Schizophrenia Flashcards
1
Q
Schizophrenia
A
- Chronic, severe disabling thought disorder
- Sxs: hallucinations, delusions, disorganized thought/behavior
- Top rate of suicide amongst psych conditions
2
Q
Positive Sxs
A
- Hallucinations
- Delusions (often auditory)
- Disorganized thinking/behavior
3
Q
Negative Sxs
A
(Think Depression)
- Flat affect
- Anhedonia
- Avolition (not moving)
- Alogia (not talking)
- Withdrawal
4
Q
Antipsychotics
A
- Block dopamine receptors (due to increased DA levels in SCZ)
- 1st gen block DA-2, BUT some respond better
- SGA: block DA2 & 5HT2A, 1st line due to decreases incidence in EPS
- Environment, genetics, stressors, and drugs can also contribute
- Good at treating positive sxs > negative
- Box Warning: NOT indicated for elderly with dementia psychosis (increased mortality), many also have stroke risk
- Need 4-6 weeks trial before failing med
5
Q
Extrapyramidal Sxs
A
- Painful dystonia - give prophylaxis, esp. in young males
- Dyskinesia
- Tardive dyskinesia - D/C drug
- Akathisia
6
Q
Natural Products for Psych
A
- Fish oil
- Used for many psych conditions
- Rx drugs usually needed additionally
7
Q
Formulation Options for Antipsychotics
A
- LA injections: given IM
- ODT tablets: prevents cheeking
- Oral susp/soln: good for kids/feeding tubes
- Acute IM inj: stat relief (often given in cocktail to decrease dystonias)
8
Q
Haldol Decanoate
A
- Haloperidol
- LA inj
- Q4w
9
Q
Risperdal Consta
A
- Rispeidone
- LA inj
- Q2w
10
Q
Invega Sustenna/Trinza
A
- Paliperidone
- LA inj
- Sustenna: q4w
- Trinza: q3mo
11
Q
Abilify Maintena
A
- Aripiprazole
- LA inj
- Q4w
12
Q
Fast Acting Inj Options
A
- Haloperidol - usually given with Ativan + Benzo OR Diphenhydramine (latter two prevent painful dystonia)
- Fluphenazine
- Zyprexa - olanzapine, NEVER give with BZD
- Geodon - ziprasidone
13
Q
ODT Antipsychotics
A
- Aripiprazole
- Clozapine
- Risperidone
- Olanzapine
- Saphris - asenaphine
14
Q
FGA Examples
A
- Haloperidol - high potency, QT prolongation,
- Fluphenazine - LA option**
15
Q
SGA Examples
A
- Aripiprazole
- Clozapine
- Lurasidone
- Ziprasidone
- Olanzapine
- Paliperidone
- Quetiapine
- Risperidone
16
Q
Clozapine Box Warning
A
Box Warning:
- Severe neutropenia - need ANC > 1500 to start and D/C if ANC < 1000
- Seizures
- Dose related: myocarditis and cardiomyopathy
- Need to have failed other AP, bad AEs, or tardive dyskinesia
17
Q
QT Prolongation in AP
A
ALL AP but some have higher risk:
- Thioridazine (FGA) - Box warning for QT prolongation
- Haloperidol (FGA)
- Chlorperazine (SGA)
- Ziprasidone (SGA) - highest risk in SGAs
- *D/C if QT > 500; higher risk with hypoK/Mg, higher risk with high doses**
18
Q
Tardive Dyskinesia Tx
A
- uUncontrollable movements
- Stop drug: Stopping usually more tapered and starting new agent
- Valbenazine - first line (VMAT2i)
- Warning for somnolence!
- Alt: Deutetrabenazine (VMAT2i)
- CI with hepatic impairment
19
Q
Clozapine SE
A
- High risk metabolic SE (weight gain, increased TG/BG)
- Highest hematologic SE risk
- Use when ALL other options fail
- Highest seizure risk (Dose-dependent)
- Smoking decreases levels of clozapine
20
Q
Zyprexa SE
A
- Olanzapine, SGA
- High risk for metabolic SE (weight gain, increased TG/BG)
- Smoking reduces level of olanzapine
- Don’t give with BZD EVER (resp. depression risk)
- QHS
21
Q
Seroquel
A
- Quetiapine, SGA
- High risk for metabolic SE (weight gain, increased TG/BG)
- Lowest EPS risk (recommended with PD)
- IR w/o regards to food; XR w/o food OR 300 kcal max
22
Q
Increase Prolactin Risk in…
A
- Risperidone
- Palideridone
- *Increased levels of prolactin can cause EPS and decrease sex hormones/sexual dysfxn/amenorrhea/galactorrhea**
23
Q
Psychotic Sxs Causing Rx Drugs
A
- Anticholinergics (central acting, high dose)
- Dextromethorphan
- DA or DA agonists (Requip, Mirapex, Sinamet) - use quetiapine if locked up and maxed out
- Interferons
- Stimulants
- Systemic steroids
24
Q
Psychotic Sxs Causing Illicit Drugs
A
- Cannabis
- Bath salts
- Cocaine, crack
- LSD - lysergic acid diethylamide
- Meth
- PCP
25
Q
Neuroleptic Malignant Syndrome
A
- Rare, lethal syndrome due to DA blockade (usually in FGA)
- Usually a more acute response (w/in two weeks of starting or post-high dose inj)
- Medical EMERGENCY: muscles freeze up and can’t breathe
- Sxs: hyperthermia, muscle rigidity (muscles breakdown and cause rhabdo/acute renal failure)
- STOP antipsychotic and use dantrolene for muscle relaxation
26
Q
Reglan
A
- DA blocker
- Metoclopramide
- Used to help move food through gut
- Can worsen EPS sxs and cause parkinsonism
27
Q
Saphris
A
- Tongue becomes numb after taking med
- SL tab, under tongue and dissolve
- Don’t eat or drink for 10 minutes afterwards
28
Q
Latuda
A
- SGA
- Lurasidone
- Take with at least 350 kcal
29
Q
Geodon
A
- SGA
- Ziprasidone
- Take with food
30
Q
Invega
A
- Paliperidone
- SGA
- Leaves ghost tablet
31
Q
Lithium DDI
A
- NSAIDs increase levels (use ASA or suldinac instead)
- Caffeine and theophylline decrease levels
- Increased 5HT syndrome risks with other antidepressants
- Increased neurotoxicity with non-DHP CCBs, phenytoin, and carbamazepine
32
Q
Lithium Counseling
A
- GI issues - titrate slowly, move dose to QHS
- Take with food - at end of meal
- Drink lots of water
- Do NOT get pregnant
- 5mL lithium citrate = 8 mEq lithium
- 8 mEq = 300 mg lithium carbonate tabs/caps
