Pharm - Schizophrenia Flashcards
Diagnostic criteria for schizophrenia
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
Four phases of schizophrenia
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)
Which NTs are typical targets of drug therapy for Schizophrenia?
DA
5HT
First line agents for schizophrenia
Second generation antipsychotics
What is the MOA of FGAs?
Block dopamine receptors in the CNS
What are the adverse effects of FGAs and why?
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.
Tardive dyskinesia what is it and Tx?
Involuntary, repetitive movements from long-term use (late EPS)
Reversible if caught early.
-don’t give anticholinergics… valbenazine is 1st drug approved for TD
Akathisia: what is it and tx?
Restlessness, difficulty staying still.
Tx: can try Benzodiazepines, lipid-soluble beta-blockers
NOT anticholinergics
Dystonia - what is it and tx?
Involuntary muscle contractions that can cause abnormal postures or repetitive movements
Tx: anticholinergics
Parkinsonism: what is it and tx?
Symptoms that mimic Parkinsons (tremor, shuffling gait).
Tx: anticholinergic agents (diphenhydramine, benztropine, trihexyphenidyl).
How does potency relate to EPS, anticholinergic effects, orthostatic hypotension and sedation?
High potency = high likelihood of EPS
Low potency = high likelihood of ACH effects, sedation, OH.
How do the AEs of SGAs compare to FGAs?
Less risk of EPS, but…
More risk of weight gain, diabetes and dislipidemia.
Clozapine: what’s unique?
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
Aripiprazole - what’s unique?
Available IM
Low risk of EPS
High Akathisia risk
FDA warning about impulse control issues (Sex, binge eat, shopping, gambling)
Asenapine - what’s unique?
Available as SL
Low EPS
Low Metabolic
High OH and sedation. High hypersensitivity reaction risk.
Brexpiprazole - what’s unique?
Dose-dependent AEs.
But, has all metabolic effects, plus akathisia and/or somnolence.
Cariprazine - what’s unique?
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.
Iloperidone - what’s unique?
OH risk
QTC prolongation
But, lower sedation, ACH, metabolic effects and EPS.
Lurasidone - what’s unique?
Take with 350 kcal of food
EPS is dose-dependent
Low risk of weight gain/metabolic issues
Low cardiac risk
Olanzapine - what’s unique?
Similar to clozapine (also requires REMS monitoring)
Available IM
Expect sedation/delirium after administering
High diabetes risk
Paliperidone - what’s unique?
Available as IM
Same SEs as risperidone (active metabolite)
(Weight gain, dose-dependent EPS)
Quetiapine - what’s unique?
Somnolence (binds to histamine receptors)
Weight gain is high
Orthostatic hypotension
Low EPS effects
Risperidone
Dopamine and serotonin antagonist
Dose-dependent EPS Weight gain (some)
Not many anticholinergic effects
Ziprasidone - what’s unique?
Must take with food if oral
Available as an injection for acute agitation
QT prolongation (bad for heart patients) Low metabolic effects
