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PRE-REG-Thuri > NERVOUS SYSTEM- SCHIZOPHRENIA > Flashcards

NERVOUS SYSTEM- SCHIZOPHRENIA Flashcards

1
Q

What is Schizophrenia?

A

Type of psychosis.

No distinction between thoughts + reality

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2
Q

What 2 things are Schizophrenia symptoms divided into?

A

Positive

Negative

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3
Q

What are 4 positive Schizophrenia symptoms?

A

Hallucination

Delusions

Disturbed thoughts + speech

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4
Q

What are 4 negative Schizophrenia symptoms?

A

Apathy (lack of interest)

Social withdrawal

Poor hygiene

Catatonia

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5
Q

What is mono-therapy for Schizophrenia?

A

Oral antipsychotic + psychological therapy

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6
Q

What antipsychotic is given for resistant schizophrenia?

A

Clozapine + oral antipsychotic

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7
Q

When is clozapine given in schizophrenia?

A

When you have tried at least 2 different antipsychotic drugs including a 2nd generation drug for enough time.

Resistant schizophrenia

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8
Q

What type of drug is given for patients who lack adherence in patients with schizophrenia or after an acute attack?

A

Depot injection

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9
Q

What are depot injections?

A

Long acting IM injection preps.

eg. name ends in embonate or decanoate

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10
Q

What is a risk of 1st generation depot injections?

A

higher risk of extrapyramidal symptoms

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11
Q

Which 4 depot injections have less EPS? (PROA)

A

paliperidone

risperidone

olanzapine embonate.

aripiprazole

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12
Q

What medication, dose and formulation to give for an acute episode of schizophrenia?

A

A lower dose of IM anti-psychotic

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13
Q

What extra step should be done when IM antipsychotic prescribed for acute episode of schizophrenia?

A

Specify dose for each route + review daily

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14
Q

What are 5 classes of 1st generation antipsychotics?

A

1.Phenothiazine

2.Butyrophenones

3.Thioxanthenes

4.diphenylbutylpiperidines

5.substituted benzamides

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15
Q

Which 3 drugs is within group 1 of the phenothiazines (1st gen)?

A

Chlorpromazine, Levopromazine, promazine

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16
Q

What drugs are in group 2 of phenothiazines (1st gen)?

A

Pericyazine

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17
Q

What 3 drugs are in group 3 of phenothiazines?

A

Prochlorperazine

Trifluoperazine

Fluphenazine

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18
Q

What SE is common in group 1 phenothiazines?

A

Increased sedation

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19
Q

What positive effect is common in group 2 phenothiazines?

A

Less EPS

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20
Q

What SE is common in group 3 phenothiazines?

A

Increased EPS effects

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21
Q

List 2 drugs within the butyrophenones class?

A

Haloperidol

Benperidol

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22
Q

List 2 drugs within the thioxanthene class?

A

flupentixol

Zuclopenthixol

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23
Q

What is promazine used as OTC for?

A

Insomnia treatment

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24
Q

What 2 SEs is associated with phenothiazines?

A

Hepatotoxic

Acute dystonic reactions

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25
Q

What effect does Flupentixol have + how should doses be given?

A

alerting effect- no evening dose

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26
Q

What is the most effective depot injection for schizophrenia relapses?

A

Zuclopenthixol

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27
Q

What is a heart related SE of haloperidol?

A

QT prolongation

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28
Q

Give an example of a drug in diphenylbutylpiperidines class?

A

Pimozide

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29
Q

Give an example of a drug which is under the substituted benzamides class?

A

Sulpiride

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30
Q

What is a cardio related SE of Pimozide?

A

QT prolongation

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31
Q

What 2 antipsychotics prolong QT?

A

Pimozide

Haloperidol

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32
Q

What is a SE related to Loxapine?

A

Bronchospasms- monitor during 1st hour after each dose for signs.

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33
Q

List 11 common 2nd generation anti-psychotics?

A

Amisulpride

Aripiprazole

asenapine

Cariprazine

Clozapine

Lurasidone

Olanzapine

Paliperidone

quetiapine

Risperidone

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34
Q

What is a negative/SE of olanzapine?

A

Weight gain + diabetes

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35
Q

What is a SE of both Amisulpride, Sulpiride + Risperidone?

A

Increased Hyperprolactinaemia

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36
Q

What 5 anti-psychotic drugs is hyperprolactinemia rare in?

A

Aripiprazole

Asenapine

Cariprazine

Clozapine

Quetiapine

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37
Q

What are the 5 SEs of Clozapine?

A

Myocarditis

Agranulocytosis

GI obstruction

Weight gain

Diabetes

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38
Q

What counselling point to tell patient on clozapine about cardio SE?

A

Report if tachycardia + STOP med

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39
Q

What is the indication of anti-psychotics?

A

Schizophrenia

BP disorder

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40
Q

What other indication are 1st Gen anti-psychotics used for?

A

Nausea + vomiting

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41
Q

What type of schizophrenia symptoms are 2nd generation anti-psychotics better at treating?

A

Negative symptoms

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42
Q

How long should patients receive anti-psychotic medication treatment until deemed ineffective?

A

Use at optimum dose for 4-6 weeks before deeming ineffective.

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43
Q

What are 4 common extra-pyramidal symptoms caused by some Anti-psychotics?

A

Parkinsonism

Dystonia

Akathesia

Tardive dyskinesia

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44
Q

What is Akathesia + when does it arise?

A

Movement disorder

within hours to weeks of starting antipsychotic treatment or on dose increase

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45
Q

When do you stop anti-psychotic meds after what EPS SE?

A

Vermicular tongue movements

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46
Q

What is a Contra-indication in using anti-psychotics?

A

Parkinson’s disease - not recommended to give.

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47
Q

What to do if EPS arises with anti-psychotic meds?

A

Tx should be reviewed with the aim of reducing exposure to drug.

48
Q

What is tardive dyskinesia + when does it arise?

A

Abnormal involuntary movements of lips, tongue, face + Jaw.

Happens when on long-term therapy or after discontinuation, sometimes irreversible.

Common in elderly females

49
Q

What is dystonia + when does it arise?

A

Uncontrolled spasm.

Can happen within hours of starting meds.

50
Q

Who is dystonia more common in?

A

Young males

51
Q

Who are parkinsonian symptoms more common in?

A

Elderly females, those with pre-existing neurological damage e.g. stroke.

Appear gradually

52
Q

What is the most serious EPS symptom?

A

Tardive dyskinesia - no treatment available

53
Q

Why do most anti-psychotic drugs increase prolactin?

A

because dopamine inhibits prolactin release - causing build up in blood

54
Q

How does aripiprazole cause hyperprolactinaemia if in rare cases?

A

In dose dependent manner- as it is a dopamine receptor partial agonist.

55
Q

Which 3 antipsychotics have a high risk of causing sexual dysfunction?

A

Haloperidol

Olanzapine

Risperidone

56
Q

Which 2 antipsychotic drugs have the lowest risk of sexual dysfunction?

A

Aripiprazole

Quetiapine

57
Q

What are the clinical symptoms of hyperprolactinaemia?

A

Sexual dysfunction

Reduced bone mineral density

Menstrual disturbances

Breast enlargement

Galactorrhoea

Increased risk of breast cancer

58
Q

What 3 antipsychotics are likely to cause symptomatic hyperprolactinaemia?

A

2nd gen (Risperidone, amisulpride, sulpiride), and first-generation antipsychotic drugs

59
Q

Which antipsychotics have a low risk of QT prolongation?

A

Aripiprazole

Clozapine

Asenapine

Flupentixol

Loxapine

Olanzapine

Paliperidone

Prochlorperazine

Risperidone

Sulpiride

60
Q

What are 4 common SE of Anti-psychotics?

A

Hyperprolactinaemia

Metabolic effects

CVD effect

Neuroleptic malignant syndrome

61
Q

Which generation of antipsychotics cause metabolic SE?

62
Q

What are 2 antipsychotics that cause weight gain? (COW)

A

Clozapine

Olanzapine

63
Q

What are some of the Metabolic SE that are caused by anti-psychotics?

A

Hyperglycaemia + diabetes

Weight gain

Dyslipidaemia

64
Q

What 5 antipsychotic drugs are more likely to cause hyperglycaemia? (CiROQ)

A

Clozapine
Risperidone
Olanzapine
Quetiapine

65
Q

What generation antipsychotics are metabolic SE more common in?

66
Q

What 4 things to monitor in patient taking anti-psychotics?

A

Diabetes- fasting glucose

Prolactin level

Weight

Lipids

67
Q

What shoud we do if a patient has Neuroleptic malignant syndrome after being on antipsychotics?

A

Stop taking the meds immediately for at least 5 days, longer better

68
Q

What are 4 symptoms of Neuroleptic malignant syndrome ?

A

Muscle rigidity

Fluctuating consciousness

Hyperthermia

Autonomic dysfunction

69
Q

What are 2 CVD effects of anti-psychotics?

A

QT prolongation
Postural hypotension

70
Q

What 2 antipsychotics can cause Postural hypotension?

A

Clozapine

quetiapine

71
Q

What to monitor in CVD patients taking anti-psychotics?

A

CVD, ECG, avoid drugs prolonging QT.

72
Q

What 2 antipsychotic drug classes has most EPS?

A

Group 3 phenothiazine + Butryrophenones

73
Q

What are the 5 SE of antipsychotics?

A

Antimuscarinic Effects

Seizures

Sedation

Sexual dysfunction

Photosensitivity (high dose)

74
Q

What is a patient counselling point for the photosensitivity SE of anti-psychotics?

A

Avoid direct sunlight

75
Q

What 2 antipsychotics are common in causing QT prolongation?

A

Pimozide
haloperidol

76
Q

What is a recent MRHA warning regarding Clozapine + other anti-psychotics?

A

monitor blood conc for toxicity

77
Q

What are 3 main SE of clozapine? (BMI)

A

Blood disorders

Myocarditis

Intestinal obstruction

78
Q

How to monitor patients’ weight on antipsychotics?

A

Weight measured at start of therapy, then weekly for first 6 weeks, then at 12 weeks and 1 year, annually.

79
Q

What 5 things are monitored in patients taking antipsychotics?

A

Weight

Fasting glucose

ECG (initiation- hx of CVD)

BP

FBC, renal profile, LFT

80
Q

How often is FBC, renal profile, LFT monitored in patients taking antipsychotics?

A

At start of therapy, then yearly

81
Q

How often is FBC, renal profile, LFT monitored in patients taking antipsychotics?

A

Starting

12 weeks

1 year then annually

82
Q

What 2 drugs have been known to treat Neuroleptic malignant syndrome?

A

Bromocriptine + dantrolene

83
Q

What bloods should be done when monitoring patient on clozapine?

A

Leucocyte + WBC

Weight, lipids
Prolactin
hba1c

84
Q

How often to monitor Leucocyte + WBC when on clozapine?

A

weekly for 18 weeks,

then every 2 weeks for 1 year

then monthly

85
Q

In what case does a specialist need to re-initiate clozapine?

A

If missed 2 doses

86
Q

What is a caution for patients on clozapine as it can lead to intestinal obstruction?

A

Colonic disease, lower abdominal surgery, constipating meds, e.g. antimuscarinic

87
Q

What was a 2017 MHRA warning for clozapine regarding intestinal obstruction?

A

Faecal intestinal obstruction, paralytic ileus

88
Q

In what 5 scenarios should blood monitoring be done for clozapine toxicity?

A

If patient stops smoking or switches to e- cig

Concomitant med which can interact- increase clozapine conc.

Patient with pneumonia/ infection.

reduced clozapine metabolism suspected

Toxicity suspected

89
Q

What patient counselling point to tell patient on clozapine due to its GI related SE?

A

Report constipation before next dose

90
Q

Why to monitor patients on clozapine who are stopping smoking?

A

Smoking lowers clozapine level.

If they stop smoking- levels of clozapine rises = toxicity

91
Q

What is a specific SE of chlorpromazine?

A

contact sensitisation - avoid direct contact.

92
Q

Can you crush chlorpromazine tablets?

93
Q

What to monitor in patients taking phenothiazines?

94
Q

List some drugs which can interact with clozapine + cause QT prolongation?

A

Sotalol

SSRIs

Clomipramine

Lithium

Macrolides

Domperidone

Hydroxyzine

Quinolone

Ondansetron

B agonist- SABA

Corticosteroids

Diuretics

Theophylline

95
Q

What electrolyte imbalance can cause torsade de pointes?

A

HypOkalaemia

96
Q

What 3 drug classes interact with clozapine to increase antimuscarinic SE?

A

Antihistamine, antimuscarinic drug-hyoscine

TCA

97
Q

What CNS depressants increase the effects when interacting with clozapine?

A

Alcohol

Antihistamine- drowsy

Barbituates

Benzos

Opioids

Z drugs

98
Q

What drug treatment is given for inappropriate sexual behaviour?

A

Benperidol

99
Q

What is the dose of Benperidol given for inappropriate sexual behaviour in adults?

A

0.25–1.5 mg daily in divided doses

100
Q

What is the dose of Benperidol given for inappropriate sexual behaviour in elderly?

A

Initially 0.125–0.75 mg daily in divided doses

101
Q

What 2 things are monitored for patients on benperidol?

A

Regular blood counts LFTs during long-term treatment.

102
Q

What is monitored when taking pimozide?

A

Annual ECG

103
Q

What to do if QT prolonged with pimozide?

A

Stop taking meds or reduce dose

Do not give other drugs which can prolong QT

Don’t give drugs which can affect electrolyte imbalance.

104
Q

What 5 things to monitor when taking antipsychotics?

A

Weight

ECG

Fasting blood glucose, hba1c

Blood pressure

FBC, U&E + LFT

105
Q

When is weight measured when on antipsychotics?

A

Start weekly for first 6 weeks, do at 3 months, 1 year then annually

106
Q

When is ECG done when on antipsychotics?

A

Before drug initiation

107
Q

When is Hba1c and BP measured when on antipsychotics?

A

3 months, 1 year, annually

108
Q

When is LFT, FBC, U +E measured when on antipsychotics?

A

Start, then yearly

109
Q

What antipsychotic is least likely to cause hyperglycaemia?

A

Haloperidol

110
Q

How long to try clozapine to assess response?

A

8-10 weeks

111
Q

How often to monitor patient if high dose antipsychotic given?

A

Every 15 mins

112
Q

How often to monitor patient if high dose antipsychotic given?

A

Every 15 mins

113
Q

How many years after stopping their antipsychotics must patients be monitored for?

114
Q

How to monitor glucose in clozapine monitoring?

A

measured at baseline, at 4–6 months, and then yearly.

Patients taking clozapine should have fasting blood glucose tested at baseline, after 1 months’ treatment, then every 4–6 months.

115
Q

What antipsychotic has a MHRA alert on gambling risk?

A

Aripiprazole

116
Q

How to monitor blood lipids + weight for clozapine?

A

Baseline,

3 months (weight should be measured at frequent intervals every 3 months in 1st year + then yearly with antipsychotics.

117
Q

How to monitor prolactin in clozapine?

A

Monitor before, 6 months, and then yearly.

PRE-REG-Thuri (44 decks)

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