Schizophrenia Flashcards
what are the positive SEs of schizo?
hallucinations, delusions, disorganized thoughts
what are the negative SEs of schizo?
decr interest/motivation, decr social interactions
schizo causes cognitive dysfunction that includes?
decreased attention or memory functions
positive SEs of schizo likely due to dopamine _______
hyperactivity
negative SEs of schizo likely due to dopamine ______
hypoactivity
how do FGAs effect the limbic system?
decreases positive psychotic symptoms
how do FGAs effect tuberoinfundibular pathway?
increase prolactin
how do FGAs effect nigrostriatal pathway?
cause EPS
how do FGAs effect mesocortical pathway?
increase negative psychotic symptoms
what are initial side effects typical in SGAs?
sedation
tachycardia
hypotension
akathisia (inability to remain still)
dystonia (involuntary muscle contractions)
what are SEs from maintenance dosing of SGAs?
parkinsonism/tardive dyskinesia
weight gain
insulin resistance/diabetes
QT prolongation
prolactin increase
sexual dysfunction
which SGAs may cause hypotension? (block alpha 1 receptors)
asenapine
clozapine
quetiapine
ziprasidone
all SGAs are non-sedating except for which 2?
clozapine and quetiapine
what are the 3 best SGA choices for low sedation?
aripiprazole
brexpiprazole
cariprazine
what are the 5 best SGA choices to prevent weight gain?
aripiprazole
brexpiprazole
cariprazine
lurasidone
ziprasidone
which 3 SGAs have minimal EPS?
clozapine
iloperidone
quetiapine
which 2 SGAs are the most sedating?
clozapine
quetiapine
which 2 SGAs cause the most weight gain?
clozapine
olanzapine
which 2 SGAs have the highest EPS?
paliperidone
risperidone
all FGAs can be used to reduce ____ symptoms of schizo, but do not reduce ___ symptoms well
positive, negative
all SGAs can be used to reduce _____ symptoms of schizo, with moderate efficacy at reducing _____ symptoms
positive, negative
what is “stage 1” treatment for schizo?
SGA
what is “stage 2” treatment for schizo?
use different SGA or use a FGA
what is “stage 3” treatment for schizo?
clozapine
OR
add 2nd antipsychotic/mood stabilizer
what is “stage 4” treatment for schizo?
medications in previous steps and ECT
what is the treatment guideline for first episode psychosis?
SGA
treatment guideline for acute severe psychosis?
haloperidol or olanzapine
maintenance treatment guideline in younger patients?
always use SGAs first
maintenance treatment guideline in middle age patients?
SGA or FGA
maintenance treatment guideline in treatment resistant patients?
FGA or clozapine
which 2 treatments are recommended for pregnancy?
clozapine and lurasidone
which 2 drugs must be taken with food?
ziprasidone and lurasidone
what is the most common EPS symptom with SGAs?
akathisia
avoid ziprasidone with ____ concerns
cardiac
why should antipsychs be slowly titrated upwards?
severe SEs if starting dose is too high
what are the risks of abruptly stopping antipsychs?
seizures, catatonia, rebound psychosis
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
what is the first line treatment of catatonia?
benzos (lorazepam)
what ANC level must pt be over to start clozapine?
1500
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
what is neutropenia?
too few neutrophils
T/F all FGA and SGA have risk of neutropenia
true
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
at what point in therapy can dystonia occur?
rapidly, usually first 1-2 doses
what is dystonia?
involuntary contractions of head/neck/eyes/back
how do we treat dystonia?
anticholinergics (diphenhydramine and benztropine)
at what point in therapy can akathisia occur?
around 1-5 months of treatment
what is akathisia?
inner restlessness, dysphoria. pt typically moves around to help relieve restlessness
how do we treat akathisia?
beta blockers (propranolol) and benzos (lorazepam)
when in therapy can pseudoparkinsonism occur?
around 6 months to 1 year of treatment
what is pseudoparkinsonism?
tremors, arm rigidity, shuffling gait (short steps, narrow-based with flexed knees and stooped posture)
treatment for pseudoparkinsonism?
anticholinergics (diphenhydramine and benztropine)
when in therapy can tardive dyskinesia occur?
after 2 years of treatment
what is tardive dyskinesia?
involuntary repetitive movements of lips, tongue, eyes, and limbs
what is the treatment for tardive dyskinesia?
stop antipsychs, switch to clozapine or aripiprazole
which antipsych do we often switch pts to who are not adhering to their medication due to weight gain?
aripiprazole
which two SGAs have highest risk for diabetes/insulin resistance?
clozapine and olanzapine
what are the side effects of neuroleptic malignant syndrome (NMS)?
hyperthermia, muscular rigidity, leukocytosis
what drug do we use to treat NMS?
what does it do?
dantrolene
reduces calcium influx to prevent cardiac/muscle damage
what’s another drug that’s a dopamine agonist we used to treat NMS?
bromocriptine
what do we use as second line treatment for NMS?
benzos or ECT
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
how do we treat catatonia?
w/ benzos (lorazepam)
what is the main symptom that distinguishes catatonia from NMS?
catatonia presents with a fever
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
which 2 antipsychs have the highest risk of increasing prolactin?
risperidone and paliperidone
which 2 antipsychs have the lowest risk of increasing prolactin?
aripiprazole and brexpiprazole
what is the interaction b/w smoking and clozapine?
smoking induces CYP1A2 which metabolizes clozapine and may decrease effectiveness of clozapine
which long acting injectable(s) is/are dosed every 2-4 weeks?
fluphenazine decanoate
haloperidol decanoate
which long acting injectable(s) is/are dosed every 4 weeks?
abilify maintenna, risperidone perseris, paliperidone sustenna
which long acting injectable(s) is/are dosed every 2 weeks?
risperidone consta
which long acting injectable(s) is/are dosed every 3 months?
pailiperidone trinza
which long acting injectable(s) is/are dosed every 6 months?
paliperidone hayfera
which long acting injectable can be given q4wks, 6wks, or 8wks?
abilify aristada
which long acting injectables have a recommendation for po overlap?
fluphenazine, haloperidol, abilifys, risperidone consta
which long acting injectables do not recommend po overlap?
risperidone perseris, all paliperidones
