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pharmacy 358 > Psychosis > Flashcards

Psychosis Flashcards

1
Q

What is schizophrenia?

A

delusions, hallucinations, blunted affect for >6 months and >1 month of at least 2 sx
(Can’t distinguish what is real)

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2
Q

What is psychosis?

A

gross impairment of reality= delusions, hallucinations without awareness of the patient

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3
Q

Is schizophrenia psychosis?

A

Schizophrenia can cause psychosis

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4
Q

What is considered treatment resistant schizophrenia?

A

no improvement despite >2 AP from 2 different classes for 6-8 weeks

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5
Q

What is difference between schizophreniform and schizophrenia?

A

Schizophreniform does not need social functional impairment and only up to 6 months

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6
Q

What is schizoaffective?

A

> 2 weeks of delusions without mood sx and periods of manic or depressive

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7
Q

What is duration of brief psychotic disorder?

A

1 day to 1 month

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8
Q

What is delusional disorder?

A

hallucinations not prominent, and function is only mildly impaired

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9
Q

What time period could a substance be blamed for psychosis?

A

within 1 month of use or withdrawal

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10
Q

Why do people with schizophrenia die on average earlier?

A

stop taking care of themselves, substance use, CVD, suicide

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11
Q

How does schizophrenia happen>

A

issues with dopamine amounts
dopamine can be influenced by serotonin, GABA and glutamate

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12
Q

Typically, at what age does schizophrenia often present?

A

15-35

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13
Q

What legal substance increases risk of psychosis?

A

cannabis use

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14
Q

Why do schizophrenia patients tend to smoke?

A

intensifies cravings for tobacco

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15
Q

What generally happens with blocking dopamine at each pathway?

A

mesolimbic- relief of (+) sx (desire, pleasure, motivation)
Nigrostriatal- EPS (movement disorders)
Mesocortical (midbrain to frontal cortex)- treats (-) sx, worse communication and social function
tuberoinfundibulnar- weight gain, ED, hyperprolactemia, osteoporosis

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16
Q

What are some prodromal features of schizophrenia?

A

not very social, not involved, bizarre ideas, preoccupation with religion, don’t like to be touched

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17
Q

What are positive sx of schizophrenia?

A

(new sx)
hallucination, paranoia, delusions, bizarre behaviour, catatonia

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18
Q

What are negative sx of schizophrenia?

A

(loss of sx)
loss of emotion, motivation, poor self care, alogia

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19
Q

What are the four sx clusters of schizophrenia?

A

Positive, negative, cognitive and mood

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20
Q

What are cognitive sx of schizophrenia?

A

memory impair, can’t concentrate

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21
Q

What are the mood sx of schizophrenia?

A

depressive, mania

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22
Q

What is catatonia?

A

no speak, rigid movements, mimicing

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23
Q

Why do schizo patients love smoking? and why is it an issue?

A

cravings- cant refrain
smoking induces metabolism of clazapine and olanzapine

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24
Q

What does nigrostriatal tract do in schizophrenics?

A

motor coordination

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25
Q

What does the mesolimbic tract do in schizophrenics?

A

positive sx due to D excess

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26
Q

What does the mesocortical tract do in schizophrenics?

A

cognitive, emotion, social function (lower)

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27
Q

What does the tuberoinfundibular tract do in schizophrenics?

A

prolactin

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28
Q

What happens to the nigrostriatal tract if we use dopamine-blocking drugs?

A

EPS

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29
Q

What happens to the mesolimbic tract if we use dopamine-blocking drugs?

A

relief of positive sx

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30
Q

What happens to the mesocortical tract if we use dopamine-blocking drugs?

A

akathsia and treatment of negative sx= increase dopamine here= 5HT
D2 action is WORSENING of - sx

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31
Q

What happens to the tuberoinfundibular tract if we use dopamine-blocking drugs?

A

hyperprolactinemia, osteoporosis, sex dfx

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32
Q

What drugs can induce psychosis?

A

stimulant use/withdrawal, caffeine, cannabis, steroids, ketamine, bupropion, alcohol

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33
Q

How do first generation AP work?

A

D2 antagonism

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34
Q

How do second gen AP work?

A

D2 antagonism
5HT 2A/2C anatgonism

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35
Q

How do third gen AP work?

A

D2 PARTIAL antagonism
5HT 2A antagonism
5HT 1A/2C agonism

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36
Q

For 1st gen AP what is their limiting s/e?

A

EPS

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37
Q

For 2nd gen AP, what is their limiting s/e?

A

metabolic

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38
Q

For 3rd gen AP what is their limiting s/e?

A

akathisia

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39
Q

What is THE most effective AP?

A

clozapine

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40
Q

True or false 1st gen AP are less efficacious than 2nd gen?

A

FALSE all the same efficacy

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41
Q

Which receptor is for positive sx and negative?

A

+= D2
-= 5HT

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42
Q

Difference between acute dystonia and tardive?

A

Acute= grimace, neck spasm
tardive= mouth spasm,

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43
Q

What are the 1st gen AP?

A

Haloperidol, fluphenazine, perphenazine, flupenthixol, chlorpromazine, methotrimeprazine

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44
Q

In regards to s/e how is risperidone unique?

A

NO anticholinergic
BUT
bad prolactin/ sex dfx

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45
Q

Is EPS related to dose?

A

OBVIOUSLY especially at 8 mg

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46
Q

Which 2nd gen has worst prolactin?

A

risperidone

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47
Q

Which 2nd gen has worst sex dfx?

A

risperidone

48
Q

IN regards to palperidone what is unique?

A

metabolite of risperidone
MORE insomnia
less weight gain COMPARED to risperidone

49
Q

WHy is olanzapine not used much?

A

WEIGHT GAIN, dizziness, smoking issues

50
Q

Why is the use of quetiapine so low?

A

T2DM and dislipidemia

51
Q

Which 2nd gens NEED food to be administered?

A

ziprasidone, lurasidone

52
Q

Why do we titrate ziprasidone so fast?

A

overcome hypomanic s/e

53
Q

What 2nd gen is weight neutral?

A

ziprasidone

54
Q

What 2nd gen has highest risk of QT prolongation?

A

ziprasidone

55
Q

Which agent does not have good evidence for schizophrenia?

A

asenapine

56
Q

What is the weird s/e of asenapine?

A

mouth numbness

57
Q

What agent has highest level of akathisia?

A

aripiprazole

58
Q

What is the goldilocks principle?

A

for aripiprazole because it is a partial antagonist and may stabilize dopamine

59
Q

What is good about brexipirazole?

A

less akathisia

60
Q

What are the 3rd gen AP?

A

prazoles, and cariprazine

61
Q

In regards to affinity what is special about cariprazine?

A

lower D2 which may be more helpful for cognitive sx and more D3

62
Q

What are the half lives of 3rd gens?

A

SUPER long like 3-4 days

63
Q

What is the evidence surrounding cariprazine?

A

not enough evidence,

64
Q

Which generation is the go to for psychosis?

A

2nd generation

65
Q

What happens to the brain during a psychotic episode?

A

LOSE brain matter

66
Q

When should long acting injectables be used?

A

if relapse or issues with adherence

67
Q

If switching to injections what must we check?

A

oral overlap periods

68
Q

What are the injectable options?

A

aripiprazole, paliperidone, risperidone

69
Q

What monitoring is needed for AP use?

A

vitals, behaviours, CBC, LFT, ECG

70
Q

What is duration of therapy?

A

18 months but usually lifelong as relapse rate is incredibly high

71
Q

What is an adequate trial of an antispychotic?

A

4-6 weeks

72
Q

What is the response rate of clozapine?

A

30%

73
Q

Why is it useful as a switch option if people get EPS?

A

works in parkinsons as well

74
Q

S/e of clozapine?

A

constipation, blurred vission, dizzy, drowsy, weight gain, metabolic, tachycardia, drool

75
Q

What is an odd and not well understood s/e of clozapine?

A

drooly

76
Q

Serious s/e of clozapine?

A

agranulocytosis, myocarditis, cardiomyopathy, constipation

77
Q

How do we mitigate agranulocytosis with clozapine?

A

Mandatory registration in monitoring

78
Q

Which CBC specifically do we need to monitor for clozapine?

A

ANC

79
Q

How can we mitigate myocarditis/cardiomyopathy?

A

troponin- heart cell damage
CRP- inflammation

80
Q

Given that the serious s/e of clozapine can happen at any time, when do they usually occur?

A

Agranulocytosis- 6 months
myocarditis- 4-6 weeks
cardiomyopathy- years

81
Q

What type of reaction occurs in myocarditis?

A

allergic like

82
Q

Can we switch brands of clozapine?

A

FUCK NO

83
Q

Which registry will new patients be put on?

A

AA-Clozapine- SHA approved= AASPIRE

84
Q

When do you have to retitrate clozapine?

A

missed doses for 2 days

85
Q

Describe the frequency of lab monitoring for clozapine.

A

weekly for 6 months, if good,
q2weeks for 6 months, if good,
q4 for 6 months

86
Q

If quitting clozapine what must the patient do?

A

weekly tests for 4 weeks

87
Q

When must the monitoring be changed to weekly?

A

if missed dose for 3 days or in yellow

88
Q

WHat is green ANC?

A

> 2

89
Q

What is yellow ANC?

A

1.5-2

90
Q

What is red ANC?

A

under 1.5

91
Q

WHat happens if you have yellow ANC?

A

dispense BUT test 2x weekly until stable

92
Q

What happens if in red ANC?

A

STOP and see ER
NEVER START AGAIN

93
Q

How much clozapine can we dispense?

A

as much to get to next blood test

94
Q

How much does smoking decrease clozapine?

A

40%

95
Q

How long after smoking does the induction last?

A

1 week

96
Q

True or false: Do e cigarettes also have the interaction?

A

NO

97
Q

What is the only antipsychotic that lowers suicide risk?

A

clozapine

98
Q

How long is an adequate trial of clozapine?

A

8 weeks

99
Q

If clozapine not working what do we do?

A

No evidence for combo or switch
ECT,CBT, Trans magnetic stimulation

100
Q

WHy is transmagnetic stim used?

A

Not much evidence but more tolerated thaan ECT

101
Q

What can we do for tardive sx?

A

only treat not cure and preventative

102
Q

What is acute dystonias?

A

head and neck spasms
life threatening if issues with swallow or breathing

103
Q

How can we treat dystonia?

A

benztropine

104
Q

How soon can dystonia present?

A

1 week

105
Q

when does akathisia occur

A

6 weeks

106
Q

How to treat akithisia?

A

reduce or change AP, benzo, propranolol, mirtazapine

107
Q

When does pseudoparkinsons happen and how can we treat?

A

6 weeks
reduce or change AP
benztropine

108
Q

What is pisa and rabbit syndrome?

A

pisa= lean
rabbit= quivering lip

109
Q

What scale can we use for tardive dyskinesia?

A

AIMS

110
Q

When does tardive dyskinesia happen?

A

> 3 months

111
Q

Treatment for TD?

A

switch to clozapine or quetiapine

112
Q

What agents can cause neuroleptic malignant syndrome?

A

ANY AP

113
Q

What is neuroleptic malignant syndrome?

A

SEVERE rigidity, fever, confusion, elevated WBC and CK

114
Q

What can we do for neuroleptic malignant syndrome?

A

stop AP
supportive care
bromocriptine

115
Q
A

pharmacy 358 (12 decks)

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