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Therapeutics 2 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

Etiology of schizophrenia

A

largely unknown
evidence supports a genetic basis
environmental stimuli or triggers may contribute to expression
intrauterine exposure to viral or bacterial infections also possible

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2
Q

Wat neurochemicals are involved in schizophrenia?

A

Dopamine and Glutamine

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3
Q

Positive symptoms of schizophrenia

A

hallucinations (auditory, visual, olfactory, gustatory, and tactile). Often threatening or commanding, patient feels compelled to perform the task or experience anxiety when they don’t
Delusions (fixed false beliefs despite validating evidence. May be bizarre in nature) paranoid themes
Thought disorder: loosening of associations, tangentiality, thought blocking, concreteness, circumstantiality, and preservation.
Incomprehensible/illogical speech and thinking

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4
Q

Negative symptoms of schizphrenia

A 
Impoverished speech and thinking
Lack of social drive
Flatness of emotional expression
Apathy
Difficult to evaluate because they occur in a continuum with normality and an be due to secondary causes
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5
Q

Characteristic symptoms of schizophrenia

A 
Delusions
Hallucinations
Disorganized speech
Grossly disorganized/catatonic behavior
Negative symptoms
Must have 2+ symptoms present for a large portion of a month
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6
Q

Diagnostic criteria for schizophrenia

A

2+ characteristic symptoms present for a large part of a month
social/occupational dysfunction - one or more major functioning areas is below level achieved previously for a significant part of time since onset of disturbance
Duration: continuous signs of disturbance for at least 6 months

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7
Q

nonpharmacologic therapies available for schizophrenia

A

psychosocial support
social skills training
cognitive-behavioral therapy
cognitive remediation

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8
Q

Advantages of second generation antipsychotics

A

greater affinity for serotonin receptors than dopamine

lower propensity for EPS and TD

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9
Q

moderate risk adverse effects of risperidone

A

dose-dependent EPS, orthostatic hypotension, weight gain

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10
Q

Severe risk adverse effects of risperidone

A

prolactin elevation (hormonal problems and sexual dysfunction)

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11
Q

moderate risk adverse effects of olanzapine

A

glucose dysregulation

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12
Q

severe risk adverse effects of olanzapine

A

weight gain and lipid abnormalities

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13
Q

moderate risk adverse effects of quetiapine

A

orthostatic hypotension, sedation, weight gain, and lipid abnormalities

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14
Q

Use ziprasidone in caution when…

A

patient has increased risk of prolongation of QTc interval, including comorbid diabetes, electrolyte disturbances, heavy alcohol consumption, being female, and congenital QTc disorders

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15
Q

Aripiprazole Mechanism

A

D2 partial agonist, deemed the “dopamine system stabilizer”
Antagonist in hyperdopaminergic states
Agonist in hypodopaminergic states

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16
Q

What should patients expect on paliperidone

A

see the shell of the tablet in stool because it won’t resolve
Potential dose-related EPS and prolactin elevation

17
Q

why should iloperidone be titrated?

A

risk of orthostatid hypotension

18
Q

How should asenapine be administered?

A

sublingually! do not chew or swallow

do not eat or drink for 10 minutes after administration

19
Q

1st generation antipsychotics available as depot formulations

A 
haloperidol
fluphenazine
invega (paliperidone)
risperidone
20
Q

What is akathesia?

A

motor/subjective restlessness

21
Q

What is dystonia

A

muscle spasms

22
Q

What is pseudoparkinsonism

A

akinesia, tremor, and rigidity

23
Q

What is TD?

A

movement disorder characterized by abnormal choreiform (rapid, objectively purposeless, irregular, and spontaneous movement) and athetoid (slow and irregular) movements occurring late in onset in relation to initiation of antipsychotic therapy

24
Q

What is Neuroleptic Malignant Syndrome (NMS)

A

LIFE THREATENING EMERGENCY!!! severe muscular rigidity, autonomic instability, and altered consciousness
Caused by rapid dose escalation, use of high potency first generation antipsychotics at high doses, and use in younger patients

25
Q

Which antipsychotics are recommended first line?

A

SGAs!! aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone

26
Q

Which antipsychotics are approved for treatment-resistant schizophrenia?

A

clozapine

27
Q

Life-threatening risk of clozapine

A

agranulocytosis

28
Q

moderate risk side effects of clozapine

A

seizures and glucose regulation

29
Q

Severe risk side effects of clozapine

A

anticholinergic side effects (everything is dry!!) orthostatic hypotension, sedation, weight gain, lipid abnormalities

30
Q

short-acting IM SGAs to treat acutely agitated or psychotic patients

A

aripiprazole
ziprasidone
olanzapine

31
Q

which antipsychotic should be taken with food?

A

ziprasidone

absorption is increased 60-70% when administered with food

32
Q

which antipsychotic is metabolized mainly via aldehyde oxidase?

A

ziprasidone

33
Q

which antipsychotic should be avoided with agents that prolong QTc interval?

A

ziprasidone

34
Q

cigarette smoking can decrease the concentrations of…

A

clozapine
olanzapine
thioridazine

35
Q

medications used to treat EPS

A

anticholinergics!!!
benztropine 1-2mg bid
trihexylphenidyl 1-3mg tid
diphenhydramine 25-50mg bid

36
Q

medications effective for akathisia?

A

beta blockers!!

propranolol 30-120mg/day

37
Q

weight check frequency in SGAs

A

every 4 weeks or so

38
Q

blood pressure and glucose check frequencies in SGAs

A

initially, at 12 weeks, then annually

39
Q

lipid check frequency in SGAs

A

initially, at 12 weeks, then annually

Therapeutics 2 (11 decks)

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