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IDT Fall > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

what are the positive SEs of schizo?

A

hallucinations, delusions, disorganized thoughts

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2
Q

what are the negative SEs of schizo?

A

decr interest/motivation, decr social interactions

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3
Q

schizo causes cognitive dysfunction that includes?

A

decreased attention or memory functions

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4
Q

positive SEs of schizo likely due to dopamine _______

A

hyperactivity

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5
Q

negative SEs of schizo likely due to dopamine ______

A

hypoactivity

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6
Q

how do FGAs effect the limbic system?

A

decreases positive psychotic symptoms

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7
Q

how do FGAs effect tuberoinfundibular pathway?

A

increase prolactin

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8
Q

how do FGAs effect nigrostriatal pathway?

A

cause EPS

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9
Q

how do FGAs effect mesocortical pathway?

A

increase negative psychotic symptoms

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10
Q

what are initial side effects typical in SGAs?

A

sedation
tachycardia
hypotension
akathisia (inability to remain still)
dystonia (involuntary muscle contractions)

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11
Q

what are SEs from maintenance dosing of SGAs?

A

parkinsonism/tardive dyskinesia
weight gain
insulin resistance/diabetes
QT prolongation
prolactin increase
sexual dysfunction

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12
Q

which SGAs may cause hypotension? (block alpha 1 receptors)

A

asenapine
clozapine
quetiapine
ziprasidone

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13
Q

all SGAs are non-sedating except for which 2?

A

clozapine and quetiapine

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14
Q

what are the 3 best SGA choices for low sedation?

A

aripiprazole
brexpiprazole
cariprazine

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15
Q

what are the 5 best SGA choices to prevent weight gain?

A

aripiprazole
brexpiprazole
cariprazine
lurasidone
ziprasidone

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16
Q

which 3 SGAs have minimal EPS?

A

clozapine
iloperidone
quetiapine

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17
Q

which 2 SGAs are the most sedating?

A

clozapine
quetiapine

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18
Q

which 2 SGAs cause the most weight gain?

A

clozapine
olanzapine

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19
Q

which 2 SGAs have the highest EPS?

A

paliperidone
risperidone

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20
Q

all FGAs can be used to reduce ____ symptoms of schizo, but do not reduce ___ symptoms well

A

positive, negative

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21
Q

all SGAs can be used to reduce _____ symptoms of schizo, with moderate efficacy at reducing _____ symptoms

A

positive, negative

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22
Q

what is “stage 1” treatment for schizo?

A

SGA

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23
Q

what is “stage 2” treatment for schizo?

A

use different SGA or use a FGA

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24
Q

what is “stage 3” treatment for schizo?

A

clozapine
OR
add 2nd antipsychotic/mood stabilizer

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25
Q

what is “stage 4” treatment for schizo?

A

medications in previous steps and ECT

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26
Q

what is the treatment guideline for first episode psychosis?

A

SGA

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27
Q

treatment guideline for acute severe psychosis?

A

haloperidol or olanzapine

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28
Q

maintenance treatment guideline in younger patients?

A

always use SGAs first

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29
Q

maintenance treatment guideline in middle age patients?

A

SGA or FGA

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30
Q

maintenance treatment guideline in treatment resistant patients?

A

FGA or clozapine

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31
Q

which 2 treatments are recommended for pregnancy?

A

clozapine and lurasidone

32
Q

which 2 drugs must be taken with food?

A

ziprasidone and lurasidone

33
Q

what is the most common EPS symptom with SGAs?

A

akathisia

34
Q

avoid ziprasidone with ____ concerns

A

cardiac

35
Q

why should antipsychs be slowly titrated upwards?

A

severe SEs if starting dose is too high

36
Q

what are the risks of abruptly stopping antipsychs?

A

seizures, catatonia, rebound psychosis

37
Q

how long does it take for full effects of all antipsychs? (what’s the one exception for clozapine?)

A

12 weeks, clozapine may take up to 6 months

38
Q

what is the first line treatment of catatonia?

A

benzos (lorazepam)

39
Q

what ANC level must pt be over to start clozapine?

A

1500

40
Q

a patient taking clozapine who’s labs come back with low WBC, ANC would be prescribed which additional antipsych and why?

A

lithium: it increases WBC

41
Q

what is neutropenia?

A

too few neutrophils

42
Q

T/F all FGA and SGA have risk of neutropenia

A

true

43
Q

what is benign ethnic neutropenia? what are the considerations when using clozapine?

A

a few ethnicities have genetically lower ANC values and can use clozapine as long as ANC is greater than 1000

44
Q

at what point in therapy can dystonia occur?

A

rapidly, usually first 1-2 doses

45
Q

what is dystonia?

A

involuntary contractions of head/neck/eyes/back

46
Q

how do we treat dystonia?

A

anticholinergics (diphenhydramine and benztropine)

47
Q

at what point in therapy can akathisia occur?

A

around 1-5 months of treatment

48
Q

what is akathisia?

A

inner restlessness, dysphoria. pt typically moves around to help relieve restlessness

49
Q

how do we treat akathisia?

A

beta blockers (propranolol) and benzos (lorazepam)

50
Q

when in therapy can pseudoparkinsonism occur?

A

around 6 months to 1 year of treatment

51
Q

what is pseudoparkinsonism?

A

tremors, arm rigidity, shuffling gait (short steps, narrow-based with flexed knees and stooped posture)

52
Q

treatment for pseudoparkinsonism?

A

anticholinergics (diphenhydramine and benztropine)

53
Q

when in therapy can tardive dyskinesia occur?

A

after 2 years of treatment

54
Q

what is tardive dyskinesia?

A

involuntary repetitive movements of lips, tongue, eyes, and limbs

55
Q

what is the treatment for tardive dyskinesia?

A

stop antipsychs, switch to clozapine or aripiprazole

56
Q

which antipsych do we often switch pts to who are not adhering to their medication due to weight gain?

A

aripiprazole

57
Q

which two SGAs have highest risk for diabetes/insulin resistance?

A

clozapine and olanzapine

58
Q

what are the side effects of neuroleptic malignant syndrome (NMS)?

A

hyperthermia, muscular rigidity, leukocytosis

59
Q

what drug do we use to treat NMS?
what does it do?

A

dantrolene
reduces calcium influx to prevent cardiac/muscle damage

60
Q

what’s another drug that’s a dopamine agonist we used to treat NMS?

A

bromocriptine

61
Q

what do we use as second line treatment for NMS?

A

benzos or ECT

62
Q

what are the common behaviors of pts with catatonia?

A

rigidity, strange movements, erratic and extreme movement, might stio talking, and echolalia: repetition of words or behaviors

63
Q

how do we treat catatonia?

A

w/ benzos (lorazepam)

64
Q

what is the main symptom that distinguishes catatonia from NMS?

A

catatonia presents with a fever

65
Q

if you are considering a diagnosis b/w NMS or catatonia, and you notice the patient has leukocytosis and elevated CPK, which of the 2 can you confidently rule out?

A

you won’t see leukocytosis and elevated CPK with catatonia, so it may be NMS

66
Q

which 2 antipsychs have the highest risk of increasing prolactin?

A

risperidone and paliperidone

67
Q

which 2 antipsychs have the lowest risk of increasing prolactin?

A

aripiprazole and brexpiprazole

68
Q

what is the interaction b/w smoking and clozapine?

A

smoking induces CYP1A2 which metabolizes clozapine and may decrease effectiveness of clozapine

69
Q

which long acting injectable(s) is/are dosed every 2-4 weeks?

A

fluphenazine decanoate
haloperidol decanoate

70
Q

which long acting injectable(s) is/are dosed every 4 weeks?

A

abilify maintenna, risperidone perseris, paliperidone sustenna

71
Q

which long acting injectable(s) is/are dosed every 2 weeks?

A

risperidone consta

72
Q

which long acting injectable(s) is/are dosed every 3 months?

A

pailiperidone trinza

73
Q

which long acting injectable(s) is/are dosed every 6 months?

A

paliperidone hayfera

74
Q

which long acting injectable can be given q4wks, 6wks, or 8wks?

A

abilify aristada

75
Q

which long acting injectables have a recommendation for po overlap?

A

fluphenazine, haloperidol, abilifys, risperidone consta

76
Q

which long acting injectables do not recommend po overlap?

A

risperidone perseris, all paliperidones

IDT Fall (29 decks)

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