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701 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

Schizophrenia pearls

A
  • Age 20-30 onset
  • Same prevalence worldwide
  • PANSS scale for mental status
  • Patient hx is important to rule out other conditions (drug-induced, comorbidity-induced)
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2
Q

When should clozapine be considered?

A
  • Treatment-resistant patients
  • Substantial risk of, or attempted suicide
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3
Q

T/F: SGA and FGA can be mixed without issues

A

F: FGA can negate efficacy of SGA

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4
Q

FGA Side Effects

A
  • EPS
  • QTc prolongation
  • Prolactin elevation
  • Dermatologic
  • Photosensitivity
  • Blue/gray skin
  • Orthostatic HTN
  • Altered thermoregulation
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5
Q

FGA BBW

A

Dementia-related psychosis -> do not use, increased risk of CV death

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6
Q

SGA Side Effects

A
  • Metabolic syndrome (Hypergly, hypertri, weight gain)
  • QTc prolongation
  • Blood dyscrasia/neutropenias
  • Seizure threshold
  • Anticholinergic
  • Sedation
  • Prolactin elevation
  • Ophthalmic effects
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7
Q

SGA BBW

A

Dementia-related psychosis

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8
Q

Which SGA is approved for agitation in Alzheimer’s?

A

Brexpiprazole

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9
Q

Which is the ONLY SGA not approved for schizophrenia?

A

Pimevanserin

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10
Q

Which SGAs are approved for MDD augmentation?

A
  • Aripiprazole
  • Brexpiprazole
  • Olanzapine (ONLY with fluoxetine)
  • Quetiapine
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11
Q

Aripiprazole

A
  • Less sedating -> insomnia, akathisia, restlessness
  • Impulsivity
    Available as tablet, solution, Mycite, Initio injection, LAI
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12
Q

Asenapine

A
  • Less weight gain
  • Less sedating/anticholinergic
  • Do not drink/eat 10 min after SL
  • CI in hepatic disease
  • High QTc risk
  • Monitor for anaphylaxis after 1st dose
  • Skin site reactions, do not apply heat to patch
    Available as SL, topical patch
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13
Q

Brexpiprazole

A
  • Long t1/2 (91h)
  • Akathisia reported (dose related)
  • Less metabolic ADEs
  • Impulsivity
    Available as oral tablet
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14
Q

Cariprazine pearls

A
  • Long t1/2 (91h) and metabolites contribute to late ADEs (accumulation)
  • Akathisia (dose related)
  • Less metabolic ADEs
    Available as oral capsule
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15
Q

Clozapine

A
  • Gold standard for refractory/suicide risk
  • Metabolic risks (greatest)
  • BBW blood dyscrasias (REMS) - dose-independent
  • QTc, bradycardia
  • Myocarditis
  • Seizure with high conc.
  • Anticholinergic -> very constipating (can be fatal)
  • Hypersalivation
  • Hepatotoxicity, fever, PE, anticholinergic toxicity
  • Dose interruption >48h needs re-titration
  • Respiratory depression with benzos
  • Clozapine + carbamazepine = low ANC
  • Must trial 2 other drugs before starting
    Available oral tablet, ODT, suspension
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16
Q

Iloperidone

A
  • Orthostatic HTN
  • Priapism
  • QTc, less sedation
  • Avoid in hepatic impairment
  • Slow titration
  • Not really used
    Available as oral tablet
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17
Q

Lurasidone

A
  • Neuro ADRs in dementia/PD
  • No notable metabolic SE or EPS
  • Sedation
    Available as oral capsule
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18
Q

Olanzapine

A
  • Second worst for metabolic risk
  • FDA BBW post-injection delirium/sedation (REMS) with LAI
  • DRESS
  • QTc
  • anticholinergic
  • Respiratory depression with benzos
    Available as oral tablet, ODT, short acting IM, LAI
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19
Q

Olanzapine + samidorphan

A
  • Risk of opioid withdrawal if dependent/using
  • Samidorphan is to mitigate metabolic effects of olanzapine
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20
Q

Paliperidone

A
  • QTc
  • GI obstruction
  • Priapism
  • Metabolite of risperidone -> similar ADE
  • Thrombotic thrombocytopenic
    purpura, antiemetic effects
    Available as oral tablet, LAI
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21
Q

Pimavanserin

A
  • No dopamine action
  • Parkinson’s psychosis
  • Avoid renal compromised
    Available oral tablet
22
Q

Quetiapine

A
  • Metabolic risks, sedating
  • Misused for sleep
  • IR and XL tablet
23
Q

Risperidone

A
  • EPS, prolactin elevation
  • TTP, antiemetic
    Available oral tablet, ODT, solution, LAI
24
Q

Ziprasidone

A
  • DRESS
  • SJS
  • QTc
  • Take with food
  • Priapism
  • NIOSH
    Available as oral tablet, short acting injection
25
Q

LAIs

A
  • Good for nonadherence
  • Delayed effect
  • Establish oral tolerability before starting
    FGA: Fluphenazine, Haloperidol
    SGA: Aripiprazole, Olanzapine (monitor for 3 hours afterwards), Risperidone, Paliperidone
26
Q

High potency FGA

A
  • Fluphenazine
  • Haloperidol

High EPS risk

27
Q

Low potency FGA

A
  • Thioridazine
  • Chlorpromazine

High anticholinergic risk

28
Q

Geriatrics

A
  • Start low, go slow
  • Fall risk -> anticholinergics, orthostasis
29
Q

Pregnancy/lactations

A
  • Lowest effective dose
  • Better to continue taking so you’re not crazy with a baby
30
Q

Can you use another LAI if a patient did not tolerate a first gen LAI?

A

Yes, newer LAIs are water-based and more tolerable generally

31
Q

Which SGAs are most sedating and have most weight gain?

A

Clozapine, Olanzapine, Quetiapine

32
Q

Which SGAs are more activating?

A

Lurasidone, Aripiprazole

33
Q

How can you treat tardive dyskinesia?

A

DC offending agent
- DONT use anticholinergics, can mask symptoms
- VMAT2 inhibitors - benazines (Valbenazine, Deutrabenazine)

34
Q

How can you treat akathisia?

A
  • Beta blockers
  • Dec dose or DC offending agent
35
Q

How can you treat pseudo-parkinsonism?

A
  • Anticholinergics
  • Dec dose or DC offending agent
36
Q

How can you treat acute dystonias?

A
  • Anticholinergics
  • IM BZDs
  • Dec dose or DC offending agent
37
Q

What is AIMS

A

Involuntary movement scale to monitor symptoms

38
Q

NMS

A
  • Rare, fatal
  • High potency drugs (but can be all APS)
  • Fever, unstable BP/HR/RR, confusion, muscle rigidity
  • Caused by dopamine agonists
39
Q

How can you treat NMS?

A
  • DC offending agent
  • DA agonists (bromocriptine)
40
Q

Which drugs have decreased effectiveness while smoking?

A

CYP1A2: Olanzapine, Clozapine

41
Q

What does acute dystonia look like?

A

Painful prolonged muscle contractions, larger muscle groups/face

42
Q

What does pseudoparkinsonism?

A

Bradykinesia, pill rolling, tremor (like normal Parkinson’s)

43
Q

Akathisia

A

Restlessness, pacing, shuffling, can’t sit still, very uncomfortable

44
Q

Tardive dyskinesia

A

Very facial focus, chewing, lip smacking, tongue thrusting

45
Q

Which SGAs have the lowest risk of EPS

A

Clozapine, quetiapine

46
Q

Why does clozapine have a REMS program?

A

Blood dyscrasias BBW - monitor for low ANC

47
Q

Which SGAs have the least amount of weight gain?

A

Aripiprazole, lurasidone, ziprasidone

48
Q

Which SGAs are likely to increase prolactin?

A

Risperidone, paliperidone

49
Q

Which SGAs are most likely to cause DRESS?

A

Olanzapine, ziprasidone

50
Q

What is the biggest concern with antipsychotics in afib patients?

A

Torsades de Pointes

51
Q

Which drugs are most likely to cause NMS?

A

High potency (fluphenazine, haloperidol), more D2

But can happen with any APS

701 (11 decks)

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