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Fall P2 > IDT - Schizophrenia, Bipolar Aebi > Flashcards

IDT - Schizophrenia, Bipolar Aebi Flashcards

1
Q

SGA

A

Second Generation Antipsychotic (newer, atypical)

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2
Q

FGA

A

First Generation Antipsychotics (older, typical)

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3
Q

Treatment Goals for Schizophrenia

A 
Decrease Symptoms
Increase Quality of Life
- minimize AE
Encourage Adherence
Decrease Hospitalization/cost
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4
Q

First Generation Antipsychotics

A

Reduce Positive symptoms
No effect on negative symptoms
Increase EPS
Less risk for Metabolic Syndrome

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5
Q

Second Generation Antipsychotics

A

Reduce Positive symptoms
Moderate efficacy at reducing negative symptoms
Possible effect on increased cognition
Less EPS

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6
Q

What Considerations should be taken with FGA dosing?

A

Potency

  • related to D2 occupancy/affinity
  • Higher D2 affinity associated with ‘stronger’ potency
  • Dosed on CPZ equivalents
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7
Q

What considerations should be taken with SGA dosing?

A

Consider side effects and dose to them

  • Initial dose, start low and titrate up slowly
  • maintenance dose, watch for long term side effects (metabolic, QT, Prolactin, EPS)
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8
Q

What is Stage 1 dosing in the Schizophrenia Algorithm?

A

First Episode Schizophrenia: Trial of a single SGA

Aripiprazole, Olanzapine, Quetiapine, Risperidone, Ziprasidone

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9
Q

What is stage 2 in the Schizophrenia Algorithm and when should it be started?

A

Started after partial or non-response from stage 1

Trial of a single SGA (different than one used in Stage one) or an FGA

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10
Q

After how many failed trials should Clozapine be used?

A

At least 2 failed trials.

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11
Q

When might Clozapine be tried earlier than stage 3?

A

Patient history of recurrent suicidality, violence or substance abuse.
Persistent positive symptoms greater than 2 years
Required if greater than 5 years

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12
Q

What must be done if a patient is taking Clozapine?

A

Much slower titration, needs weekly lab draws for WBC and ANC, coordinated Dosing, REMS in Clozapine Registry.

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13
Q

What is there a high risk of with Clozapine?

A

Neutropenia, Leukopenia or agranulocytosis

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14
Q

What other Antipsychotics have a risk of Neutropenia

A

All FGA and SGA

Haloperidol, Olanzapine, Quetiapine and risperidone usually seen from 4wks-4months

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15
Q

What APs have a high risk of weight gain?

A

SGA’s (Olanzapine, Clozapine)

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16
Q

Which FGA’s have a medium high risk for weight gain?

A

Low potency FGAs

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17
Q

What AP’s have the lowest risk for weight gain?

A

High Potency FGAs, Aripiprazole and Ziprasidone

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18
Q

Which APs are more high risk in patients with Diabetes or Insulin Resistance

A

SGAs = higher risk, Clozapine and Olanzapine most
FGA’s = lower risk
Ziprasidone, aripiprazole

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19
Q

If a patient suffered from Gynecomastia, weight gain and heart paliptations, which medication should be chosen?

A

Aripiprazole

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20
Q

Which Antipsychotic Drugs have the highest risk of Prolactin Elevation?

A

Risperidone, Palieridone, Haldol (First Generation Antipsychotics)

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21
Q

Which Antipsychotic drugs have a lower risk of Prolactin Elevation

A

Quetiapine, Clozapine

Aripiprazole (lowest)

22
Q

Which Antipsychotic Drugs have the highest risk for QT prolongation?

A

Thioridazine, Pimozide > Ziprasidone > Palieridone

23
Q

Which Antipsychotic drugs have the Lowest risk for QT prolongation?

A

Clozapine (highest of rest) Aripiprazole, Fluphenazine, Chlorpromazine (equal)

24
Q

Why might serum levels of Clozapine be reduced in a patient who smokes tobacco?

A

Clozapine Metabolized by same enzyme induced by Cyp 1A2, which breaks down and excretes drug faster.

25
Q

What are some advantages of long acting AP injectables over oral dosage?

A

Improvement of adherence

Pharmacies/Medical administration

26
Q

What are some disadvantages of Long acting AP injectables over oral dosage?

A

Expensive

Cant be retrieved out of body

27
Q

For an individual with schizophrenia who wants to reintegrate into society and work what APs would be best?

A

Risperidone

28
Q

If a person is pacing constantly and cant seem to sit still what Extrapyramidal side effect might they be experiencing?

A

Akathesia

29
Q

If a patient suffered from Gynecomastia, weight gain and heart paliptations, which medication should be chosen?

A

Aripiprazole

30
Q

Which Antipsychotic Drugs have the highest risk of Prolactin Elevation?

A

Risperidone, Palieridone, Haldol (First Generation Antipsychotics)

31
Q

Which Antipsychotic drugs have a lower risk of Prolactin Elevation

A

Quetiapine, Clozapine

Aripiprazole (lowest)

32
Q

Which Antipsychotic Drugs have the highest risk for QT prolongation?

A

Thioridazine, Pimozide > Ziprasidone > Palieridone

33
Q

Which Antipsychotic drugs have the Lowest risk for QT prolongation?

A

Clozapine (highest of rest) Aripiprazole, Fluphenazine, Chlorpromazine (equal)

34
Q

Why might serum levels of Clozapine be reduced in a patient who smokes tobacco?

A

Clozapine Metabolized by same enzyme induced by Cyp 1A2, which breaks down and excretes drug faster.

35
Q

What are some advantages of long acting AP injectables over oral dosage?

A

Improvement of adherence

Pharmacies/Medical administration

36
Q

What are some disadvantages of Long acting AP injectables over oral dosage?

A

Expensive

Cant be retrieved out of body

37
Q

For an individual with schizophrenia who wants to reintegrate into society and work what APs would be best?

A

Risperidone

38
Q

If a person is pacing constantly and cant seem to sit still what Extrapyramidal side effect might they be experiencing?

A

Akathesia

39
Q

What Is often a compliance issue with Asenapine oral tablets?

A

Taste Awful

40
Q

Why might treatment with antipsychotics lead to more psychotic, agitations and delusions over time?

A

Dopamine affect from D2 antagonism

41
Q

What Antipsychotics are FDA approved for Bipolar disorder?

A 
Aripiprazole
Quetiapine
Risperidone
Olanzapine
Olanzapine/Fluoxetine
Ziprasidone
42
Q

What drugs can elicit mania in bipolar patients?

A

Alcohol, Bronchodilators, Caffeine, Cocaine, Stimulants, Steroids, TCAs, Hallucinogens, Dopamine Agonists, Pseudophed, Interferon

43
Q

Bipolar I vs Bipolar II

A

Bipolar I - both manic and depressive episodes that vary in length
Bipolar II - less severe manic episodes but frequent depressive episodes

44
Q

What is Cyclothymia?

A

A chronic but milder form of bipolar disorder characterized by episdoes of hypomania and depression that last for at least two years

45
Q

What is mixed episode Bipolar Disorder?

A

Where an individual experiences both Mania and depression simultaneously

46
Q

How many times must an individual experience mania or depression to have Rapid-cycling bipolar disorder?

A

4 or more episodes within one year

47
Q

What length of time defines a Manic Episode?

A

at least 7 days of an abnormal or persistently elevated or irritable mood.

48
Q

What test may be given to screen for Manic behavior

A

DSM-5

49
Q

How does the DSM-5 define a Hypomanic Episode?

A

similar to a manic phase, but less intense, only required to persist for 4 days, should be observable by others that the person is noticeably different from a regular non-depressed mood.

50
Q

What Mood stabilization medications are FDA approved for Bipolar Disorder?

A

Vaplroate
Carbamazepine
Lamotrigine
Lithium

51
Q

What Antipsychotics are FDA approved for Bipolar disorder?

A 
Aripiprazole
Quetiapine
Risperidone
Olanzapine
Olanzapine/Fluoxetine
Ziprasidone
52
Q

What Medications are best used to treat euphoric hypomania or psychotic mania?

A

Lithium, Valproate, Aripiprazole, Quetiapine, Risperidone or Ziprasidone

Fall P2 (13 decks)

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