Schizophrenia Flashcards
positive symptoms
hallucinations
delusions
ideas of influence
disorganized speech
disconnected thoughts
negative symptoms (4 A’s)
flat Affect (no emotional expression)
Alogia (inability to carry a logical conversation)
Anhedonia (inability to experience pleasure)
Avolition (lack of motivation)
cognitive symptoms
impaired attention
impaired working memory
impaired executive function
Low potency antipsychotics
chlorpromazine
thioridazine
low EPS risk
high anticholinergic risk
High potency antipsychotics
fluphenazine
haloperidol
high EPS risk
low anticholinergic risk
Acute dystonia
painful prolonged muscle contractions
involuntary buccal, facial, oculogyric movement
may involve back, arms, legs
onset 24-96 hrs after med change
Acute dystonia treatment
anticholinergics
IM Benzos
decrease dose or d/c offending agent
Pseudo-parkinsonism
bradykinesia
tremor
pill rolling
cogwheel rigidity
postural and oral abnormalities
onset 1-2 weeks post med change
Pseudo-parkinsonism treatments
anticholinergics
decrease dose or d/c offending agent
Akathisia
restlessness
pacing
shuffling
compulsion to stay in motion
distress
onset hrs-days after med change
Akathisia treatment
beta blockers
decrease dose or d/c offending agent
Tardive dyskinesia
tongue thrusting, chewing, lip smacking, grimacing, limb twisting, rocking
onset months-years after med change
Tardive dyskinesia reatment
prevention
DC offending agent
First Generation Antipsychotics
Chlorpromazine (Thorazine)
Fluphenazine (Proxiln)
Haloperidol (Haldol)
Perphenazine (Trilafon)
Thioridazine (Mellaril)
Thiothixene (Navane)
First Generation Antipsychotics ADEs
EPS
QTc prolongation
Prolactin elevation
dermatologic
photosensitivity
blue-gray skin (haldol)
orthostatic HTN
altered thermoregulation
Extra-pyramidal symptoms (EPS)
involuntary movement
tremors
stiff muscles
Antipsychotics available as Long Acting Injections (LAIs)
Aripiprazole (Maintena, Aristada)
Olanzapine (Zyprexa)
Paliperidone (Sustenna, Trinsa)
Risperidone (Consta IM) (Perseris SQ)
Fluphenazine
Haloperidol
Aripiprazole (Abilify)
impulsivity
2nd gen
little weight gain
less sedating
may cause insomnia, akathisia, restlessness
Asenapine (Saphris)
topical patch available
2nd gen
among the least sedating and anticholinergic
high risk for QT prolongation
anaphylaxis may occur after a single dose
CI: severe hepatic disease
Brexpiprazole (Rexulti)
impulsivity
2nd gen
akathisia
long t1/2
fewer metabolic effects
Clozapine (Clozaril, Fazaclo)
Blood dyscrasia, metabolic risk
2nd gen
gold standard for refractory illness (suicidality)
QTc prolongation
seizure
myocarditis
MUST BE PRESCRIBED A BOWEL REGIMEN
REMS program
Iloperidone (Fanapt)
orthostatic hypotension, slow titration needed
2nd gen
no notable prolactin inc
QTc warnings
less sedating
caution in hepatic impairment
Lurasidone (Latuda)
do not use with strong CYP3A4 inhibitor/inducor
2nd gen
no notable prolactin inc
less sedation
approved for adolescent use
depression associated with bipolar disorder as monotherapy or adjunct with lithium or valproate
Lumateperone (Caplyta)
2nd gen
well tolerated
somnolence
sedation
fatigue
constipation
olanzapine (Zyprexa)
metabolic risks, DRESS
2nd gen
post injection delirium/sedation -> REMS for LAI
sedating
QTc
ANC
Paliperidone (Invega)
EPS, Prolactin
2nd gen
no PO overlap required
must be maintained on Sustenna for at least 4 months before Trinza
Pimavanserin (Nuplazid)
no dopamine
2nd gen
indicated for treatment of hallucinations and delusions associated with Parkinson’s disease psychosis
QTc warnings
Quetiapine (Seroquel)
sedation, anticholinergic effects cataracts
2nd gen
may be misused as sleep aid
Risperidone (Risperdal)
EPS, prolactin
2nd gen
Aqueous injection for IM admin
Ziprasidone (Geodon)
contraindicated in pats with high risk of QTc prolongation
2nd gen
DRESS
Anticholinergic effects
dry mouth
blurry vision
sedation
constipation
hallucinations
memory problems
General Second Generation Antipsychotic ADEs
Metabolic syndrome
- hypertriglyceridemia
- hyperglycemia
- weight gain
QTc prolongation
blood dyscrasia
dec seizure threshold
anticholinergic effects
sedation
prolactin elevation
ophthalmic effects
