrenia?
Positive–> Negative–>Cognitive
What is the response rate of symptoms to treatment?
Top 3: Combativeness, Tension and hyperactivity,hallucinations–>Bottom 3: Realistic planning, judgment, insight (anosognosia).
What to know about FGAs?
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).
What to know about SGAs?
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.
Which SGAs have the highest weight gain potential?
Clozapine and Olanzapine, then FGAs, then Quetiapine.
Which SGAs have the lowest weight gain potential?
Lurasidone, Aripiprazole, Cariprazine.
Which SGAs affect glucose intolerance most?
Clozapine and Olanzapine, asenapine, iloperidone, aripiprazole is lowest.
Which SGAs have the highest movement disorder risk?
Cariprazine, Aripiprazole, Lurasidone, Risperidone
Which SGAs have the lowest movement disorder risk?
Clozapine, Quetiapine, Brexpiprazole
Which SGAs have the highest sedation risk?
Clozapine, Olanzapine, Quetiapine
Which SGAs have the lowest sedation risk?
Aripirazole, Brexipiprazole, Cariprazine
What SGA is associated with Agranulocytosis?
Clozapine
Which SGAs have DRESS (drug related eosinophila and systemic symptoms)?
Olanzapine, Ziprasidone
Which SGAs cause hyperprolactinemia?
Paliperidone, Risperidone
Which SGAs cause hypersentivity reactions?
Asenapine, Cariprazine
Which SGAs cause pathological gambling and compulsive behavior?
Aripiprazole, Brexpiprazole
Which SGAs cause seizures?
Cariprazine, Clozapine
Which SGAs cause dose-dependent decrease in thyroid hormone levels?
Quetiapine
What are the treatment guidelines for schizophrenia?
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
What to know about Clozapine?
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.
What are the long acting injectables?
Aripiprazole, Fluphenazine, Haloperidol, Olanzapine (REMS drug), Paliperidone, Risperidone.
Which SSRI has the longest half life?
Fluoxetine
Which SSRIs is activating?
Fluoxetine, sertraline
Which SSRI is sedating?
Paroxetine
Which SSRIs are neutral?
citalopram, escitalopram
Which SSRI are 2D6 inhibitors?
fluoxetine, paroxetine
Which SSRI is a QTC pprolongation risk?
Citalopram at 40 mg
Which SSRI is category D in pregnancy?
Paroxetine
What to know about buproprion?
Activating and weight decrease
What to know about desvenlafaxine?
Neutral on sleep and weight gain
What to know about Vilazodone?
Activating and Neutral on weight gain but must be taken with food
Which Anti-depressants help counteract weight loss?
Mirtazapine, paroxetine, TCAs
Which anti-depressants help counteract weight gain?
bupropion, duloxetine, SSRIs (besides paroxetine), venlafaxine
Which antidepressants help counteract insomnia?
mirtazapine, TCAs, paroxetine, trazodone
Which antidepressants help counteract hypersomnia?
Bupropion, duloxetine, fluoxetine, sertaline, vilazodone
Which antidepressants help counteract suicidal ideation?
NOT TCAs, avoid bupropion, use SSRIs
Which antidepressants help with neuropathic pain?
duloxetine, TCAs (amitriptyline, desipramine, nortriptyline)
Which antidepressants help in pregnancy?
SSRIs (fluoxetine, sertraline) NOT paroxetine
