Pharm - Schizophrenia

Question 1

Diagnostic criteria for schizophrenia

Answer 1

At least two symptoms for at least one month:

• Delusions, Hallucinations, Disorganized speech (one must be one of these)
• Disorganized or catatonic behavior, Negative symptoms

Question 2

Four phases of schizophrenia

Answer 2

Prodromal (gradual dev. of symptoms)
Acute (psychotic behavior)
Stabilization (decreasing symptoms)
Stable (absence of or super declined presence of symptoms).

Residual symptoms likely to remain (poor self-care, anxiety, depression)

Question 3

Which NTs are typical targets of drug therapy for Schizophrenia?

Answer 3

DA

5HT

Question 4

First line agents for schizophrenia

Answer 4

Second generation antipsychotics

Question 5

What is the MOA of FGAs?

Answer 5

Block dopamine receptors in the CNS

Question 6

What are the adverse effects of FGAs and why?

Answer 6

EPS/movement disorders (DA)

Anticholinergic effects (can’t see, can’t spit, can’t pee, can’t shit… blind as a bat, mad as a hatter, hot as a hare, red as a beet, dry as a bone)

Orthostatic hypotension (NOR receptors on blood vessels)

Block dopamine, ACH, histamine and norepinephrine receptors.

Question 7

Tardive dyskinesia what is it and Tx?

Answer 7

Involuntary, repetitive movements from long-term use (late EPS)

Reversible if caught early.
-don’t give anticholinergics… valbenazine is 1st drug approved for TD

Question 8

Akathisia: what is it and tx?

Answer 8

Restlessness, difficulty staying still.

Tx: can try Benzodiazepines, lipid-soluble beta-blockers
NOT anticholinergics

Question 9

Dystonia - what is it and tx?

Answer 9

Involuntary muscle contractions that can cause abnormal postures or repetitive movements

Tx: anticholinergics

Question 10

Parkinsonism: what is it and tx?

Answer 10

Symptoms that mimic Parkinsons (tremor, shuffling gait).

Tx: anticholinergic agents (diphenhydramine, benztropine, trihexyphenidyl).

Question 11

How does potency relate to EPS, anticholinergic effects, orthostatic hypotension and sedation?

Answer 11

High potency = high likelihood of EPS

Low potency = high likelihood of ACH effects, sedation, OH.

Question 12

How do the AEs of SGAs compare to FGAs?

Answer 12

Less risk of EPS, but…

More risk of weight gain, diabetes and dislipidemia.

Question 13

Clozapine: what’s unique?

Answer 13

Works on negative symptoms
Only one to decrease suicidal thinking in schizophrenia
BEST. But, has to have failed 1 SGA and 1 FGA

Needs REMS monitoring d/t risk of neutropenia, heart complications (myocarditis, cardiomyopathy, cardiac arrest, bradycardia), seizures

Question 14

Aripiprazole - what’s unique?

Answer 14

Available IM

Low risk of EPS
High Akathisia risk

FDA warning about impulse control issues (Sex, binge eat, shopping, gambling)

Question 15

Asenapine - what’s unique?

Answer 15

Available as SL

Low EPS
Low Metabolic

High OH and sedation. High hypersensitivity reaction risk.

Question 16

Brexpiprazole - what’s unique?

Answer 16

Dose-dependent AEs.

But, has all metabolic effects, plus akathisia and/or somnolence.

Question 17

Cariprazine - what’s unique?

Answer 17

Big chance of OH at onset and as dose increases.

Some neutropenia.
BUT, good for people experiencing weight gain with others - risk of weight gain is low.

Question 18

Iloperidone - what’s unique?

Answer 18

OH risk
QTC prolongation

But, lower sedation, ACH, metabolic effects and EPS.

Question 19

Lurasidone - what’s unique?

Answer 19

Take with 350 kcal of food

EPS is dose-dependent
Low risk of weight gain/metabolic issues
Low cardiac risk

Question 20

Olanzapine - what’s unique?

Answer 20

Similar to clozapine (also requires REMS monitoring)

Available IM
Expect sedation/delirium after administering
High diabetes risk

Question 21

Paliperidone - what’s unique?

Answer 21

Available as IM
Same SEs as risperidone (active metabolite)

(Weight gain, dose-dependent EPS)

Question 22

Quetiapine - what’s unique?

Answer 22

Somnolence (binds to histamine receptors)
Weight gain is high
Orthostatic hypotension

Low EPS effects

Question 23

Risperidone

Answer 23

Dopamine and serotonin antagonist

Dose-dependent EPS 
Weight gain (some)

Not many anticholinergic effects

Question 24

Ziprasidone - what’s unique?

Answer 24

Must take with food if oral
Available as an injection for acute agitation

QT prolongation (bad for heart patients)
Low metabolic effects

Question 25

What to know about dementia patients?

Answer 25

BBW: don’t use any antipsychotics with older adults who have dementia

Question 26

How to identify FGAs?

Answer 26

End in -zine except for Haloperidol, Loxapine, Thiothixine

Only SGA that ends in -zine is Cariprazine

Question 27

What’s up with QT prolongations?

Which meds have the highest risk?

Answer 27

Antipsychotics can cause longer interval between Q & T. Predisposes the patient to ventricular arrythmias.

FGAs: Chlorpromazine, Haloperidol, Thioridazine
SGAs: Clozapine, Ziprasidone, Iloperidone

Question 28

What’s the MOA of SGAs?

Answer 28

Partial block of dopamine

Increased block of serotonin

Question 29

What does smoking do to antipsychotic consumption?

Answer 29

Smoking is an inducer of enzyme 1A2 that processes antipsychotics.
Makes it not as effective - metabolizes it faster

Question 30

What do Chlorpromazine and Fluphenazine have to do with the 2D6 enzyme?

Answer 30

They inhibit it, so drug concentrations metabolized by this enzyme will go up in body.