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Schizophrenia Flashcards

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1
Q

FGAs

A

IND:
MOA: DA-2 antagonists. Reduce dopaminergic NTx in the 4 DA pathways. Primary target is the Mesolimbic system to suppress psychosis
BOX: Increased mortality in elderly patients with dementia-related psychosis.
Cardiovascular or infections
CON:
ADR: Anticholinergic/antihistamine. Orthostatic hypotension from Alpha-1 blockade. Hyperprolactinemia. QTc PROLONGATION. Blood abnormalities, seizures, photosensitivity, NMS.

Drug induced movement disorders: Acute dystonia within a week of starting treatment. Treat with Benztropine.
Acute still: May also see drug-induced parkinsonism or akathasia. Treat with anticholinergics.

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2
Q

DA routes activated by FGAs

A

Mesolimbic: Anti-psychotic effects
Nigrostriatal: EPS
Tuberoinfundibular: Hyperprolactinemia
Mesocortical: Negative s/s and cognitive effects

Higher incidence of neuro side effects; Tardive Dyskinesia, EPS

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3
Q

EPS from FGA

A

Months after starting. jerky, stiff, writhing of tongue.
IRREVERSIBLE.
D/t increased sensitivity of receptors d/t chronic blockade.
Treat: Switch to SGA

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4
Q

US BOX WARNING OF ALL ANTIPSYCHOTICS

A

Increased mortality in elderly patients with dementia-related psychosis.
Cardiovascular or infections

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5
Q

Potency

A

Different sizes, not different efficacies

Chlorpromazine: Low potency, higher ADR
Perphenazine: Medium, medium
Haloperidol: High, low

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6
Q

Neuroleptic Malignant Syndrome

A

Rare but serious. Extremely high mortality risk a/w FGAs
s/s: Lead pipe rigidity, sudden high fever, arrhythmias, BP abnormal, profuse sweating.
Worse s/s: LOC, seizures, unresponsiveness
Treatment: D/c antipsychotic ASAP. Support, Benzodiazepines. DANTROLENE (muscle relaxer) or BROMOCRIPTINE (DA agonist). Wait 2 weeks, then try lowest effective dose or switch to SGA

TELL DIFFERENCE OF S/S AND TREATMENT AND CAUSES OF SEROTONIN SYNDROME VS NMS

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7
Q

Haloperidol

A

IND: Schizo, bipolar, delirium, tourette’s
MOA: FGA
BOX: FGA
CON: PD
ADR: QTc PROLONGATION, EPS, anticholinergic, neuroendocrine, sedation, opthalmic

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8
Q

Chlorpromazine

A 
IND: Schizo and HICCUPS
MOA: FGA
BOX: n/a
CON: 
ADR: QTc PROLONGATION, EPS, anticholinergic, neuroendocrine, sedation, ortho hypotension
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9
Q

Perphenazine

A

IND: Schizo, N/V
MOA: FGA
BOX: n/a
CON: Bone marrow suppression. Blood dyscrasias. Liver dz
ADR: FGA and agranulocytosis. No QT prolongation

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10
Q

FGA v SGA

A

Equal efficacy EXCEPT

Clozapine (Clozaril) is the best anti-psychotic but the last line agent.

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11
Q

SGAs

A

DA-2 and 5HT2A Antagonists.
Stronger affinity for 5HT2A than FGAs
Higher incidence of metabolic syndrome, Lower incidence of EPS

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12
Q

Clozapine

A

IND: Schizo, last line
MOA: SGA
BOX: SEVERE neutropenia (Clozapine REMS)
Increased mortality in elderly w/dementia
Ortho hypotension; highest risk during initial titration. Has led to cardiac arrest
Seizures
Myocarditis, Cardiomyopathy, and Mitral valve incompetence
CON:
ADR: Fatal agranulocytosis. HTN/hypo, GI, CNS effects, Fever.
Requires adjustments

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13
Q

Clozapine REMS

A

Risk is dropping WBC or ANC leading to neutropenia and killing the pt. Must be within normal ranges 3500wbc/2000anc.
Cutoffs: WBC less than 3000 or ANC less than 1500; interrupt treatment and monitor daily until resolved.
WBC under 2000 or ANC under 1000, D/c permanently

Provider and pharmacies must enroll to prescribe. Pharmacy requires proof of recent lab.
Weekly monitoring every 6 months

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14
Q

Risperidone

A 
IND: Schizo, bipolar
MOA: SGA
BOX: n/a
CON:
ADR: HYPOPROLACTINEMIA IN CHILDREN/ADOLESCENTS. Weight gain.
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15
Q

Olanzapine

A

IND: schizo, bpd, depression
MOA: SGA
BOX: Post-injection monitoring d/t potential for delirium/sedation from injection
CON:
ADR: ENDOCRINE/METABOLIC; WEIGHT GAIN more than other SGAs. Ortho hypo, gi, weakness. Less EPS than Halo or Risperidone. Decrease Bilirubin. Increase AST/ALT

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16
Q

Quetiapine

A

IND: Schizo, bpd, depression
MOA: Norquetiapine is a M1 receptor antagonist; produces the sedative effect. Good agent for insomnia pts
BOX: Suicidal thoughts/behavior in children-YA
CON:
ADR: Potential for extra sedation
Lower dose for hepatic impairment

17
Q

Paliperidone

A 
IND: Schizo
MOA: Active metabolite of Risperidone
BOX: n/a
CON:
ADR: Tachycardia, endocrine/metabolic, vomiting, EPS, dizzy, drowsy, dystonia, akathisia
18
Q

Iloperidone

A 
IND: Schizo
MOA: 
BOX: n/a
CON:
ADR: Endocrine/metabolic, weight gain. dizzy/drowsy. Tachycardia. QTc prolongation
19
Q

Asenapine

A 
IND: Schizo and bpd
MOA: Does have a topical patch
BOX: n/a
CON: Severe hepatic impairment
ADR: Increased serum CPK. LOW risk of endo/metabolic
20
Q

Lumateperone

A 
IND: Schizo
MOA: 
BOX: n/a
CON:
ADR: Drowsy/sedation

Psych (9 decks)

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