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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
what is "stage 4" treatment for schizo?
medications in previous steps and ECT
26
what is the treatment guideline for first episode psychosis?
SGA
27
treatment guideline for acute severe psychosis?
haloperidol or olanzapine
28
maintenance treatment guideline in younger patients?
always use SGAs first
29
maintenance treatment guideline in middle age patients?
SGA or FGA
30
maintenance treatment guideline in treatment resistant patients?
FGA or clozapine
31
which 2 treatments are recommended for pregnancy?
clozapine and lurasidone
32
which 2 drugs must be taken with food?
ziprasidone and lurasidone
33
what is the most common EPS symptom with SGAs?
akathisia
34
avoid ziprasidone with ____ concerns
cardiac
35
why should antipsychs be slowly titrated upwards?
severe SEs if starting dose is too high
36
what are the risks of abruptly stopping antipsychs?
seizures, catatonia, rebound psychosis
37
how long does it take for full effects of all antipsychs? (what's the one exception for clozapine?)
12 weeks, clozapine may take up to 6 months
38
what is the first line treatment of catatonia?
benzos (lorazepam)
39
what ANC level must pt be over to start clozapine?
1500
40
a patient taking clozapine who's labs come back with low WBC, ANC would be prescribed which additional antipsych and why?
lithium: it increases WBC
41
what is neutropenia?
too few neutrophils
42
T/F all FGA and SGA have risk of neutropenia
true
43
what is benign ethnic neutropenia? what are the considerations when using clozapine?
a few ethnicities have genetically lower ANC values and can use clozapine as long as ANC is greater than 1000
44
at what point in therapy can dystonia occur?
rapidly, usually first 1-2 doses
45
what is dystonia?
involuntary contractions of head/neck/eyes/back
46
how do we treat dystonia?
anticholinergics (diphenhydramine and benztropine)
47
at what point in therapy can akathisia occur?
around 1-5 months of treatment
48
what is akathisia?
inner restlessness, dysphoria. pt typically moves around to help relieve restlessness
49
how do we treat akathisia?
beta blockers (propranolol) and benzos (lorazepam)
50
when in therapy can pseudoparkinsonism occur?
around 6 months to 1 year of treatment
51
what is pseudoparkinsonism?
tremors, arm rigidity, shuffling gait (short steps, narrow-based with flexed knees and stooped posture)
52
treatment for pseudoparkinsonism?
anticholinergics (diphenhydramine and benztropine)
53
when in therapy can tardive dyskinesia occur?
after 2 years of treatment
54
what is tardive dyskinesia?
involuntary repetitive movements of lips, tongue, eyes, and limbs
55
what is the treatment for tardive dyskinesia?
stop antipsychs, switch to clozapine or aripiprazole
56
which antipsych do we often switch pts to who are not adhering to their medication due to weight gain?
aripiprazole
57
which two SGAs have highest risk for diabetes/insulin resistance?
clozapine and olanzapine
58
what are the side effects of neuroleptic malignant syndrome (NMS)?
hyperthermia, muscular rigidity, leukocytosis
59
what drug do we use to treat NMS? what does it do?
dantrolene reduces calcium influx to prevent cardiac/muscle damage
60
what's another drug that's a dopamine agonist we used to treat NMS?
bromocriptine
61
what do we use as second line treatment for NMS?
benzos or ECT
62
what are the common behaviors of pts with catatonia?
rigidity, strange movements, erratic and extreme movement, might stio talking, and echolalia: repetition of words or behaviors
63
how do we treat catatonia?
w/ benzos (lorazepam)
64
what is the main symptom that distinguishes catatonia from NMS?
catatonia presents with a fever
65
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?
you won't see leukocytosis and elevated CPK with catatonia, so it may be NMS
66
which 2 antipsychs have the highest risk of increasing prolactin?
risperidone and paliperidone
67
which 2 antipsychs have the lowest risk of increasing prolactin?
aripiprazole and brexpiprazole
68
what is the interaction b/w smoking and clozapine?
smoking induces CYP1A2 which metabolizes clozapine and may decrease effectiveness of clozapine
69
which long acting injectable(s) is/are dosed every 2-4 weeks?
fluphenazine decanoate haloperidol decanoate
70
which long acting injectable(s) is/are dosed every 4 weeks?
abilify maintenna, risperidone perseris, paliperidone sustenna
71
which long acting injectable(s) is/are dosed every 2 weeks?
risperidone consta
72
which long acting injectable(s) is/are dosed every 3 months?
pailiperidone trinza
73
which long acting injectable(s) is/are dosed every 6 months?
paliperidone hayfera
74
which long acting injectable can be given q4wks, 6wks, or 8wks?
abilify aristada
75
which long acting injectables have a recommendation for po overlap?
fluphenazine, haloperidol, abilifys, risperidone consta
76
which long acting injectables do not recommend po overlap?
risperidone perseris, all paliperidones

IDT Fall (29 decks)

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