NERVOUS SYSTEM- SCHIZOPHRENIA Flashcards
1
Q
What is Schizophrenia?
A
Type of psychosis.
No distinction between thoughts + reality
2
Q
What 2 things are Schizophrenia symptoms divided into?
A
Positive
Negative
3
Q
What are 4 positive Schizophrenia symptoms?
A
Hallucination
Delusions
Disturbed thoughts + speech
4
Q
What are 4 negative Schizophrenia symptoms?
A
Apathy (lack of interest)
Social withdrawal
Poor hygiene
Catatonia
5
Q
What is mono-therapy for Schizophrenia?
A
Oral antipsychotic + psychological therapy
6
Q
What antipsychotic is given for resistant schizophrenia?
A
Clozapine + oral antipsychotic
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
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
9
Q
What are depot injections?
A
Long acting IM injection preps.
eg. name ends in embonate or decanoate
10
Q
What is a risk of 1st generation depot injections?
A
higher risk of extrapyramidal symptoms
11
Q
Which 4 depot injections have less EPS? (PROA)
A
paliperidone
risperidone
olanzapine embonate.
aripiprazole
12
Q
What medication, dose and formulation to give for an acute episode of schizophrenia?
A
A lower dose of IM anti-psychotic
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
14
Q
What are 5 classes of 1st generation antipsychotics?
A
1.Phenothiazine
2.Butyrophenones
3.Thioxanthenes
4.diphenylbutylpiperidines
5.substituted benzamides
15
Q
Which 3 drugs is within group 1 of the phenothiazines (1st gen)?
A
Chlorpromazine, Levopromazine, promazine
16
Q
What drugs are in group 2 of phenothiazines (1st gen)?
A
Pericyazine
17
Q
What 3 drugs are in group 3 of phenothiazines?
A
Prochlorperazine
Trifluoperazine
Fluphenazine
18
Q
What SE is common in group 1 phenothiazines?
A
Increased sedation
19
Q
What positive effect is common in group 2 phenothiazines?
A
Less EPS
20
Q
What SE is common in group 3 phenothiazines?
A
Increased EPS effects
21
Q
List 2 drugs within the butyrophenones class?
A
Haloperidol
Benperidol
22
Q
List 2 drugs within the thioxanthene class?
A
flupentixol
Zuclopenthixol
23
Q
What is promazine used as OTC for?
A
Insomnia treatment
24
Q
What 2 SEs is associated with phenothiazines?
A
Hepatotoxic
Acute dystonic reactions
25
What effect does Flupentixol have + how should doses be given?
alerting effect- no evening dose
26
What is the most effective depot injection for schizophrenia relapses?
Zuclopenthixol
27
What is a heart related SE of haloperidol?
QT prolongation
28
Give an example of a drug in diphenylbutylpiperidines class?
Pimozide
29
Give an example of a drug which is under the substituted benzamides class?
Sulpiride
30
What is a cardio related SE of Pimozide?
QT prolongation
31
What 2 antipsychotics prolong QT?
Pimozide
Haloperidol
32
What is a SE related to Loxapine?
Bronchospasms- monitor during 1st hour after each dose for signs.
33
List 11 common 2nd generation anti-psychotics?
Amisulpride
Aripiprazole
asenapine
Cariprazine
Clozapine
Lurasidone
Olanzapine
Paliperidone
quetiapine
Risperidone
34
What is a negative/SE of olanzapine?
Weight gain + diabetes
35
What is a SE of both Amisulpride, Sulpiride + Risperidone?
Increased Hyperprolactinaemia
36
What 5 anti-psychotic drugs is hyperprolactinemia rare in?
Aripiprazole
Asenapine
Cariprazine
Clozapine
Quetiapine
37
What are the 5 SEs of Clozapine?
Myocarditis
Agranulocytosis
GI obstruction
Weight gain
Diabetes
38
What counselling point to tell patient on clozapine about cardio SE?
Report if tachycardia + STOP med
39
What is the indication of anti-psychotics?
Schizophrenia
BP disorder
40
What other indication are 1st Gen anti-psychotics used for?
Nausea + vomiting
41
What type of schizophrenia symptoms are 2nd generation anti-psychotics better at treating?
Negative symptoms
42
How long should patients receive anti-psychotic medication treatment until deemed ineffective?
Use at optimum dose for 4-6 weeks before deeming ineffective.
43
What are 4 common extra-pyramidal symptoms caused by some Anti-psychotics?
Parkinsonism
Dystonia
Akathesia
Tardive dyskinesia
44
What is Akathesia + when does it arise?
Movement disorder
within hours to weeks of starting antipsychotic treatment or on dose increase
45
When do you stop anti-psychotic meds after what EPS SE?
Vermicular tongue movements
46
What is a Contra-indication in using anti-psychotics?
Parkinson's disease - not recommended to give.
47
What to do if EPS arises with anti-psychotic meds?
Tx should be reviewed with the aim of reducing exposure to drug.
48
What is tardive dyskinesia + when does it arise?
Abnormal involuntary movements of lips, tongue, face + Jaw.
Happens when on long-term therapy or after discontinuation, sometimes irreversible.
Common in elderly females
49
What is dystonia + when does it arise?
Uncontrolled spasm.
Can happen within hours of starting meds.
50
Who is dystonia more common in?
Young males
51
Who are parkinsonian symptoms more common in?
Elderly females, those with pre-existing neurological damage e.g. stroke.
Appear gradually
52
What is the most serious EPS symptom?
Tardive dyskinesia - no treatment available
53
Why do most anti-psychotic drugs increase prolactin?
because dopamine inhibits prolactin release - causing build up in blood
54
How does aripiprazole cause hyperprolactinaemia if in rare cases?
In dose dependent manner- as it is a dopamine receptor partial agonist.
55
Which 3 antipsychotics have a high risk of causing sexual dysfunction?
Haloperidol
Olanzapine
Risperidone
56
Which 2 antipsychotic drugs have the lowest risk of sexual dysfunction?
Aripiprazole
Quetiapine
57
What are the clinical symptoms of hyperprolactinaemia?
Sexual dysfunction
Reduced bone mineral density
Menstrual disturbances
Breast enlargement
Galactorrhoea
Increased risk of breast cancer
58
What 3 antipsychotics are likely to cause symptomatic hyperprolactinaemia?
2nd gen (Risperidone, amisulpride, sulpiride), and first-generation antipsychotic drugs
59
Which antipsychotics have a low risk of QT prolongation?
Aripiprazole
Clozapine
Asenapine
Flupentixol
Loxapine
Olanzapine
Paliperidone
Prochlorperazine
Risperidone
Sulpiride
60
What are 4 common SE of Anti-psychotics?
Hyperprolactinaemia
Metabolic effects
CVD effect
Neuroleptic malignant syndrome
61
Which generation of antipsychotics cause metabolic SE?
gen 2
62
What are 2 antipsychotics that cause weight gain? (COW)
Clozapine
Olanzapine
63
What are some of the Metabolic SE that are caused by anti-psychotics?
Hyperglycaemia + diabetes
Weight gain
Dyslipidaemia
64
What 5 antipsychotic drugs are more likely to cause hyperglycaemia? (CiROQ)
Clozapine
Risperidone
Olanzapine
Quetiapine
65
What generation antipsychotics are metabolic SE more common in?
2nd gen
66
What 4 things to monitor in patient taking anti-psychotics?
Diabetes- fasting glucose
Prolactin level
Weight
Lipids
67
What shoud we do if a patient has Neuroleptic malignant syndrome after being on antipsychotics?
Stop taking the meds immediately for at least 5 days, longer better
68
What are 4 symptoms of Neuroleptic malignant syndrome ?
Muscle rigidity
Fluctuating consciousness
Hyperthermia
Autonomic dysfunction
69
What are 2 CVD effects of anti-psychotics?
QT prolongation
Postural hypotension
70
What 2 antipsychotics can cause Postural hypotension?
Clozapine
quetiapine
71
What to monitor in CVD patients taking anti-psychotics?
CVD, ECG, avoid drugs prolonging QT.
72
What 2 antipsychotic drug classes has most EPS?
Group 3 phenothiazine + Butryrophenones
73
What are the 5 SE of antipsychotics?
Antimuscarinic Effects
Seizures
Sedation
Sexual dysfunction
Photosensitivity (high dose)
74
What is a patient counselling point for the photosensitivity SE of anti-psychotics?
Avoid direct sunlight
75
What 2 antipsychotics are common in causing QT prolongation?
Pimozide
haloperidol
76
What is a recent MRHA warning regarding Clozapine + other anti-psychotics?
monitor blood conc for toxicity
77
What are 3 main SE of clozapine? (BMI)
Blood disorders
Myocarditis
Intestinal obstruction
78
How to monitor patients' weight on antipsychotics?
Weight measured at start of therapy, then weekly for first 6 weeks, then at 12 weeks and 1 year, annually.
79
What 5 things are monitored in patients taking antipsychotics?
Weight
Fasting glucose
ECG (initiation- hx of CVD)
BP
FBC, renal profile, LFT
80
How often is FBC, renal profile, LFT monitored in patients taking antipsychotics?
At start of therapy, then yearly
81
How often is FBC, renal profile, LFT monitored in patients taking antipsychotics?
Starting
12 weeks
1 year then annually
82
What 2 drugs have been known to treat Neuroleptic malignant syndrome?
Bromocriptine + dantrolene
83
What bloods should be done when monitoring patient on clozapine?
Leucocyte + WBC
Weight, lipids
Prolactin
hba1c
84
How often to monitor Leucocyte + WBC when on clozapine?
weekly for 18 weeks,
then every 2 weeks for 1 year
then monthly
85
In what case does a specialist need to re-initiate clozapine?
If missed 2 doses
86
What is a caution for patients on clozapine as it can lead to intestinal obstruction?
Colonic disease, lower abdominal surgery, constipating meds, e.g. antimuscarinic
87
What was a 2017 MHRA warning for clozapine regarding intestinal obstruction?
Faecal intestinal obstruction, paralytic ileus
88
In what 5 scenarios should blood monitoring be done for clozapine toxicity?
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
What patient counselling point to tell patient on clozapine due to its GI related SE?
Report constipation before next dose
90
Why to monitor patients on clozapine who are stopping smoking?
Smoking lowers clozapine level.
If they stop smoking- levels of clozapine rises = toxicity
91
What is a specific SE of chlorpromazine?
contact sensitisation - avoid direct contact.
92
Can you crush chlorpromazine tablets?
NO
93
What to monitor in patients taking phenothiazines?
LFT
94
List some drugs which can interact with clozapine + cause QT prolongation?
Sotalol
SSRIs
Clomipramine
Lithium
Macrolides
Domperidone
Hydroxyzine
Quinolone
Ondansetron
B agonist- SABA
Corticosteroids
Diuretics
Theophylline
95
What electrolyte imbalance can cause torsade de pointes?
HypOkalaemia
96
What 3 drug classes interact with clozapine to increase antimuscarinic SE?
Antihistamine, antimuscarinic drug-hyoscine
TCA
97
What CNS depressants increase the effects when interacting with clozapine?
Alcohol
Antihistamine- drowsy
Barbituates
Benzos
Opioids
Z drugs
98
What drug treatment is given for inappropriate sexual behaviour?
Benperidol
99
What is the dose of Benperidol given for inappropriate sexual behaviour in adults?
0.25–1.5 mg daily in divided doses
100
What is the dose of Benperidol given for inappropriate sexual behaviour in elderly?
Initially 0.125–0.75 mg daily in divided doses
101
What 2 things are monitored for patients on benperidol?
Regular blood counts LFTs during long-term treatment.
102
What is monitored when taking pimozide?
Annual ECG
103
What to do if QT prolonged with pimozide?
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
What 5 things to monitor when taking antipsychotics?
Weight
ECG
Fasting blood glucose, hba1c
Blood pressure
FBC, U&E + LFT
105
When is weight measured when on antipsychotics?
Start weekly for first 6 weeks, do at 3 months, 1 year then annually
106
When is ECG done when on antipsychotics?
Before drug initiation
107
When is Hba1c and BP measured when on antipsychotics?
3 months, 1 year, annually
108
When is LFT, FBC, U +E measured when on antipsychotics?
Start, then yearly
109
What antipsychotic is least likely to cause hyperglycaemia?
Haloperidol
110
How long to try clozapine to assess response?
8-10 weeks
111
How often to monitor patient if high dose antipsychotic given?
Every 15 mins
112
How often to monitor patient if high dose antipsychotic given?
Every 15 mins
113
How many years after stopping their antipsychotics must patients be monitored for?
2 years
114
How to monitor glucose in clozapine monitoring?
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
What antipsychotic has a MHRA alert on gambling risk?
Aripiprazole
116
How to monitor blood lipids + weight for clozapine?
Baseline,
3 months (weight should be measured at frequent intervals every 3 months in 1st year + then yearly with antipsychotics.
117
How to monitor prolactin in clozapine?
Monitor before, 6 months, and then yearly.
