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Neuro Psych & Abuse Exam 1 > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

schizophrenia patho

A

dec brain size and asymmetry, inc ventricle size, dec grey matter
DA deficit

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2
Q

dx of schizo

A

delusions
hallucinations
disorganized speech
grossly disorganized or catatonic behavior
negative sx

2 or more of these present for significant portion of time in 1 month period that affects work, relationships, school etc.

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3
Q

what is considered tx resistant

A

pt trialed on 2+ APs for at least 8 weeks on optimized dose

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4
Q

mixing FGA and SGA can mitigate bennies of

A

SGA

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5
Q

FGAs includes

A

haloperidol
chlorpromazine
periphenazine
fluphenazine
thioridazine
thiothixene

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6
Q

FGAs AE and BBW

A

EPS (tardive dyskinesias, akesthesias,
QTc p
inc prolactin level
derm
photosnes
blue-grey skin
orthostatic hypotension
altered thermoregulation

BBW: dementia related psychosis;inc mortality in elderly patients w dementia-related psychosis

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7
Q

SGAs includes

A

aripiprazole
quetiapine
clozapine
olanzapine
ziprasidone
risperidone
lurasidone
blexiprazole
paliperidone
cariprazine
Iloperidone

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8
Q

SGAs AE and BBW

A

QTc p
anticholinergic
inc prolactin (palperidone, risperidone)
dec seizure threshold
blood dyscarias
sedation
ophthalmic (quetiapine)

BBW: dementia related psychosis; inc mortality in elderly patients w dementia-related psychosis

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9
Q

tx options if pt is AP naive

A

risperidone, aripiprazole, ziprasidone (any AP except clozapine)

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10
Q

high potency FGA and AE trend

A

hapoperidol
fluphenazine
thiothixine
trifluoperazine
perphenazine

higher EPS, less anticholinergic risk

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11
Q

APs that have the most inc prolactin

A

FGA:
thioridazine
thiothixene
chlorpromazine
fluphenazine
haloperidol

SGA:
risperidone
paliperidone (P!)

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12
Q

FGAs w anticholinergic AE

A

thioridazine
chlorpromazine
loxapine
molindone

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13
Q

Aripiprazole
weight gain?
sedation?
key AE?
dosage forms

A

less weight gain
less sedation
can cause IMPULSIVITY, insomnia, akathisia, restlessness,
LAI (maintena, aristada)
new products: mycite and aristada initio

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14
Q

asenapine
bennies
AE
pearl

A

new topical patch available!
change patch daily on upper arm, back, abdomen, hip

little weight gain, least sedating and anticholinergic AE
CI in severe heaptic disease
high risk of QTc prolongation
topical patch may cause skin irritation
anaphylaxis at a single dose

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15
Q

impulsivity AE

A

aripiprazole
brexipiprazole

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16
Q

brexipiprazole
AE
pearls

A

IMPULSIVITY
akasthisia (DOSE RELATED)
t1/2 = 91 hours
less metabolic changes than others
po only!

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17
Q

caripiprazole (vraylar)
pearls

A

akasthisia (dose related)
long t1/2 2-4d

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18
Q

clozapine

A

blood dyscrasia
QTc prolongation
constipation–> NEED bowel regimen
seizure
myocarditis
METABOLIC CONDITIONS
monitoring? see notes

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19
Q

Iloperidone

A

ORTHOSTATIC HYPOTENSION–> titrate slowly
less sedating and no prolactin increase
po only!
if on CYP-is –> dec dose 50%

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20
Q

which APs are PO only

A

brexipiprazole
Iloperidone
lurasidone
lumateperone
pimavanserin

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21
Q

Lumateperone

A

no metabolic, EPS, ECG changes
po only!
well-tolerated

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22
Q

Olanzapine
forms
AE
REMS?
uses

A

REMS for post-injection delirium and sedation syndrome
metabolic, ANC, QTc, sedation issues
DRESS!!!
sedation, metabolic issues, QTc, ANC
used in sz w acute BPD monotherapy

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23
Q

which APs have REMS and what is the REMS for?

A

Clozapine - blood acrasias
Olanzapine - post-injection delirium and sedation syndrome

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24
Q

Quetiapine

A

misused, do not use as sleep aid
QTc, sedation, metabolic issues
metab by 3A4

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25
Q

risperidone

A

LAI (IM and SQ), po, ODT, po suspension
INC PROLACTIN\
SQ uncomfy; cant touch area

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26
Q

ziprasidone

A

po cap TAKE W FOOD, SAI IM
DRESS!
CI in patients at high risk QTc p

27
Q

pregnancy may need higher/lower doses and of what medications

A

higher; clozapine, olanzapine

28
Q

APs FDA approved in pediatrics

A

aripiprazole
lurasidone
olanzapine
quetiapine
palperidone
risperidone

29
Q

short acting injectables

A

chlorpromazine
haloperidol
fluphenazine

olanzapine
ziprasidone

30
Q

LAI

A

fluphenazine
heloperidol

aripiprazole
olanzapine
risperidone
paliperidone

31
Q

injectables with no po overlap recommended/required

A

risperidone (LAI)
olanzapine

32
Q

newer injectables (SGAs) are better bc…

A

water based, less discomfort and better tolerated

33
Q

APs with the most sedation

A

chlorpromazine
thioridazine

clozapine
quetiapine

34
Q

APs with the most EPS

A

chlorpromazine
haloperidol
fluphenazine
perphenazine
thioridazine
thiothixene

risperidone
palperidone

35
Q

APs with most anticholinergic AE

A

chlorpromazine
thioridazine

clozapine - bowel regimen

36
Q

APs w most orthostasis AE

A

chlorpromazine
thioridazine

clozapine
Iloperidone

37
Q

APs with most weight gain

A

Chlorpromazine

clozapine
olanzapine

38
Q

Aps with most CV AE

A

haloperidol
chlorpromazine

clozapine
Iloperidone
Ziprasidone

39
Q

acute dystonias tx

A

anticholinergics or benzos IM

40
Q

pseudoparkinsonism tx

A

anticholinergics

41
Q

tardive dyskinesias tx

A

prevention is key, switch AP, use Ingrenna
caution: anticholinergics MASK sx

42
Q

anticholinergic AE tx

A

bowel preps

43
Q

akathisia AE tx

A

dec dose, BBs (propranolol, nadolol, metoprolol)

44
Q

new tx Lybalvi is ___ + ___

A

olanzapine +samidorphan
need 7d opiate free period or 14d LA-opiate free period

45
Q

positive sz sx

A

hallucinations
delusions
ideas of influence
disorganized speech
discontinued thoughts

46
Q

negative sx sz

A

AAAA

flat Affect
Alogia - not speaking
Anhedonia
Avolition

47
Q

A patient starts an AP for sz and calls saying they see a capsule in their stool and is concerned. Which AP is this

A

Paliperidone

48
Q

pt has parkinsons psychosis and has associated delusions and hallucinations
what is the best tx option

A

Pimvanserin

49
Q

APs metabolized by CYP3A4

A

Aripiprazole
Brexipiprazole
Cariprazine
Clozapine
Iloperidone
Lurasidone
Lumateperone
Paliperidone
Pimaavanserin
Quetiapine
Ziprasidone

(All except risperidone, olanzapine, asenapine)

50
Q

patient is experiencing significant impulsivity on their new AP
which APs cause this

A

aripiprazole
brexipiprazole

51
Q

pt receiving a LAI SQ and is instructed not to touch the area or let clothing touch the area. patient also later develops significant gynecomastia. which LAI is this

A

Risperidone LAI

52
Q

which APs are ODT

A

risperidone
clozapine
olanzapine

53
Q

patient is informed that a new AP was released that is a patch. which AP is this

A

asenapine

54
Q

which APs have dose-related akasthinia

A

brexipiprazole
cariprazine

55
Q

patients should avoid smoking in which APs and why

A

clozapine and olanzapine
induced 1A2 which decreased Cp of AP
if smoking, need increased dose. if quits smoking, decrease dose

56
Q

which APs have long t1/2s and what are the half-lifes

A

brexipiprazole 91h
cariprazine 2-4d

57
Q

REMS program for clozapine - how frequently do draws need to be done

A

qwk x6mo then BIW x6mo then qmo

58
Q

pt takes AP po for the first time and is experiencing significant orthostatic hypotension.
which AP is this and how could it be prevented

A

Iloperidone
slow titration needed!

59
Q

avoid ______ if taking strong CYP3A4 inhibitors or inducers

A

Lurasidone

60
Q

which AP now approved for 10-17 yo w BPD type I in addition to MDD w BPD I

A

Lurasidone

61
Q

patients need bowel regimen when on

A

clozapine

62
Q

paliperidone
pt wants to switch from LAI Invega Sustena to LAI Trinza. how long does pt need to be on Sustena before they can try Trinza

A

4 months of qmo injections

63
Q

which APs have BBW for use in patients with dementia-related psychosis

A

all APs

64
Q

Ziprasidone CI with

A

high risk QTc p

Neuro Psych & Abuse Exam 1 (5 decks)

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