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P2 Therapeutics > Pharmacotherapy of Schizophrenia > Flashcards

Pharmacotherapy of Schizophrenia Flashcards

1
Q

5 key features that define psychotic disorders

A
  1. Delusions
  2. Hallucinations (usually auditory, but also visual, tactile, or olfactory)
    3 Disorganized thinking/speech
  3. Disorganized or abnormal motor behavior
  4. Negative symptoms
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2
Q

When is the typical onset of schizophrenia? For men and women?

A

Late adolescence to early adulthood
Men: late teens, early 20s
Women: late 20s, early 30s

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3
Q

Smoking is associated with the induction of _____ because of hydrocarbons produced and inhaled, which ______ the serum concentration of ____ substrate antipsychotics (olanzapine, asenapine, clozapine, loxapine)

A

1A2
1A2
decreases

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4
Q

Three substances that can hasten the onset of schizophrenia, exacerbate symptoms, and reduce time to relapse

A

Marijuana
Cocaine
Amphetamine

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5
Q

Should substance use treatment and mental health treatment be undertaken at the same time in schizophrenia patients?

A

Yes

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6
Q

What should be considered when choosing an antipsychotic for a patient?

A
  1. Doses per day
  2. Side effects
  3. Previous drug therapy
  4. Cost
  5. Concomitant drug therapy
  6. Need for monitoring
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7
Q

Older antipsychotic agents are primarily antagonists of which receptor?

A

D2

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8
Q

The efficacy of typical antipsychotics for positive symptoms is _________ to that of atypical antipsychotics

A

similar

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9
Q

Which typical antipsychotic is most commonly used?

A

Haloperidol - routine and PRN

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10
Q

Which antipsychotics are associated with more EPS?

A

Higher potency typicals
Atypical: risperidone + paliperidone

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11
Q

Typical antipsychotics are very effective for treating ________ symptoms but are likely to worsen _______ and ________ symptoms

A

Positive
Negative, cognitive

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12
Q

Atypical antipsychotics are usually antagonists of which receptors?

A

D2
5HT2A

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13
Q

Which atypical antipsychotics are partial agonists?

A

Aripiprazole
Brexipiprazole
Cariprazine

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14
Q

Partial agonists are associated with more _________ other antipsychotics

A

Akathisia

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15
Q

Aripiprazole and brexpiprazole are both ______ + _______ substrates, while cariprazine is only a _____ substrate

A

2D6 + 3A4
3A4

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16
Q

Partial agonists are approved for adjunct treatment in ________, so all have a boxed warning for __________ ___________

A

depression
suicidal thoughts/behavior

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17
Q

Which of the “pines” have sublingual and patch formulations?

18
Q

Asenapine, clozapine, and olanzapine are all substrates of which CYP?

19
Q

Quetiapine is a substrate of which CYP?

20
Q

Which “pines” have a risk for QTc prolongation?

A

Asenapine
Clozapine
Quetiapine

21
Q

Olanzapine has a high risk for __________ ___________ and warning for ________

A

high risk - metabolic syndrome
warning - DRESS

22
Q

The “pines” have a higher incidence of which side effects compared to other antipsychotics?

A

Weight gain
Sedation

23
Q

Quetiapine has a boxed warning for what?

A

suicidal ideation

24
Q

Boxed warnings for clozapine (7)

A
  1. Neutropenia
  2. Orthostasis
  3. Bradycardia
  4. Syncope
  5. Seizures
  6. Myocarditis
  7. Cardiomyopathy
25
Q

Side effects of clozapine (6)

A
  1. Sedation
  2. Weight gain
  3. Constipation
  4. Hypersalivation
  5. Dry mouth
  6. GI hypomotility with obstruction risk
26
Q

Asenapine patch instructions

A

Apply one patch every 24 hours, rotate patch site to minimize application site reactions

27
Q

If taken with a 1A2 inhibitor, how should you adjust the dose of asenapine?

A

Reduce the dose because it’s a 1A2 (and UGT) substrate

28
Q

Monitoring timeline for Clozapine REMS

A

Weekly x 6 months
Biweekly x 6 months
Then every 4 weeks

29
Q

Mechanism of action of Samidorphan

A

opioid antagonist with preferential activity at the mu opioid receptor

30
Q

Asenapine has a warning for what?

A

QTc prolongation

31
Q

Which of the “dones” have a warning for QTc prolongation?

A

Iloperidone
Ziprasidone
Paliperidone

32
Q

Which “dones” are substrates of 2D6?

A

Iloperidone
Risperidone (minor 3A4)

33
Q

Lurasidone is a substrate of CYP _____

34
Q

Ziprasidone is a substrate of CYP ______ (1/3) and aldehyde oxidase (2/3)

A

3A4
less worry for CYP interactions!

35
Q

Which “dones” should be taken with food?

A

Lurasidone
Ziprasidone

36
Q

Which “dones” have the highest D2 blockade of all the atypical antipsychotics?

A

Risperidone
Paliperidone

37
Q

Side effects of risperidone and paliperidone (5)

A
  1. EPS
  2. Hyperprolactinemia
  3. Weight gain
  4. Sedation
  5. Orthostasis
38
Q

Lumateperone (Caplyta) is a substrate of CYP _____

39
Q

Overlap with oral aripiprazole for ___ weeks when starting Abilify Maintena and ___ weeks for Aristada

A

Maintena - 2 weeks
Aristada - 3 weeks

P2 Therapeutics (18 decks)

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