Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

competency 10/11 > neuro: schizophrenia > Flashcards

neuro: schizophrenia Flashcards

1
Q

antipyschotic meds, aka

A

neuroleptics
- Generally tranquilize without impairing consciousness and without causing
paradoxical excitement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

indications for antipsychotics

A
  • schizo and related psychoses
  • acute mania
  • short-term adjunctive mgmt of severe anxiety or psychomotor agitation, violent behaviour

other uses:
- antiemetic in palliative care (chlorpromazine, haloperidol, prochlorperazine)
- adjunct treatment for major depression (quetiapine, aripiprazole)
- irritability a/w autism disorder (risperidone)
- motor tics and adjunctive treatment in choreas and Tourette’s syndrome (haloperidol)
- intractable hiccups (haloperidol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

antipyschotics for schizo

A

relieve sx of psychosis such as thought disorder, hallucinations and delusions
- less effective in apathetic withdrawn patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

is long-term treatment necessary after first episode of psychosis?

A

yes, prevent illness from becoming chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

a person who is maintaining well on antipyschotic may relapse if

A

treatment is withdrawn inappropriately
- relapse is often delayed for several weeks after cessation of treatment
- adipose tissues act as depot resesrvoir after chronic regular usage of antipsychotics: antipsychotics store in fat cells then diffuse back into bloodstream after treatment cessation and until depletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

methods to overcome poor treatment adherance

A
  • IM long-acting injections
  • Community Psychiatric Nurse
  • Patient and Family (Caregiver) Education
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

central dopamine systems is composed of the following 4 tracts

A
  • mesolimbic tract
  • mesocorticol tract
  • nigrostriatal tract
  • tuberoinfundibular tract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

mesolimbic tract

A

common moa for all antipsychotics: blockade of the dopamine receptors in this tract
- overactivity in this region is responsible for the pos sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

mesocorticol tract

A

responsible for higher-order thinking and executive functions
- dopamine blockade or hypofunction in this region results in neg sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

nigrostriatal tract

A

modulates body movement
- dopamine blockade in this region causes EPSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

tuberoinfundibular tract

A

dopamine blockade in this region of the anterior pituitary leads to hyperprolactinemia
- unopposed secretion of prolactin into blood stream: can cause osteoporosis, sexual dysfunction, gynecomastia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

d2 antagonism

A

improve +sx
se: EPSE, hyperprolactinemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

5ht1a agonism

A

anxiolytic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

5ht2a antagonsim

A

antidepressant effects? improve -sx?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

5ht2c antagonism

A

se: weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

h1 antagonism

A

se: sedation/weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

a1 antagonism

A

orthostasis, sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

m1 antagonism

A

memory dysfunction, peripheral anticholinergic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

IKr antagonism

A

qtc interval prolongation: pro-arrhythmic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

adequate trial

A

at optimal therapeutic doses, at least 2-6 weeks
- clozapine trial req up to 3months
- additional augmentation trial of up to 8-10weeks req if another antipsychotic is added to clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

long-acting injectables

A

IM Risperidone microspheres, IM Paliperidone prolonged release suspension, IM Aripiprazole LAI, IM
Haloperidol decanoate, IM Flupenthixol Decanoate, IM Zuclopenthixol decanoate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

consider clozapine in those

A

treatment-resistant ie. failed >= 2 adequate trials of diff antipsychotics, at least 1 should be a SGA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

routine _____ monitoring is req for pt on clozapine

A

hematological: FBC monthly - risk of agranulocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

precautions to antipsychotic use

A

Cardiovascular disease
􀂇 QTc prolongation (contraindicated)
􀂇 ECG required esp. if physical exam identifies cardiovascular
risk factors, or if there is personal history of cardiovascular
disease, or if patient is being admitted as inpatient.
􀂱 PD: EPSE worsened by antipsychotics
􀂱 Epilepsy & conditions predisposing to seizures
􀂱 Depression
􀂱 Myasthenia gravis
􀂱 Prostatic hypertrophy
􀂱 Angle-closure glaucoma
􀂱 Severe respiratory disease
􀂱 History of jaundice
􀂱 Blood dyscrasias, esp. for Clozapine
􀂱 Elderly with Dementia - increased risks for mortality and stroke

25
Q

which antipsychotics must be taken w food

A

lurasidone, ziprasidone

26
Q

which SGA better in terms of metabolic profile

A

ziprasidone, aripiprazole, brexiprazole
lurasidone also q good

27
Q

which SGA worst in terms of metabolic profile

A

clozapine, olanzapine

28
Q

mgmt of side effects: dystonia (muscle spasms eg. oculogyric crisis, torticollis)

A

risks:
- high potency antipsychotics eg. haloperidol
- neuroleptic-naive patients
- young males

onset: within mins (if im/iv) or hrs (if PO)

IM anticholinergics eg. benztropine, diphenhydramine

29
Q

mgmt of side effects: pseudo-parkinsonism (tremors, rigidity, bradykinesia, salivation)

A

risks:
- elderly females
- those with previous neurological damage eg. head injury or stroke

onset: days or weeks

decr antipsychotic dose or switch to SGA
+ anticholinergics PRN eg. benzhexol or benztropine

30
Q

mgmt of side effects: akathisia (restlessness)

A

risks: high potency antipsychotics > risp > olan > quet/cloz

onset: hrs to weeks

decr antipsyhotic dose or switch to SGA
or clonazepam low dose prn
or propranolol 20mg TDS, max 160mg/d
- anticholinergics generally unhelpful

31
Q

mgmt of side effects: tardive dyskinesia (orofacial moements eg. lip chewing, tongue protrusion, pelvic thrusting)

A

risks: FGA>SGA, those who develop acute EPSEs when inisitated on FGA, WORSENS W ANTICHOLINERGIC DRUGS

onset: months/years to develop, 50% irreversible

discontinue any anticholinergics, decr antipsychotic or switch to SGA (clozapine possibly effective), or reversible inhibitor of vesicular monoamine transporter 2 (VMAT2) valbenazine 40-80mg/d, or clonazepam PRN

32
Q

mgmt of side effects: hyperprolactinemia

A

risks: FGA, pali>risp> other SGA

decr FGA dose, dopaine agonist (eg. amantadine, bromocriptine), or switch to aripiprazole

33
Q

mgmt of side effects: metabolic

A

risks: olan/cloz (high), cpz/quet/risp (moderate), ari,lura,zip,halo (low)

lifestyle modification: diet or exercise, treat dm w metformin, treat hld, switch to lower risk agents

34
Q

mgmt of side effects: cv, orthostatic hypoTN

A

risks: cpz, cloz > risp, pali, quet > olan, zip, ari, sulpride

switch to lower risk agents
- get up slowly from sitting or lying position

35
Q

mgmt of side effects: qtc proongation

A

thio>cpz>zip>halo>ilo?qut?risp?olan
high doses, IV halo, hypoK, IHD, female

switch to lower risk agent:
- >440ms for male
- >470ms for female

36
Q

mgmt of side effects: VTE/PE

A

low potency>SGA>FGA> high potency, air

manage emergent DVT

37
Q

mgmt of side effects: sedation

A

switch to lower risk agent (risp, pali,zip,ari)

38
Q

mgmt of side effects: seizure

A

switch to high potency agents eg halo

39
Q

mgmt of side effects: neuroleptic malignant syndrome - muscle rigidity, fever, incr ck

A

IV dantrolene 50mg TDS, oral dopamine agonist eg. amantadine, bromocriptine

switch to SGA

40
Q

pt on quet

A

eye exam every 6 months

41
Q

clozapine impt but rare adr

A

agranulocytosis: decr absolute neutrophil and WBC count
- ANC<1.5x10^9/L
- WBC <3x10^9/L

weekly counts for the first 6 months then every 2 weeks for next 6 months then weekly
- sg: weekly for first 18 weeks then monthly

42
Q

monitoring parameters

A

BMI, waist circumference, fasting blood sugar/HbA1c, lipid panel, plasma prolactin, bp, EPSE, WBC and ANC, ECG

43
Q

ziprasidone need to monitor

A

ECG, qt prolongation

44
Q

antipyschotics for breastfeedign

A

olanzapine, quetiapine
- pt on clozapine should continue on the drug and not breastfeed

45
Q

antipyschotics for renal impairment

A

oral aripiprazole preferred
- avoid sulpride and amisulpride

46
Q

antipyschotics for hepatic impairment

A

sulpride, amisulpride preferred

47
Q

elderly

A

Avoid drugs with high propensity for a1-adrenergic blockade
(orthostatic hypotension eg. cloz) or anticholinergic side effects (constipation,
urinary retention, delirium); start low go slow; simplify regime; avoid
adverse interactions; avoid long T½ drugs
- Precaution: FGAs and SGAs reported to incr mortality and CVAs
dementia patients

48
Q

pregnancy

A

Olanzapine, Clozapine, to watch for gestational diabetes

49
Q

antipsychotics may worsen what disease condition

A

parkinson’s

50
Q

cbz and cloz

A

agranulocytosis

51
Q

time course of treatment response

A

Early improvements
- 1st week: decr agitation, aggression, hostility
- 2-4 weeks: decr paranoia, hallucinations, bizarre behaviors + improved organization in thinking

Late improvements
- 6-12 weeks: decr delusions, negative Sxs may improve
- 3-6 months: cognitive Sxs may improve (with SGAs)

52
Q

FGA and SGA moa

A

d2 antagonist in mesolimbic dop tract, improve + sx

53
Q

SGA only moa

A

5ht2a anta may improve mood sx and possibly also - sx

54
Q

SGA: -ines

A

clozapine, olanzapine, quetiapine: relatively more sedating, more weight gain

55
Q

SGA: -ones or -piprazoles

A

risperidone, lurasidone, ziprasidone, aripiprazole: relatively less sedating, less weight gain

56
Q

IM rapid acting

A

IM haloperidone or olanzapine

57
Q

IM long actign

A

IM haloperidol deconate, 4-weekly dose of 200mg

58
Q
A

competency 10/11 (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions