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PHRM 845 > L54-57 Pharmtx of Schizo Ott > Flashcards

L54-57 Pharmtx of Schizo Ott Flashcards

1
Q

5 key features that define psychotic disorders

A

-delusions
-hallucinations
-disorganized thinking and speech
-disorganized or abnormal motor behavior
- negative sxs

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2
Q

T or F: Hallucinations in schizo are typically visual but can also be auditory, tactile, or olfactory

A

False, usually auditory

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3
Q

T or F: Onset of schizophrenia is early childhood to adolescence

A

False, adolescence to early adulthood

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4
Q

onset of schizo late teens, early 20s
A. Men
B. Women

A

A. Men

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5
Q

T or F: Smoking is associated with induction of 3A4, which decreases serum conc of 3A4 substrate antipsychotics *

A

False, 1A2

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6
Q

T or F: All antipsychotic drugs are considered to be equally effective in clinical trials with no exceptions

A

False, the exception is that clozapine is goated and the most effective

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7
Q

oral antipsychotic drug tx is generally considered first-line unless what

A

pt presents w/ reason to consider IM depot drug tx first

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8
Q

T or F: the efficacy of typical antipsychotics for positive sxs is similar atypical antipsychotics

A

True

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9
Q

which of the following is a 1st gen typical antipsychotic but displays atypical antipsychotic properties?
A. Haloperidol
B. Loxapine
C. Fluphenazine
D. Thioridazine

A

B. Loxapine

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10
Q

Most commonly used typical antipsychotic - routine and prn
A. Haloperidol
B. Loxapine
C. Fluphenazine
D. Thioridazine

A

A. Haloperidol

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11
Q

T or F: Higher potency typicals lead to more EPS

A

True

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12
Q

T or F: typical antipsychotics are effective for treating positive sxs, and may have negative sxs benefits

A

False, they make negative sxs worse

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13
Q

What effect do partial agonists have on dopamine transmission?

A

Stabilize it

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14
Q

T or F: Partial agonists are associated with less akathisia than other antipsychotics

A

False, more akathisia

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15
Q

Which of the following is approved for adjunct treatment in depression?
A. Haloperidol
B. Loxapine
C. Aripiprazole
D. Sugammadex

A

C. Aripiprazole -> partial agonists are typicaly adjunct

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16
Q

2D6 and 3A4 substrate
A. Aripiprazole
B. Brexpiprazole
C. Cariprazine

A

A and B

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17
Q

Moderate akathisia
A. Aripiprazole
B. Brexpiprazole
C. Cariprazine

A

all of them, they’re partial agonists

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18
Q

3A4 substrate only
A. Aripiprazole
B. Brexpiprazole
C. Cariprazine

A

C

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19
Q

Low weight gain
A. Aripiprazole
B. Brexpiprazole
C. Cariprazine

A

A

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20
Q

Low-moderate weight gain
A. Aripiprazole
B. Brexpiprazole
C. Cariprazine

A

B and C

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21
Q

Atypical antipsychotics ending what what suffix have higher weight gain than other agents?

A

-pine

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22
Q

sublingual and patch formulations
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine

A

A. Asenapine

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23
Q

1A2 substrate
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine

A

A B and C

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24
Q

3A4 substrate
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine

A

D

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25
Q

Boxed warning of neutropenia, orthostasis, bradycardia, syncope, seizures, myocarditis, cardiomyopathy
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine

A

B. Clozapine

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26
Q

QTc prolongation
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine

A

A B D (all but olanzapine)

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27
Q

DRESS warning
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine

A

C. Olanzapine

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28
Q

High risk metabolic syndrome
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine

A

C. Olanzapine

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29
Q

Boxed warning for suicidal ideation
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine

A

D. Quetiapine

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30
Q

Weight gain and sedation
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine

A

B C and D
(asenapine has weight gain but not sedation)

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31
Q

How often do you apply an asenapine transdermal patch?

A

every 24 hours

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32
Q

T or F: Asenapine transdermal patches have a warning for QTc prolongation

A

True

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33
Q

When is it appropriate to reduce the dose of an asenapine transdermal patch?

A

If given with a UGT or strong 1A2 inhibitor (Fluvoxamine**)

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34
Q

what are the timelines for monitoring clozapine REMS

A

weekly x 6 months, biweekly x 6 months, then every 4 weeks.

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35
Q

what drug is added to olanzapine to mitigate weight gain and metabolic syndrome potential?

A

Samidorphan

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36
Q

what the fuck is samidorphan? **

A

opioid antagonist with preferential activity at the mu opioid receptor (is the mu important?)

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37
Q

Less D2 antagonism, more 5HT2a antagonist - less EPS
A. The. “-pines”
B. The “-dones”

A

A. The “-pines”

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38
Q

Higher weight gain than other agents
A. The. “-pines”
B. The “-dones”

A

A. The “-pines”

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39
Q

Even D2 and 5HT2A antagonists
A. The. “-pines”
B. The “-dones”

A

B. The “-dones”

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40
Q

High risk for orthostasis and syncope
A. Iloperidone
B. Lurasidone
C. Ziprasidone

A

A. Iloperidone

41
Q

QTc prolongation
A. Iloperidone
B. Lurasidone
C. Ziprasidone

A

A and C

42
Q

2D6 substrate
A. Iloperidone
B. Lurasidone
C. Ziprasidone

A

A. Iloperidone

43
Q

Higher risk for akathisia
A. Iloperidone
B. Lurasidone
C. Ziprasidone

A

B. Lurasidone

44
Q

Warning for suicidal thoughts - adjunct for bipolar depression
A. Iloperidone
B. Lurasidone
C. Ziprasidone

A

B. Lurasidone

45
Q

Take with 350 calories (thanks Cora)
A. Iloperidone
B. Lurasidone
C. Ziprasidone

A

B. Lurasidone

46
Q

DRESS warning
A. Iloperidone
B. Lurasidone
C. Ziprasidone

A

C. Ziprasidone

47
Q

3A4 substrate (1/3) and aldehyde oxidase (2/3) (less worry for P450 interactions
A. Iloperidone
B. Lurasidone
C. Ziprasidone

A

C. Ziprasidone

48
Q

Highest D2 blockade for atypical antipsychotics
A. The. “-pines”
B. The “-dones”

A

B. The “-dones”

49
Q

High risk EPS, moderate metabolic side effects
A. The. “-pines”
B. The “-dones”

A

B. The. “-dones”

50
Q

2D6 substrate (minor 3A4)
A. Risperidone
B. Paliperidone

A

A. Risperidone

51
Q

EPS, hyperprolactinemia, weight gain, sedation,orthostasis (this one is weird because the other side of the table says similar side effects to the other drug so maybe just both?)
A. Risperidone
B. Paliperidone

A

A. Risperidone

52
Q

Renally eliminated-dose adjustment in impairment
A. Risperidone
B. Paliperidone

A

B. Paliperidone

53
Q

QTc prolongation
A. Risperidone
B. Paliperidone

A

B. Paliperidone

54
Q

Lumateperone:
- (high/low) risk for weight gain or metabolic side effects
- (high/low) risk for EPS or akathisia
- ___ substrate

A

Low, Low, 3A4

55
Q

FDA approved for tx of hallucinations or delusions in a pt with PD ***
A. Risperidone
B. Lumateperone
C. Clozapine
D. Pimavanserin

A

D. Pimavanserin

56
Q

Inverse agonist and antagonist at the 5HT2A receptor
A. Risperidone
B. Lumateperone
C. Clozapine
D. Pimavanserin

A

D. Pimavanserin

57
Q

Pimavanserin is a ___. substrate

A

3A4

58
Q

Haloperidol decanoate (IM Inj) dosing that was bold
- Given every ___ weeks
- Load: __ times oral dose
- Maintenance: __ times oral dose
- __ based - Z-track (wtf does this mean)

A

4 weeks
20 times oral dose
10 times oral dose
oil based

59
Q

What must you do with initiation of Risperdal tx (this is IM risperidone)

A

supplement with oral risperidone (or another antipsychotic) for the first few weeks of treatment - “i tell providers until 3rd injection” **

60
Q

what is the subq abdominal injection of risperidone called

A

Perseris

61
Q

If on 3 mg oral risperidone, what dose should be initiated if transitioning to perseris (abdominal subq version)? what about 4 mg?

A

3 oral -> 90mg
4 oral -> 120 mg

62
Q

If you are starting Perseris, what should be considered if taking a 3A4 inducer?

A

avoid completely or give a higher dose of injection -> could also use oral supplementation whatever that means

63
Q

Rykindo (IM inj of risperidone)
- Every __ week injection
- oral dose overlap is (longer/shorter) than Risperdal Consta

A

every 2 weeks
oral dose overlap is short (7 vs 21 days)

64
Q

Abdominal OR upper arm subq injection:
A. Uzedy
B. Risperdal Consta
C. Rykindo
D. Perseris

A

A. Uzedy

65
Q

Given once monthly or every 2 months
A. Uzedy
B. Risperdal Consta
C. Rykindo
D. Perseris

A

A. Uzedy

66
Q

Loading dose, then booster, then every 4 weeks (starting 5 weeks after loading dose)
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera

A

A. Invega Sustenna

67
Q

Initial loading and booster doses must be given in deltoid to improve absorption consistency
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera

A

A. Invega Sustenna

68
Q

May require dose adjustment in moderate to severe renal impairment.
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera

A

A. Invega Sustenna

69
Q

May be initiated in a pt who has been stable after at least 4 invega sustenna doses
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera

A

B. Invega Trinza

70
Q

Recommended to be given deltoid; gluteal admin results in a lower Cmax
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera

A

B. Invega Trinza

71
Q

Not recommended if CrCl < 50 mL/min **
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera

A

B. Invega Trinza

72
Q

May be initiated after stable Invega Sustenna for 4 months or stable Invega Trinza after one 3- month dose
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera

A

C duh but i just put this in here so i could read it again

73
Q

Gluteal only
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera

A

C. Invega hayfera

74
Q

Can cause PDSS (Post-dose delirium sedation syndrome)
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera
D. Zyprexa Relprevv

A

D. Zyprexa Relprevv

75
Q

How long do you need to overlap Abilify Maintena with oral aripiprazole?

A

at least 14 days after first injection

76
Q

what are the two methods of injection for abilify maintena?

A

deltoid or gluteal

77
Q

okay memorize the stupid ass table on slide 34 i guess

A

fuck me right

78
Q

Gluteal only
A. Abilify Maintena
B. Abilify Asimtufii
C. Aristada (arip lauroxil)
D. Aristada Initio

A

B. Abilify Asimtufii

79
Q

Every 2 month dosing - 720mg, 960 mg
A. Abilify Maintena
B. Abilify Asimtufii
C. Aristada (arip lauroxil)
D. Aristada Initio

A

B. Abilify Asimtufii

80
Q

continue oral aripiprazole for 2 weeks after first injection
A. Abilify Maintena
B. Abilify Asimtufii
C. Aristada (arip lauroxil)
D. Aristada Initio

A

A and B

81
Q

Overlap with oral aripiprazole for 3 weeks after first injection
A. Abilify Maintena
B. Abilify Asimtufii
C. Aristada (arip lauroxil)
D. Aristada Initio

A

C. Aristada (arip lauroxil)

82
Q

is a prodrug
A. Abilify Maintena
B. Abilify Asimtufii
C. Aristada (arip lauroxil)
D. Aristada Initio

A

Aristada

83
Q

developed to avoid need for 21 day oral overlap of antipsychotic
A. Abilify Maintena
B. Abilify Asimtufii
C. Aristada (arip lauroxil)
D. Aristada Initio

A

D. Aristada Initio

84
Q

Avoid in pts who are 2D6 poor metabolizers or with strong 3A4 or 2D6 inhibitors
A. Abilify Maintena
B. Abilify Asimtufii
C. Aristada (arip lauroxil)
D. Aristada Initio

A

D. Aristada Initio

85
Q

what are three most common antipsychotic injections used in psychiatric emergencies?

A

Haloperidol, chlorpromazine, fluphenazine - halo is most common tho

86
Q

Which of the following CANNOT be given at the same time as a benzo bc of a box warning of respiratory depression
A. Haloperidol
B. Chlorpromazine
C. Fluphenazine
D. Olanzapine

A

D. Olanzapine

87
Q

what drug and dosage form exists for immediate tx of psychiatric emergencies but is not commonly used

A

loxapine for inhalation (Adasuve)

88
Q

Clinical tx strategies for EPS:
Tx for acute dystonia

A

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

89
Q

Clinical tx strategies for EPS:
tx for Drug-induced parkinson’s

A

Oral anticholinergic (benztropine, trihexyphenidyl, diphenhydramine)

90
Q

Clinical tx strategies for EPS:
tx for akathisia

A

Propranolol is 1st line but a benzo (usually lorazepam) can also be used

91
Q

Clinical tx strategies for EPS:
Tx for tardive dyskinesia

A

VMAT2 Inhibitors **

92
Q

2D6/3A4 substrate
A. Tetrabenazine
B. Valbenazine
C. Deutetrabenazine

A

B. Valbenazine

93
Q

QTc prolongation
A. Tetrabenazine
B. Valbenazine
C. Deutetrabenazine

A

B and C

94
Q

(just) 2D6 substrate
A. Tetrabenazine
B. Valbenazine
C. Deutetrabenazine

A

C. Deutetrabenazine

95
Q

T or F: Neuroleptic Malignant Syndrome does not classify as a medical emergency

A

False, it is a medical emergency

96
Q

sxs of neuroleptic malignant syndrome (5 or so)

A

hyperpyrexia
tachycardia
labile BP
Muscle rigidity - elevated CK(?) myoglobinuria

97
Q

Neuroleptic Malignant Syndrome:
Treatment is __________ -> d/c antipsychotics, consider DA’s

A

supportive

98
Q

T or F: You should not initiate other antipsychotics after neuroleptic malignant syndrome occurs

A

False, its actually not contraindicated to have future antipsychotic use

99
Q

3 metabolic adverse effects from atypical antipsychotics

A

PHRM 845 (34 decks)

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