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PHAR 358 - Therapeutics (Dr. K. Halpape) > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Define what schizophrenia is.

A

6 or more mths in length of 1 or more mths accompanied by 2 or more of these symptoms:

-Delusions
-Hallucinations
-Disorganized Speech / Behaviors
-Negative Sx (ie. Blunted Affect, Less Spoken Words, Absence of Pleasure, No Motivation)

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2
Q

Describe what psychosis is.

A

Impaired sense of reality in the absence of patient awareness

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3
Q

Define what TRS is.

A

No sx improvement in spite of trialing two or more APs (from two different classes).

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4
Q

How is Schizophreniform Disorder (SPD) similar to full blown Schizophrenia?

A

1 - 6mths of same symptoms, but social / occupational function is not compromised (is in Schizophrenia).

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5
Q

How does Schizoaffective Disorder (SAD) differ from Bipolar?

A

Social / Occupational function is not impaired in spite of psychotic symptoms being present.

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6
Q

How does a Brief Psychotic Disorder (BPD) differ from Schizophreniform Disorder (SPD)?

A

BPD lasts less than a month, with a return to premorbid function (if it persists beyond 1mth or impairs function, then consider it SPD).

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7
Q

Which illicit street drug shows the highest rates of Substance-Induced Psychosis (SIP) development?

A

Crystal Meth

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8
Q

How might a patient with Delusional Disorder present (in comparison to somebody with a schizo-type disorder)?

A

1 or more months of delusions, but hallucinations are not prominent & behavior is not evidently bizarre (function is only mildly impaired).

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9
Q

Does schizophrenia affect women more than men?

A

Nope (equal distribution).

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10
Q

What are some of the more prevalent comorbidities seen in those with schizophrenia?

A

Obesity / Diabetes
CVD
Suicide
Smokers (60 - 90%)

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11
Q

What are some of the barriers that prevent schizophrenic patients from adhering to their medications?

A

-Reduced AP motivational drive
-Side effects
-Stigma
-$$$
-Ethnic Minority

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12
Q

The key theory underlying pathophysiologic progression of Schizophrenia is ______ dysregulation.

A

Dopamine

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13
Q

What other NTs play a role in Schizophrenia?

A

Serotonin, GABA, Glutamate dysregulation

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14
Q

Dopamine blockade at the level of the Nigrostriatal pathway leads to the patient experiencing what types of symptoms?

A

EPS (ie. Movement Disorders)

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15
Q

Dopamine blockade within the Mesolimbic pathway blunts what experiences?

A

Positive Symptoms (ie. Pleasure / Reward, Desires, Motivational Behaviors)

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16
Q

Dopamine blockade within the Mesocortical pathway leads to what?

A

Akathisia (unable to remain still, “ants in pants” feeling)

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17
Q

The most common types of hallucinations experienced by schizophrenic patients are _____ & ______ in nature.

A

visual, auditory

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18
Q

What are the more common catatonic presentations of schizophrenic patients?

A

-Sudden onset, waxy muscle rigidity & mutism (most common); sometimes excessive motor activity w/o obvious cause.

-Echoing speech also common.

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19
Q

Leading cause of premature death in those with schizophrenia is _______.

A

suicide

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20
Q

CYP1A2 hyperactivation in those who smoke alters the effectiveness of what two agents used to treat schizophrenia?

A

Olanzapine, Clozapine

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21
Q

What three interesting patient groups should be screened for schizophrenia as they are considered to be “high risk”?

A

Syphilis, Hep C, HIV

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22
Q

What agents predominantly bring upon psychosis?

A

Pro-Dopamine agents

-Amphetamines / Cocaine
-Bupropion
-Caffeine
-Cannabis
-Chloroquine
-Efavirenz
-Ketamine
-Steroids

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23
Q

What are considered to be the five major antipsychotic receptor targets?

A

A1
D2
H1
Muscarinic
5-HT2A

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24
Q

2nd Gen APs are more commonly associated with what types of adverse effects?

A

Metabolic

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24
Q

1st Gen APs are more commonly associated with what types of adverse effects?

A

Movement (EPS)

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25
Q

3rd Gen APs are more commonly associated with what unique side effect?

A

Akathisia

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26
Q

How does Serotonin 2A / 2C antagonism improve negative schizophrenic symptoms?

A

Increases Dopamine release in Mesocortical Pathway.

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27
Q

D2 antagonism improves positive symptoms of schizophrenia, but causes what types of adverse effects?

A

-EPS

-Elevated Prolactin (boob development, abnormal periods, osteoporosis)

-Sexual Dysfunction

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28
Q

Alpha 1 / 2 antagonism causes what types of adverse effects?

A

-Postural Hypotension
-Dizzy
-Reflex Tachycardia
-Drooling

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29
Q

Muscarinic antagonism causes what types of adverse effects?

A

-Dry Mouth
-Constipation
-Blurry Vision
-Urinary Retention
-Confusion / Memory Disturbances

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30
Q

Haloperidol is a FGA that has pronounced ___ receptor antagonistic activity.

A

D2

31
Q

Risperidone is a SGA that has ______, ___, & _____ adrenergic receptor activity.

A

5-HT2, D2, Alpha-Adrenergic

32
Q

Aripiprazole is a Third-Gen AP that has partial agonist activity at ______ / ___ receptors, as well as antagonistic activity at _____ receptors.

A

Agonist: 5-HT1A, D2
Antagonist: 5-HT2A

33
Q

Clozapine has most distinctive activity at ___, _______, ____, & ____ receptors.

A

D4, 5-HT2A, A1, M1

34
Q

Chlorpromazine & Methotrimeprazine are considered _____ (high or low) potency FGAs.

A

low

35
Q

Low potency FGAs are more commonly associated with what types of side effects?

A

Anticholinergic

36
Q

High potency FGAs (ie. Haloperidol, Fluphenazine, Perphenazine, Flupenthixol) are more commonly associated with what types of side effects?

A

Movement Disorders

37
Q

Daily Risperidone doses of above ___ mg/day show greater rates of EPS.

A

6mg/day

38
Q

Which SGA demonstrates the highest rates of prolactin production increases, sexual dysfunction & EPS?

A

Risperidone

39
Q

Significant CYP2D6 DDI with Risperidone users that can bring upon EPS signs?

A

Fluoxetine

40
Q

What SGA is actually the active metabolite of Risperidone?

A

Paliperidone

41
Q

Are the following side effects more or less experienced by those on Paliperidone (compared to Risperidone):

Orthostatic Hypo
Insomnia
Wt Gain
Sexual Dysfunction

A

OH: Less
Insomnia: More
Wt Gain: Less
Sex Dys: Similar

42
Q

Big issues with Olanzapine (compared to other SGAs)?

A

-Wt Gain (»>)
-AC / Muscarinic SEs
-Metabolic Disorders
-Smoking (sig. interaction)

43
Q

In what indication type would we see the highest Quetiapine dose being given:

Antidepressant
Hypnotic
Antipsychotic

A

Antipsychotic

44
Q

What becomes an increased risk at higher Quetiapine doses?

A

Diabetes / Dyslipidemia

45
Q

Unique administration instructions for those on Ziprasidone?

A

Give with lots of food (>/= 500kcal in order to max out absorption).

46
Q

Benefits of Ziprasidone compared to other SGAs? Contraindications?

A

Benefits: Much less metabolic side effect experiences.

C/Is: QT Prolongation, Recent MI, Concurrent QT Prolonging Drugs.

47
Q

Unique side effects of Asenapine?

A

Mouth Numbness x 1hr post-doses

48
Q

Admin instructions / benefits to Lurasidone use over other SGAs?

A

TWF (350 kcal), less metabolic concerns.

49
Q

Third Gen APs demonstrate greater rates of what side effect compared to other classes?

A

Akathisia (Aripiprazole worst in its class, Brexipiprazole slightly better).

50
Q

On what receptors is Aripiprazole a partial agonist? Antagonist?

A

PA: 5HT1A / D2
Antagonist: 5HT2A

51
Q

Because of its long t1/2, we cannot increase Aripiprazole doses more frequently than q__ wks.

A

2wks

52
Q

How often is an IM Aripiprazole injection given?

A

q4wks (requires 2wks po overlap)

53
Q

Is Aripiprazole more activating or sedating in nature?

A

More activating (typically)

54
Q

Does Aripiprazole have pronounced effects on wt gain?

A

Minimal

55
Q

Which third gen AP has a longer t1/2: Aripiprazole or Brexipiprazole?

A

Brexipiprazole

56
Q

Does Cariprazine have a higher or lower affinity for D2 receptors than Ari & Brexi?

A

Lower

57
Q

At low doses, Cariprazine has a _____ (higher / lower) affinity for D3 receptors than it does D2 receptors.

A

higher

58
Q

What benefit does Cariprazine’s high D3 affinity at lower doses have?

A

Potentially better treatment of negative Schizophrenia symptoms.

59
Q

In terms of binding affinity, a lower Ki value means a drug has _____ (higher / lower) affinity.

A

Higher (inverse relationship between number & strength of affinity).

60
Q

Benefits of using LAIAs over po agents for treating Schizophrenia?

A

-Reduced relapse risk
-Reduced hospitalizations
-Reduced caregiver burden
-Improved adherence

61
Q

The Canadian Schizophrenic Guidelines endorse maintenance AP therapies for at least what length of time?

A

2yrs

62
Q

What is the minimum treatment duration for First Episode Psychosis (FEP)?

A

18mths

63
Q

What is the first line agent for TRS?

A

Clozapine

64
Q

Clozapine acts upon what receptors?

A

D1 / D2 / D4
5HT2A
A1
M1

65
Q

Common Clozapine side effects?

A

-Constipation
-Blurry Vision
-Dizzy / Drowsy
-Drooling
-Wt Gain
-Incr. Chol / Sugars
-OH / Ref Tachy

66
Q

Serious Clozapine side effects?

A

-Decr. WBCs
-Myocarditis
-Cardiomyopathy
-Constipation
-Seizures
-NMS

67
Q

Agranulocytosis is most likely to occur with Clozapine usage within the first ____ mths of treatment.

A

6

68
Q

Myocarditis is most likely to occur with Clozapine usage within the first __ - __ wks of treatment.

A

4 - 8wks

69
Q

How is myocarditis monitored for with Clozapine users?

A

CRP / Troponin qwkly x first 6wks of starting drug

70
Q

What are some objective signs a recently started Clozapine patient might be experiencing myocarditis / cardiomyopathies?

A

-Orthostatic BP changes
-Fatigued / Decr. Exercise Tolerance
-Chest Pains
-Palpitations w Incr. HR
-SOB
-Peripheral Edema
-Fever

71
Q

What is unique about Clozapine’s CBC?

A

Is a differential (measures amount of each specific type of WBC).

72
Q

What WBC Ct is particularly important when monitoring Clozapine?

A

Absolute Neutrophil Count (ANC)

73
Q

My patient is registered with AA-Clozapine. Can I dispense another brand of Clozapine for them in the situation of a backorder?

A

Nooooo

74
Q

145 / 187

A

bleh

PHAR 358 - Therapeutics (Dr. K. Halpape) (8 decks)

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