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Psych/Sub abuse/Alcohol Therapeutics > Schizo > Flashcards

Schizo Flashcards

1
Q

Positive symptoms

A

Hallucinations, delusions, ideas of influence from external forces, disorganized speech/disconnected thoughts
-dopamine antagonism

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2
Q

Negative symptoms

A

Flat affect (no emotion), alogia (inability to carry convo), anhedonia (no pleasure in anything), avolition (lack of drive/motivation)
-SGA/atypical agents

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3
Q

FGA APS

A

-chlorpromazine (low potency)
-fluphenazine (high potency)
-haloperidol (high potency)
-perphenazine (med potency)
-thioridazine (mod/high potency)
-thiothixene (mod/high potency)

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4
Q

FGA SE

A

EPS, QTc prolongation, prolactin elevation, photosensitivity, blue gray skin, orthostatic hypotension, altered thermoregulation

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5
Q

SGA APS

A

Aripiprazole, Asenapine, Brexpiprazole, Cariprazine, Clozapine, Iloperidone, Lurasidone, Lumateperone, Olanzapine, Paliperidone, Pimavanserin, Quetiapine, Risperidone, Ziprasidone

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6
Q

SGA SE

A

Metabolic syndrome, QTc prolongation, blood dyscrasia/neutropenia’s, seizure threshold, anticholinergic effects, sedation, prolactin elevation, ophthalmic effects

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7
Q

Short acting injectables

A

Chlorpromazine, Haloperidol, Fluphenazine, Olanzapine, Ziprasidone

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8
Q

Long acting injectables

A

Fluphenazine, Haloperidol, Aripiprazole, Olanzapine, Risperidone, Paliperidone

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9
Q

Aripiprazole clinical pearls

A

-May be activating and less sedating than other AEDs
-Insomnia, AKATHISIA, restlessness
-LAI
-Can cause IMPULSIVITY bc of dopamine agonism
-ODT contains phenylalanine (allergy)
-Can be used in peds

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10
Q

Asenapine clinical pearls

A

-little weight gain, least sedating and anticholinergic
-do not eat or drink 10 mins after taking SL tab
-High risk QTc, topical patch can cause skin irritation, anaphylaxis can occur

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11
Q

Asenapine CI

A

severe hepatic diseases

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12
Q

Brexpiprazole (Rexulti) clinical pearls

A

-Impulsivity
-Akathisia (dose related), long half life (91 hrs), fewer metabolic changes

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13
Q

Cariprazine clinical pearls

A

-Akathisia (dose related), long half life (2-4 days)

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14
Q

Paliperidone (Invega)

A

-EPS, Prolactin
-LAI
-Can be used in PEDs
-No PO overlap required
-Food inc bioavailability
-Tab can be in stool
-Acts like FGA
-Must be on Sustenna for 4 months before put on trinza

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15
Q

Clozapine clinical pearls

A

-Blood dyscrasia, metabolic risk, REMs program
-For refractory illness (suicidality), QTc, seizures, myocarditis, constipation, hypersialorrhea, worst for metabolic conditions (cholesterol/BP meds can help)
-Seizure risk inc with dose so might need a AED (mood stabilizer)
-If interrupted >48 hours, need to restart at lowest dose
-REMs: first 6 months: weekly draws, next 6 months: biweekly draws, 1 year: draws every month
-Should avoid benzos (lorazepam)
-orthostasis
-sedation

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16
Q

Iloperidone clinical pearls

A

-most likely to cause orthostatic hypotension (slow titration), QTc, less sedating, need 50% dose reduction if given w/ CYP inhibitors
-Not recommended in severe hepatic impairment
-cardio AE

17
Q

Lurasidone (Latuda) clinical pearls

A

-avoid strong CYP3A4 inhibitors/inducers
-less sedation and orthostasis
-Renal/hepatic dosing needed
-Depression associated with BPD as mono therapy or adjunct to lithium or VPA
-Can be used in PEDs

18
Q

Lumateperone clinical pearls

A

-no significant changes in metabolic parameters, not associated with inc in EPS
-Not recommended in breastfeeding
-Monitor w/ MRI for signs of multifocal lucoencepalophy
-May impair fertility, & during 3rd trimester can have EPS withdrawal, feeding disorder may occur

19
Q

Olanzapine clinical pearls

A

-Metabolic risks, DRESS
-Post injection delirium/sedation syndrome, REMs for LAI (3 hr observation), monitor ANC
-Should avoid if on lorazepam
-Lybalvi: olanzapine + samidorphan: less weight gain, need to be off opioids for 7-14 days before initiating
-Can be used in PEDs

20
Q

Pimavanserin clinical pearls

A

-Avoid CYP3A4s or reduce dose
-No dopamine receptor activity
-Used for treatment in hallucinations & delusions with parkinson’s disease (dopamine deficiency)
-Not recommended for renal compromise < 30 ml/min

21
Q

Quetiapine (Seroquel) clinical pearls

A

-Sedation, metabolic issues
-Can be misused
-Often prescribed for sleep
-Can cause cataracts
-Weight gain
-Can be used in PEDs

22
Q

Risperidone clinical pearls

A

-EPS, prolactin elevation
-Can be used in PEDs
-LAI
-Refrigeration
-There is a SQ injection that can not be touched after injected and needs to be carefully injected and pumped 50 times
-Acts like FGA

23
Q

Ziprasidone

A

-Give with food
-DRESS
-Used for manic crisis
-CI: no use in those at risk for QTc
-Cardo AE

24
Q

Acute dystonias

A

jaw locked up, trouble speaking

25
Q

High risk APS for Acute dystonias

A

High potency or high dose FGA, younger men

26
Q

Treatment for Acute dystonias

A

Anticholinergics, IM benzos, dec or d/c dose

27
Q

Pseudoparkinsonism

A

tremor, postural abnormalities, difficulty turning

28
Q

High risk APS for Pseudoparkinsonism

A

High potency or high dose FGA, older females

29
Q

Treatment for Pseudoparkinsonism

A

Anticholinergics, dec or d/c agent

30
Q

Akathisia

A

restlessness, pacing, shuffling, compulsion to stay in motion, distress

31
Q

High risk APS for Akathisia

A

High potency FGA, aripiprazole, risperidone

32
Q

Treatment for Akathisia

A

Beta-blockers, dec or d/c agent (propranolol, nadolol, metoprolol

33
Q

Tardive dyskinesia

A

limb twisting, rocking, tongue thrusting

34
Q

High risk APS for Tardive dyskinesia

A

High potency or high dose FGA, older female, AA

35
Q

Treatment for Tardive dyskinesia

A

Prevention, d/c agent, switch APS (clozapine), use Ingrezza

36
Q

NMS

A

Rare but lethal
high potency drugs cause but possible all APS
Risk: dehydration, organic mental disorder
treatment: d/c APS
increasedWBC,CPK,LFT

37
Q

Benazines (ingrezza)

A

CI: MAOis
Interactions: CYP3A4 inducers/inhibitors
May prolong QTc

38
Q

Metabloc syndrome

A

need 3 criteria: obesity, abnormal lipid panels, high BP, high BG

Psych/Sub abuse/Alcohol Therapeutics (5 decks)

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