Psychiatric Conditions: Schizophrenia/ Psychosis Flashcards
Common Schizophrenia symptoms
Hallucinations
Delusions
Disorganized thinking/belief
Negative Schizophrenia symptoms
Loss of interest in everyday activities
Lack of emotion (apathy)
inability to plan or carry out activities
poor hygiene
Social withdrawal
Loss of motivation
Lack of speech
Positive Schizophrenia symptoms
Hallucinationos
Delusions
Disorganized thinking/behavior
Difficulty paying attention
1st line txm for Schizophrenia
second gen antipsychotics, less EPS
Antipsychotics in elderly patients
not indicated for agitation control in elderly patients with dementia related psychosis
inc risk of mortality
First Gen antipsychotics
Low Potency = Chlorpromazine, Thioridazine
Mild potency = Loxapine (adasuve = inhalation), Perphenazine
High Potency = Haloperidol, Fluphenazine, Thiothixene, Trifluoperazine
FGA boxed warnings
Elderly pts w/ dementia related psychosis
Thioridazine = QT prolong
Adasuve = REMS for bronchospasm
FGA warnings
Cardiovascular effects: QT prolongation, tachycardia
Anticholinergic effects
EPS
Hyperprolactinemia
Neuroleptic malignant syndrome (NMS)
blood dyscrasias
FGA side effects
Sedation
dizziness
anticholinergic effects
EPS
FGA notes
Lower potency = inc sedation, less EPS
Higher potency = dec sedation, more EPS
Second Gen antipsychotics
Aripiprazole = Abilify
Clozapine = Clozaril
Lurasidone = Latuda
Olanzapine = Zyprexa
Paliperidone = Invega
Quetiapine = Seroquel
Risperidone = Risperdal
Ziprasidone = Geodon
Asenapine = Saphris
Brexpiprazole = Rexulti
Cariprazine = Vraylar
ILoperidone = Fanapt
Lumateperone = Caplyta
Aripiprazole (Abilify) side effects
Akathisia, activating or sedating, headache, anxiety, constipation
lower risk of weight gain, some QT prolong, EPS
Clozapine (Clozaril) boxed warings
sig risk of neutropenia/arganulocytosis (REMS program)
Myocarditis and cardiomyopathy
seizures = dose related
Clozapine (Clozaril) side effects
Agranulocytosis, seizures, constipation, somnolence, metabolic syndrome (inc weight/BG/lipids), hypersalivation
Clozapine (Clozaril) monitoring
REMS, pharmacy/prescriber have to be certified and pt enrolled
baseline ANC > 1,500, weekly checks X 6 months, then bi weekly X 6 months, then monthly.
Stop if ANC < 1,000
Lurasidone (Latuda) Contraindications
Strong CYP450 3A4 inducers/inhibitors
Lurasidone (Latuda) side effects
Somnolence, EPS (dystonia), Nausea
lower risk of metabolic syndrome, lower effect on weight/BG/Lipids
Olanzapine (Zyprexa) Boxed warnings
Injection have to monitor for 3hrs and given in Health care facility, REMS program
Olanzapine (Zyprexa) side effects
Somnolence
metabolic syndrome = inc weight/BG/lipids
Zyprexa Relprevv
inject that last 2-4 weeks
REMS program
restricted use
Paliperidone (Invega) side effects
inc prolactin = sexual dysfunction
EPS, especially at higher doses
tachycardia, QT prolong
metabolic syndrome = inc weight/BG/lipids
somnolence
Quetiapine (Seroquel) side effects
Somnolence, metabolic syndrome
Low EPS risk, often used in Parkinson’s patients
XR = take w/o food, or with light meal
Risperidone (Risperdal) Side effects
inc prolactin = sexual dysfunction
EPS, especially at higher doses
tachycardia, QT prolong
metabolic syndrome = inc weight/BG/lipids
Somnolence
Ziprasidone (Geodan) Contraindications
QT prolong, dont use if QT risk
Ziprasidone (Geodan) side effects
Somnolence, dizziness, nausea, EPS
Asenapine (Saphris) Contraindications and Side effects
CI: sever hepatic impairment
Side effects: Tongue numbness (w/ sublingual), somnolence, EPS, AT prolong
Psychosis in parkinson txm
Pimavanserin (Nuplazid)
Pimavanserin (Nuplazid) warnings and Side effects
Warnings: QT prolong, not approved for dementia related psychosis
Side effects: Peripheral edema, confusion
Smoking effect on antipsychotics
can reduce lvls and need higher doses of antipsychotics
ie. Olanzapine and clozapine
Tardive dyskinesia medicatons
Valbenazine (Ingrezza)
Deutetrabenazine (Austedo)
Valbenazine (Ingrezza) warnings
somnolence
QT prolong
Deutetrabenazine (Austedo) Contraindications and warnings
CI: hepatic impairment, MAOi within 14 days
Warnings: Somnolence, Qt prolong
NMS signs
hyperthermia
extreme muscle rigidity
mental status change
tachycardia, tachypnea, BP changes
Txm of NMS
stop antipsychotic and provide supportive care
relax muscle, can use benzodiazepines, dantrolene or dopamine agonist (bromocriptine)
switch antipsychotics after resolution
