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AI Exam 2 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

Hallucinations, Delusions, Perceptions, Thought insertion, Echo, Withdrawal, Broadcasting, Disorganised speech, Disorganised or catatonic behaviour are examples of what Schizophrenia Symptoms?

A

Positive

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2
Q

Flattened moods, Avolition, Alogia, Anhedonia, Social isolation, Slow movements and Poor self-care or self-neglect are examples of what Schizophrenia Symptoms?

A

Negative

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3
Q

Speech may be reduced in quantity (poverty of speech), is known as what?

A

Alogia

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4
Q

A failure to enjoy positive emotional or pleasurable experiences is known as what?

A

Anhedonia

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5
Q

Can a patient with Schizophrenia experience cognitive symptoms?

A

YES!

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6
Q

What are the two diagnostic tools of Schizophrenia?

A

DSM5 and ICD10

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7
Q

What are the first generation, Phenothiazine anti-psychotic drugs?

A

-Chlorpromazine
-Levomepromazine
-Promazine
-Pericyazine
-Trifluoperazine
-Periphenazine

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8
Q

What are the first generation, Butyrophenones anti-psychotic drugs?

A

Haloperidol, Benperidol

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9
Q

What are the first generation, Thioxanthenes anti-psychotic drugs?

A

Flupentixol, Zuclpenthixol

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10
Q

What are the first generation, Diphenylbutylpiperidines anti-psychotic drugs?

A

Pimozide

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11
Q

What are the first generation, Substituted benzamides anti-psychotic drugs?

A

Sulpiride and Amisulpride

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12
Q

What are the second generation anti-psychotics?

A

-Clozapine
-Olanzapine
-Risperidone
-Paliperidone
-Quetiapine
-Aripiprazole
-Lurasidone

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13
Q

What generation anti-psychotic do we use for negative symptoms?

A

Second generation

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14
Q

If a patient has a first generation depot / long acting injection, what needs to be done first?

A

A small test dose to test for sensitivities to EPSE’s and the oil base

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15
Q

If a patient has a second generation depot / long acting injection, what needs to be done first?

A

No test dose of injection but need trail or SGA oral treatment

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16
Q

What is high dose antipsychotic prescribing? (HDAT)

A

1) A single antipsychotic prescribed above the BNF max
OR
2) 2+ antipsychotics prescribed concurrently (100%+ of daily dose!)

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17
Q

If a patient is at risk of self harm or accidents what could we consider doing?

A

Rapid Tranquillisation

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18
Q

What does NICE recommend for Rapid Tranquillisation?

A

-IM Lorazepam
*On its own or
-IM Haloperidol with IM Promethazine

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19
Q

What medication is licensed for the treatment of resistant Schizophrenia?

A

Clozapine

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20
Q

What drug class is Clozapine?

A

D2 Weak Antagonist at dopamine D2 receptor

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21
Q

What receptor does Clozapine act through?

A

5-HT2A receptor

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22
Q

How long is blood monitoring weekly for on Clozapine?

A

18 weeks - 2 weekly until one year!

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23
Q

If a patient gets a green result on Clozapine what does that mean?

A

Continue blood tests are within range!

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24
Q

If a patient gets a Amber result on Clozapine what does that mean?

A

Repeat bloods twice weekly until either red or green

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25
Q

If a patient gets a RED result on Clozapine, what does that mean?

A

Immediate stopping of therapy and DAILY bloods!

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26
Q

How should you discontinue Antipsychotics?

A

Slowly and gradually particularly after long term treatment

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27
Q

What can symptomatic treatment include when stopping anti-psychotic treatment?

A

Short-term use of benzodiazepines for anxiety and sleep

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28
Q

Should you cross taper when switching antipsychotics?

A

YES

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29
Q

What type of anti-psychotic can cause:
-Metabolic side effects
-Weight gain
-Hyperglycemia
-Hyperlipidemia
-Anticholinergic
-Cardiac
-Hyperprolactemia
-Sexual dysfunction

A

Second generation antipsychotics

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30
Q

What drug can cause hyperprolactemia?

A

Risperidone

31
Q

What anti-psychotic can cause:
-Neurological s/e
-Extrapyramidal side effects (EPSEs)
-Anticholinergic
-Cardiac
-Hyperprolactemia
-Sexual dysfunction

A

First generation antipsychotics

32
Q

What are examples of Extrapyramidal side effects?
EPSEs

A

Acute:
-Akathesia, Dystonia, Parkinsonism

Tardive dyskinesia

33
Q

Extrapyramidal side effects (EPSEs), are associated with what type of dose?

A

High does of high potency first gen

34
Q

Uncontrolled muscle spasms are known as?

A

Dystonia

35
Q

How can Dystonia be treated?

A

Anticholinergics (Procyclidine)
OR switching to second gen or reducing dose

36
Q

How do we treat the EPSE of Parkinsonism symptoms?

A

-Reduce the dose
-Switch medication to one less likley
-Anticholinergic - procyclidine

37
Q

Inner restlessness is known as?

A

Akathisia

38
Q

How do we treat Akathisia?

A

-Dose reduction
-Switch
-Short course of benzos

39
Q

When starting what drug is a short course of benzos considered?

A

Aripiprazole

40
Q

How do we treat tardive dyskinesia?

A

-Stop Anticholinergic meds
-Reduce dose of antipsychotic meds
-Switch to clozapine or quetiapine

41
Q

Weight gain, increased insulin and glucose levels, dyslipidaemia are examples of what side effect of anti-psychotics?

A

Metabolic syndrome

42
Q

What inhibits prolactin release?

A

Dopamine - hence dopamine antagonists increase prolactin plasma levels

43
Q

How do we manage Hyperprolactinemia?

A

-Reduce dose
-Switch to a prolactin sparing
-Consider adding low dose aripiprazole

44
Q

How can sexual dysfunction be managed from anti-psychotics?

A

-Adjust antipsychotic dose
-Add 3-6mg Aripiprazole (off license)
-Sildenafil

45
Q

What is an example of a psychostimulant?

A

Modafinil

46
Q

A patient with narrow-angle glaucoma can’t have what anti-psychotic?

A

Olanzapine

47
Q

What drugs at high doses can cause anticholinergic side effects?

A

Olanzapine and Quetiapine

48
Q

What anti-psychotics can cause Anticholinergic side effects?

A

First gen with low potency and Clozapine

49
Q

What anti-psychotics can cause sudden cardiac death?

A

-Quetiapine and Venlafaxine
*QT interventions

50
Q

What drug has serious cardiac side effects of:
Thromboembolism
Myocarditis
Cardiomyopathy

A

Clozapine

51
Q

What drug can cause serious haematological effects:
Agranulocytosis

A

Clozapine

52
Q

A patient on Clozapine is constipated, what should we offer?

A

1st - Stimulant
2nd - Stool softer/Osmotic laxative

53
Q

A patient on Clozapine is experience Hypersalivation, what can be used to manage this?

A

-Antimuscarinics = constipation
-Hyoscine hydrobromide

54
Q

What can Clozapine cause?

A

Aspiration Pneumonia due to Hypersalivation

55
Q

What is NMS - in relation to anti-psychotics?

A

Neuroleptic Malignant Syndrome

56
Q

What is NMS?

A

An acute disorder of thermoregulation and neuromotor control

57
Q

What is the treatment for NMS?

A

-STOP antipsychotic
-Consider benzos
-Call ambulance and transfer to hospital

58
Q

When restarting anti-psychotics after NMS how many days should we wait?

A

5 days

59
Q

What anti-psychotics should we try when restarting after NMS?

A

One that is structurally unrelated to the causative agent or one with lower dopamine affinity such as:
Quetiapine, Clozapine or Aripiprazole

60
Q

What drug levels are 50% reduced by smoking?

A

Clozapine and Olanzapine

61
Q

What drug levels are 20% reduced by smoking?

A

Haloperidol

62
Q

Clozapine levels are increased by 60% by what?

A

Caffeine

63
Q

In what pathway in Schizophrenia is there a reduction in dopaminergic activity?

A

Mesocortical pathway

64
Q

All drugs that are used in the treatment of Schizophrenia have activity at what receptors?

A

D2

65
Q

What pathways are Dopamine pathways?

A

-Mesocortical pathway
-Mesolimbic pathway
-Tuberohypophyseal

66
Q

How can cocaine cause psychosis?

A

Dopamine release stimulates D2 receptors

67
Q

How does Reserpine decrease psychosis?

A

Depletes dopaminergic and noradrenergic synapses

68
Q

How does bromocriptine exacerbate Schizophrenia?

A

Dopamine agonist which makes a response happen increases symptoms

69
Q

How does L-DOPA cause hallucinations?

A

This is a side effect of dopaminergic drugs (DOPA) - Dopamine = positive symptoms occur

70
Q

How does taking Chlorpromazine cause Psuedo-Parkinsonism?

A

Affects motorsymptoms in the nigrostriatal pathways

71
Q

Why does lactation occur from taking Chlorpromazine?

A

D2 is blocked in tuberoseal pathway increasing prolactin secretion.

72
Q

Why can sedation occur from taking Chlorpormazine?

A

H1 antagonism causing sedation

73
Q

Why can postural HTN occur from taking Chlorpromazine?

A

A1 antagonism

74
Q

Why can patients taking Chlorpromazine get a dry mouth?

A

Muscarinic side effect

AI Exam 2 (16 decks)

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