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Behavioral Health > Pharm - Schizophrenia > Flashcards

Pharm - Schizophrenia Flashcards

1
Q

general MoA of antipsychotics

A

post synaptic blockade of brain dopamine D2 receptors

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2
Q

FGAs MoA

A
  • D2 antagonists
  • they lower neurotransmission in the 4 dopamine pathways
  • they can also block H1, M1 and alpha1 receptors
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3
Q

SGAs MoA

A
  • 5HT2A antagonists
  • very high affinity for 5-HT2A
  • lower D2 affinity than haloperidol
  • dissociate rapidly from D2 receptors
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4
Q

adverse effect profile of FGAs vs SGAs

A
  • FGAs: higher risk of neurological side effects

- SGAs: higher risk of metabolic side effects

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5
Q

common metabolic side effects of the antipsychotics

A
  • weight gain
  • hyperglycemia leading to DM
  • hyperlipidemia
  • hypertension
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6
Q

weight gain as an adverse effect of antipsychotics

A

-can be significant (.5 - 5 kg over 10 weeks)

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7
Q

monitoring parameter for weight gain and DM in a pt taking an antipsychotic

A
  • monitor weight at every visit
  • baseline weight and BMI
  • BP
  • fasting triglycerides/fasting lipids
  • ask about family hx of DM
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8
Q

therapeutic management intervention for a pt who develops DM or significant weight gain

A
  • can switch from a higher risk drug to lower risk
  • metformin 1000-2000 mg/day
  • lifestyle intervention
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9
Q

what risk increases in a pt taking a SGA?

A
  • cardiovascular risk

- clozapine is associated w/ potentially fatal causes of myocarditis and cardiomyopathy

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10
Q

monitoring parameters and interventions to reduce cardiovascular risk (BP, lipids, DM)

A
  • tx hyperlipidemia according to cardiovascular risk assessment (like a state)
  • tx HTN according to current guidelines
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11
Q

orthostatic hypotension as an adverse effect of antipsychotics

A
  • d/t the apha adrenergic blockage
  • often accompanied by orthostatic tachy
  • happens most commonly a few days after exposure or when dose is increased
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12
Q

monitoring parameters for orthostatic hypotension

A
  • BP and HR should be monitored during intiation of tx
  • at 3 months
  • and annually thereafter
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13
Q

most appropriate therapeutic management intervention when a pt develops orthostatic hypotension

A
  • usually self limiting
  • possible slowing in rate of dose titration
  • division of single daily dose into 2 or 3 small doses
  • change in medication
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14
Q

increased QTc interval as an adverse effect of antipsychotics

A

-twice the risk of QT prolongation than someone not taking the drug

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15
Q

monitoring parameters for increased QTc interval

A
  • get baseline EKG and serum K
  • EKG at least annually, including at dose adjustments and changes in cardiac condition
  • if FGA is lower risk, monitor EKG and potassium in those w/ hx of cardiac dz
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16
Q

appropriate therapeutic management intervention when pt develops increased QTc interval secondary to FGA

A
  • dont initiate tx if baseline is > 450 ms
  • during tx: if > 500 ms or increase of 60 ms or more = significant risk of torsades and warrants change in tx
  • avoid using inhibitors of CYP-2D6 and drugs that prolong QT
17
Q

sexual dysfunction as an adverse effect of the antipsychotics

A

-dysfunction is all phases of sexual activity

18
Q

monitoring parameter for sexual dysfunction

A
  • as specifically about difficulties w/ sexual function initially and annually
  • evaluate prolactin if complaint
19
Q

hyperprolactinemia as adverse effect of antipsychotics

A

-direct blockade of pituitary dopamine receptors allows uninhibited secretion of prolactin

20
Q

monitoring parameters for hyperprolactinemia

A

-a serum prolactin level is indicated if the pt develops signs of sexual dysfunction or galactorrhea

21
Q

serious allergic reactions are an adverse effect associated w/ what 2 drugs?

A
  • ziprasidone
  • asenapine

*warning has been issued regarding a potentially fatal drug reaction w/ eosiniphilia and systemic sx (DRESS)

22
Q

agranulocytosis is an adverse effect of what drug?

A

clozapine

23
Q

monitoring parameters for agranulocytosis

A
  • for pts w/ pre-existing low cell counts or have had drug induced leukocytopenia in the past, monitoring is recommended during first few months of tx
  • reasonable approach: ANC at baseline, after 1-2 weeks, and after 3-6 months
24
Q

the fall risk with antipsychotics is related to what?

A
  • sedation
  • anticholinergic effects
  • orthostatic hypotension
25
Q

monitoring parameters for fall risk

A

-complete a fall risk assessment when initiating antipsychotic tx and recurrently for pts continuing on long-term antipsychotics

26
Q

appropriate therapeutic management intervention w/ regards to sedation

A
  • most severe early in tx (warn the pt)

- if they experience sedation they should be asked about it periodically

27
Q

appropriate therapeutic management intervention w/ regards to anticholinergic effects

A

-for aggressive tx of constipation use prophylactic agents to prevent serious side effects like fecal impaction/bowel perf

28
Q

EPS as an adverse effect of antipsychotics

A
  • EPS sx include akathisia, parkinsonism, and dystonias
  • MC with haloperidol, fluphenazine, thiothixene, and trifluoperazine
  • uncommon w/: quetiapine, clozapine, and iloperidone
29
Q

TD as an adverse effect of antipsychotics

A
  • MC w/ haloperidol, fluphenzine, thiothixene, trifluoperazine
  • not seen w/ clozapine
30
Q

monitoring parameters for EPS

A
  • evaluate weekly until medication dose is stable for 2 weeks
  • then assess q 6 months
31
Q

monitoring parameters for TD

A
  • assess q 3-6 months throughout the course of tx, at shorter interval for high risk pts
  • ask about restlessness, slow movements, shaking and rigidity at baseline and weekly w/ dose increases
  • use AIMS to track development/progression of sx
32
Q

most appropriate therapeutic management for a pt w/ EPS/TD

A
  • only certain method of prevention is to avoid tx with antipsychoitcs
  • if developed during tx immediately dc med if possible
  • if you can’t dc: use SGAs over FGAs - use cross titration or maintain current med while titrating the new one

Behavioral Health (11 decks)

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