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IC10 Flashcards

1
Q

symptoms of Schizophrenia

A

See DSM-4 criteria (pg10)

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2
Q

1st-line antipsychotics for psychosis treatment

A

Suitable non-clozapine antipsychotic (FGA or SGA)

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3
Q

When to use clozapine

A

failed ≥ 2 adequate trials of different antipsychotics (at least 1 should be a SGA)

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4
Q

methods to overcome poor treatment
adherence

A
  • IM long-acting injections
  • Community Psychiatric Nurse – home visit and administer LAI regularly
  • Patient and Family (Caregiver) Education
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5
Q

affective disorder means

A

mood disorders (e.g. psychotic depression)

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6
Q

Schizophrenia: Primary pathophysiological abnormality may occur in one of various neurotransmitters: ______

A

dysregulation of dopaminergic (DA), serotonergic (5HT) and glutamatergic functions

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7
Q

Drugs/ substances that could induce psychosis

A

alcohol, benzodiazepines, barbiturates, antidepressants, corticosteroids, CNS stimulants, Hallucinogens, BB, dopamine agonists

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8
Q

How often should MSE be performed?

A

Every visit / every time u see the patient

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9
Q

What non-pharm therapy can reduce auditory hallucinations?

A

Repetitive Transcranial Magnetic Stimulation

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10
Q

What is Electroconvulsive Therapy (ECT) reserved for?

A

treatment-resistant Schizophrenia

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11
Q

Is LT treatment necessary aft 1st episode of psychosis?

A

Yes

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12
Q

How long does relapse occur after cessation of treatment?

A

often delayed for several weeks, as Adipose tissues act as depot reservoir after chronic regular usage of antipsychotics

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13
Q

How do antipsychotics help with schizophrenia?

A

They relieve symptoms of psychosis such as thought disorder, hallucinations and delusions, and prevent relapse

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14
Q

Dopamine blockade in___ of the anterior pituitary leads to hyperprolactinemia

A

Tuberoinfundibular (TI) Tract

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15
Q

Overactivity in ____ is responsible for positive symptoms of Schizophrenia.

A

mesolimbic tract

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16
Q

MOA of antipsychotics

A

Blocks dopamine receptors in mesolimbic tract

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17
Q

Which tract is responsible for higher-order thinking and executive functions?

A

Mesocortical tract

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18
Q

Dopamine blockade/ hypofunction in mesocortical tract results in _____

A

negative symptoms

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19
Q

Which tract modulates body movement?

A

Nigrostriatal tract

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20
Q

Dopamine blockade in nigrostriatal tract results in ____

A

extrapyramidal side effects

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21
Q

Antagonism of M1 receptor results in ____

A

Anticholinergic effects

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22
Q

Antagonism of alpha 1 receptor results in ____

A

Orthostasis

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23
Q

Antagonism of H1 receptor results in _____

A

Sedation

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24
Q

Antagonism of 5-HT2c receptor results in ____

A

Weight gain

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25
How long is the trial for non-clozapine antipsychotic?
At least 2-6 weeks at optimal therapeutic dose
26
How long is the trial for clozapine?
Up to 3 months
27
How long is the trial for antipsychotic added to clozapine?
Up to 8-10 weeks
28
What to consider when selecting an antipsychotic for the patient?
- past response/ failure - efficacy - side effect
29
What to monitor patients for those on clozapine?
Mandatory routine hematological monitoring
30
When to check ECG for schizo patients?
1. Has CV risk factors 2. Hx of CVD 3. Admitted as inpatient as naiive to antipsychotics
31
Contraindication for antipsychotic
QTc prolongation
32
Precaution to use of antipsychotic
– Parkinson's (incr ESPE) – Prostatic hypertrophy – Angle-closure glaucoma – Severe respiratory disease – Elderly w dementia (incr risk of mortality & stroke)
33
Dose for lorazepam in acute agitation tx
1-2mg
34
Possible tx for acute agitation (if pt cooperative)
1. Oral lorazepam 2. Oral antipsychotics (haloperidol, risperidone, quetiapine, olanzapine)
35
Possible tx for acute agitation (if pt un-cooperative)
1. IM lorazepam 2. IM Olanzapine (space 1h from IM lorazepam) 3. IM haloperidol (consider use of anticholinergic) 4. IM promethazine (cause sedation)
36
Tx for catatonia (frozen in thoughts)
Benzodiazepines: IM/PO lorazepam
37
tmax of antipsychotics
mostly 1-3h (except Brexpiprazole, Olanzapine, Aripiprazole)
38
t1/2 of antipsychotics
long t1/2 (can give once daily dosing), except some
39
Risk when consolidating doses
Hypotension & seizures
40
Initiation dose for haloperidol
0.5 – 3 mg BD or TDS or 3 – 5 mg BD or TDS (severe symptoms)
41
Usual adult dose for haloperidol
5-15mg
42
Max dose for haloperidol
20 mg (oral)
43
Max dose for CLOZAPINE
900mg
44
Starting dose for CLOZAPINE
12.5 mg ON/BD (day 1), 25-50 mg ON (day 2), increase gradually if well tolerated in steps of 25-50 mg/day
45
Starting dose for OLANZAPINE
10mg/day
46
Usual dose for OLANZAPINE
5-20mg
47
Max dose for QUETIAPINE
800 mg
48
Starting dose for RISPERIDONE
2mg/day in 1 -2 divided doses
49
Usual dose for RISPERIDONE
2-6mg
50
Max dose for RISPERIDONE
16mg/day
51
Major metaboliser of risperidone
CYP2D6
52
Active metabolite of risperidone
Paliperidone (9-hydroxy)
53
Examples of long-acting IM antipsychotics inj
Haloperidol decanoate, risperidone long-acting, paliperidone prolonged-release
54
Dystonia clinical presentation
Muscle spasm e.g. oculogyric crisis, torticollis
55
Which antipsychotic has a high potency?
Haloperidol
56
Management for dystonia
IM anticholinergic e.g. benztropine, diphenhydramine
57
Who has higher risk of developing Pseudo-parkinsonism?
Elderly females, those with previous neurological damage (e.g. head injury, stroke)
58
Management of Pseudo-parkinsonism
1. Reduce antipsychotic dose, or switch to SGA 2. Anticholinergic PRN
59
Akathisia clinical presentation
Restlessness
60
Which ESPE have a late onset?
Tardive dyskinesia
61
Tardive dyskinesia clinical presentation
Uncontrollable orofacial movements
62
Anticholinergic drugs worsen which ESPE?
Tardive dyskinesia
63
Management for hyperprolactinemia
-decr FGA dose -Dopamine agonist (e.g. amantadine, bromocriptine) -Switch to Aripiprazole
64
Antipsychotics with high risk of metabolic SE
Olanzapine, clozapine
65
Antipsychotics with lower risk of metabolic SE
Aripiprazole, Lurasidone, haloperidol, Ziprasidone
66
Signs of Neuroleptic malignant syndrome (NMS)
Muscle rigidity, fever, autonomic dysfunction (incr PR, labile BP, diaphoresis), altered consciousness, incr CK
67
Management for NMS
-IV Dantrolene 50mg TDS, oral dopamine agonist (e.g. amantadine, bromocriptine), supportive measures. -Switch to SGA
68
When to discontinue antipsychotic for haematological disturbances?
WBC<3x10^9/L or ANC<1.5x10^9/L
69
Which drug req ECG monitoring
Ziprasidone
70
Monitoring freq for WBC and ANC for clozapine
Weekly for first 18 weeks, then monthly
71
Monitoring freq for EPSE exam
-Weekly for 1st 2 weeks after initiation new antipsychotic or until dose stabilized -Low-risk patients: FGA q6 months;SGA q12 months -High-risk patients: FGA: q3 months; SGA q12 months
72
Monitoring freq for BP
3 months after initiating SGA then annually
73
Monitoring freq for lipid panel
-Low-risk patients: q2-5 years -High-risk patients: (3 months after initiating SGA), q6 months
74
Monitoring freq for BMI
-Weekly for 1st six weeks or every visit (at least monthly x 3 months for SGA) x 6 months -q3 months when dose stabilized
75
Monitoring freq for waist circumference
- every visit x 6 months, then annually
76
Monitoring freq for Fasting Blood Sugar
-Low-risk patients: annually -High-risk patients: 4 months after initiating new antipsychotic (or 3 months after initiating SGA), then annually
77
Preferred antipsych for pregnancy & what to monitor
Olanzapine,Clozapine,to watch for gestational diabetes
78
Preferred antipsych for breastfeeding
Olanzapine or Quetiapine
79
Can clozapine be used for breastfeeding?
patients on Clozapine should continue on the drug and not breastfeed
80
Preferred antipsych in renal impairment & what to avoid
Oral Aripiprazole preferred; Avoid sulpiride and Amisulpride
81
Preferred antipsych in hepatic impairment
Sulpiride, Amisulpride preferred
82
How to monitor effectiveness for therapy
MSE
83
Time course of tx response
1st wk: decr agitation 2nd-4th wk: decr paranoia, hallucination 6-12 wk: decr delusion, -ve sx may improve 3-6 months: cognitive sx may improve with SGA
84
Which type of SGA generally have more sedation/ weight gain SE?
-ines e.g. clozapine, olanzapine, quetiapine
85
____ antagonism can help improve negative sx
5HT2A

PR3153 (17 decks)

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