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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
If a patient gets a RED result on Clozapine, what does that mean?
Immediate stopping of therapy and DAILY bloods!
26
How should you discontinue Antipsychotics?
Slowly and gradually particularly after long term treatment
27
What can symptomatic treatment include when stopping anti-psychotic treatment?
Short-term use of benzodiazepines for anxiety and sleep
28
Should you cross taper when switching antipsychotics?
YES
29
What type of anti-psychotic can cause: -Metabolic side effects -Weight gain -Hyperglycemia -Hyperlipidemia -Anticholinergic -Cardiac -Hyperprolactemia -Sexual dysfunction
Second generation antipsychotics
30
What drug can cause hyperprolactemia?
Risperidone
31
What anti-psychotic can cause: -Neurological s/e -Extrapyramidal side effects (EPSEs) -Anticholinergic -Cardiac -Hyperprolactemia -Sexual dysfunction
First generation antipsychotics
32
What are examples of Extrapyramidal side effects? EPSEs
Acute: -Akathesia, Dystonia, Parkinsonism Tardive dyskinesia
33
Extrapyramidal side effects (EPSEs), are associated with what type of dose?
High does of high potency first gen
34
Uncontrolled muscle spasms are known as?
Dystonia
35
How can Dystonia be treated?
Anticholinergics (Procyclidine) OR switching to second gen or reducing dose
36
How do we treat the EPSE of Parkinsonism symptoms?
-Reduce the dose -Switch medication to one less likley -Anticholinergic - procyclidine
37
Inner restlessness is known as?
Akathisia
38
How do we treat Akathisia?
-Dose reduction -Switch -Short course of benzos
39
When starting what drug is a short course of benzos considered?
Aripiprazole
40
How do we treat tardive dyskinesia?
-Stop Anticholinergic meds -Reduce dose of antipsychotic meds -Switch to clozapine or quetiapine
41
Weight gain, increased insulin and glucose levels, dyslipidaemia are examples of what side effect of anti-psychotics?
Metabolic syndrome
42
What inhibits prolactin release?
Dopamine - hence dopamine antagonists increase prolactin plasma levels
43
How do we manage Hyperprolactinemia?
-Reduce dose -Switch to a prolactin sparing -Consider adding low dose aripiprazole
44
How can sexual dysfunction be managed from anti-psychotics?
-Adjust antipsychotic dose -Add 3-6mg Aripiprazole (off license) -Sildenafil
45
What is an example of a psychostimulant?
Modafinil
46
A patient with narrow-angle glaucoma can't have what anti-psychotic?
Olanzapine
47
What drugs at high doses can cause anticholinergic side effects?
Olanzapine and Quetiapine
48
What anti-psychotics can cause Anticholinergic side effects?
First gen with low potency and Clozapine
49
What anti-psychotics can cause sudden cardiac death?
-Quetiapine and Venlafaxine *QT interventions
50
What drug has serious cardiac side effects of: Thromboembolism Myocarditis Cardiomyopathy
Clozapine
51
What drug can cause serious haematological effects: Agranulocytosis
Clozapine
52
A patient on Clozapine is constipated, what should we offer?
1st - Stimulant 2nd - Stool softer/Osmotic laxative
53
A patient on Clozapine is experience Hypersalivation, what can be used to manage this?
-Antimuscarinics = constipation -Hyoscine hydrobromide
54
What can Clozapine cause?
Aspiration Pneumonia due to Hypersalivation
55
What is NMS - in relation to anti-psychotics?
Neuroleptic Malignant Syndrome
56
What is NMS?
An acute disorder of thermoregulation and neuromotor control
57
What is the treatment for NMS?
-STOP antipsychotic -Consider benzos -Call ambulance and transfer to hospital
58
When restarting anti-psychotics after NMS how many days should we wait?
5 days
59
What anti-psychotics should we try when restarting after NMS?
One that is structurally unrelated to the causative agent or one with lower dopamine affinity such as: Quetiapine, Clozapine or Aripiprazole
60
What drug levels are 50% reduced by smoking?
Clozapine and Olanzapine
61
What drug levels are 20% reduced by smoking?
Haloperidol
62
Clozapine levels are increased by 60% by what?
Caffeine
63
In what pathway in Schizophrenia is there a reduction in dopaminergic activity?
Mesocortical pathway
64
All drugs that are used in the treatment of Schizophrenia have activity at what receptors?
D2
65
What pathways are Dopamine pathways?
-Mesocortical pathway -Mesolimbic pathway -Tuberohypophyseal
66
How can cocaine cause psychosis?
Dopamine release stimulates D2 receptors
67
How does Reserpine decrease psychosis?
Depletes dopaminergic and noradrenergic synapses
68
How does bromocriptine exacerbate Schizophrenia?
Dopamine agonist which makes a response happen increases symptoms
69
How does L-DOPA cause hallucinations?
This is a side effect of dopaminergic drugs (DOPA) - Dopamine = positive symptoms occur
70
How does taking Chlorpromazine cause Psuedo-Parkinsonism?
Affects motorsymptoms in the nigrostriatal pathways
71
Why does lactation occur from taking Chlorpromazine?
D2 is blocked in tuberoseal pathway increasing prolactin secretion.
72
Why can sedation occur from taking Chlorpormazine?
H1 antagonism causing sedation
73
Why can postural HTN occur from taking Chlorpromazine?
A1 antagonism
74
Why can patients taking Chlorpromazine get a dry mouth?
Muscarinic side effect

AI Exam 2 (16 decks)

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