Schizophrenia Flashcards
Core Signs and Sx’s :
1. Positive sx’s? (4)
2.Cognitive sx’s? (3)
3. Negative sx’s? (4)
4. Mood sx’s? (4)
Can cause Social And Occupational Dysfunction such as? (4)
- Delusions, hallucinations (auditory or visual), disorganization (speech), agitation
- Attention, memory, executive function
- Alogia (dysfunction of speaking), avolition (reduced desire/motivation), anhedonia, blunted affect (Restricted range and intensity of emotional expression–> unchanged facial expression poor eye contact)
- Cheerful or sad, depression, dysphoria, hopelessness
- Social isolation, employment, relationships, self care
- Name (4) FGA’s or “Typical”
- MOA?
- Decr in __, worsening of __ and __ sx’s. Can induce ___, and leads to ___
- Loxapine inhalation powder has a BBW for?
PK :
5. Haloperidol has a half life of?
-Metabolized by ? (2)
6. FLuphenazine is primarily metab by __ and smoking tobacco may ?
-Its also a substrate of CYP ?
7. Loxapine has no reported cases of __ or __
8. Chlorpromazine is a substrate of
- Chlorpromazine (Thorazine)
- Fluphenazine (Prolixin)
- Haloperidol (Haldol)
- Loxapine (Loxitane/Adasuve)
- Primarily antagonizes D2 receptors
- Positive sx’s, negative, cognitive. EPS, hyperprolactinemia
- Bronchospasms
- 24 hrs , CYP 3a4, 2d6
- CYP1A2, incr clearance up to 62%
- CYp 2d6 - transminitis , liver toxicity
- CYp 2d6
EPS :
1. Acute dystonia sx’s and management drugs ? (2)
2. Akathisia sx’s and management drugs? (2)
3. Pseudoparkinsonism sx’s and management drugs ?
4. TARDIVE DYSKINESIA sx’s and management ?
- acute muscle spasms typically in head/neck (facial grimacing)
-Diphen, Benztropine - restlessness;inability to sit still, internal compulsion to move *risk factor for suicide
-Propanolol, Benztropine - Tremor , cogwheel rigidity, shuffling gait, stooped posture, pill rolling movements,
-Trihexyphenidyl, Amantadine - Hyperkinetic, stereotypical movements of face, tongue and limbs
-Valbenazine, Deutetrabenazine, avoid anticholinergics, consider switching to Clozapine
FGA : Adverse Effects DOPAMINE RECEPTOR
1. On the dopamine receptor, it can cause the following ae’s? (3)
- High potency drugs ? and EPS effects?
- Low potency? EPS effects?
- Hyperprolactinemia , EPS (dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia) , Worsened negative sx’s (FGA’s»_space;» SGA’s)
- Haloperidol and Fluphenazine –> VERY HIGH EPS
- Chlorpromazine –> Low- mod EPS
FGA Adverse Effects : Muscarinic Receptor
1. What ae’s can happen at this muscarinic receptor? (5)
2. For haloperidol and fluphenazine , how extreme are the ach effects?
3. For Chlorpromazine how extreme are Ach effects?
HISTAMINE RECEPTOR :
1. Ae’s? (3)
2. Haloperidol + Fluphenazine?
3. Chlorpromazine?
ALPHA RECEPTOR
1. Ae’s? (3)
2. Haloperidol and Fluphenazine hypotensive effects?
3. Chlorpromazine hypotensive effects?
- Dry mouth, blurred vision, constipation, urinary retention, drowsiness
- LOW
- HIGH
- weight gain, sedation, vasodilation
- Low sedative effects
- HIGH sedative effects
- ortho hypo, sedation, priapism
- Low hypotensive effects
- HIGH hypotensive effects
Additional AE’s FGA’s :
1. Slowed __
2. __ dysfunction
3. BBW for?
4. Dermatologic?
5. Hematologic (rare)
6. COnvulsant ?
-BBW of this for which drug?
7. Opthalmologic?
- thikning
- sexual
- incr risk of death in elderly pt’s with dementia related psychosis (BBW for all antipsychotics)
- Photosensitivity
- Leukopenia, eosinophilia, thrombocytopenia, agranulocytosis, VTE
- All antipsychs lower seizure threshold
- Thioridazine - cornea and lens pigmentation (Thioridazine, chlorpromazine)
Second Generation ANtipsychs : “atypical”
1. Name 7
2. MOA?
3. considered __ in nearly all schizophrenia management guidelines
4. Loosely binding to D2 receptor allows for ?
5. Decr of risk EPS is done through ?
6. 5HT2A antagonism theory and negative sx’s and cog sx’s?
- Aripiprazole (Abilify)
- CLozapine (Clozaril)
- Lurasidone (Latuda)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Ziprasidone (Geodon)
- Antagonize D2 and 5HT2A receptors
- First line
- DECR positive sx’s and decr the risk of EPS (Clozapine and Quetiapine)
- 5HT2A antag
- improve neg sx’s AND POSSIBLY cog sx’s
Unique SGA”s : MOA
1. what 3 receptors does it work on ?
2. Which agents r these ?
- 5HT2A antag, 5HT1A PARTIAL AGONIST, D2 PARTIAL AGONIST *Note the other SGA’s antagonize D2**
- ABILIFY, brexpiprazole and cariprazine
SGA : Dosing and Clinical Pearls
1. Aripiprazole (Abilify ) *
- Dosage range?
-Prominent ___ but lower risk of ___
-BBW for ?
-Has a LAI, must give what ?
- Asenapine (Saphris)
-DOsage forms?
-Patient must be able to __ and needs to avoid ___ 10 mins after each dose - Brexpiprazole (Rexulti)
- Increased risk of? Lower risk of? - Cariprazine (vraylar)
-Concerned about ?
-Incr risk of ?
-High potency at __ so may add benefit for __ and __ - Clozapine (Clozaril) *
- Dosage range?
-Starting dose cannot exceed?
-BBW for ? (4)
-CYP1A2 substrate so affected by ?
-Associated with ?
-Significant ___ (4)
- 10-30 mg/day
- akathisia , metabolic side effects
-Suicidal ideation/behavior in children, adolescence, and young adults
-Oral test dose first to evaluate allergy to med - SL and patch
- open foil package, food/water - Akathisia, metab side effects
- EPS
-Akathisia
-D3 receptor, cognition, neg sx’s - 12.5-900 mg/day
- 25mg/day
- seizures (dose related), ortho hypo, myocarditis, agranulocytosis
- Smoking tobacco (clozapine goes down)
-little to no movement ae’s
- metab effects, sedation , hypersalivation, and constipation
- Lumateperone must be taken with ?
- How frequently dosing?
-Take w/__
-WHat substrate? - Lurasidone (Latuda)
-Must be taken with ?
-Prominent ___, but lower risk of ?
-Don’t use with ? (this is a CI) - Olanzapine (zyprexa) *
-Dosage?
-What substrate, affected by what?
-Signifcant ___, __
-Has LAI form, must do what? - Paliperidone (Invega) *
- ACtive metabolite of ?
-what kind of elim ?
-E, H!
-WHat dosage form ?
-Has LAI, oral test dose needed - Quetiapine (Seroquel)
-Dosing for IR and XR?
-Very low risk of ?
-Signif __ and __
-Substrate of CYP3A4 - Risperidone *
- Dosing range?
-Greatest risk of ? especially at doses?
-HYPER ____!!
-LAI avail, oral test dose needed
-CYP2D6 Substrate - Ziprasidone (Geodon)
- Must be taken with ?
-heart ae?
-Lower risk of ?
- MEAL, avoid meals w/high fat content
-Once daily
-evening meal due to incr sedation
-CYP 3A4 - > =350 calorie meal
-Akathisia, metabolic side effects
-strong CYP3a4 inhibs or inducers - 5-30 mg/day
- CYP 1a2, smoking
-Metab effects, sedation !
-Oral test dose - Risperidone (Converted by 2D6)
- RENAL
-EPS, HYPERprolactinemia
-OROS tablet - IR 25-800 mg/day
XR : 300-800 mg/day
-EPS
-Metab effects, sedation - 0.5-8mg/day
EPS, due to highest D2 blockade
->= 6 mg/day
-PROLACTINEMIA - > =500 calorie meal
-QTc prolongation
-metab side effects
Lumateperone MOA :
1. Simultaneously modulates ? (4)
B. DDI with ?
FORMULATIONS
1. Which SGA’s have ODT? (4)
2. WHich have oral solution? (3)
3. Which have RAI?
4. Which have LAI? (4)
5. which have TD patch?
- D2 pre synaptic partial agonist, post synaptic antag : Decr pos sx’s and decr risk EPS
- 5HT2A antag –> improve neg and possibly cog sx’s
- D1 receptor modulator of glutamate –> potential improves cog sx’s and exec functions
- SERT (Potential antidepressant effects)
B. Strong CYP3a4 inhibs or inducers
- Abilify, clozapine, zyprexa, risperdal
- Abilify, clozapine, risperdal
- olanz, ziprasidone
- abilify ,Olanz, paliperidone, risperdal
- Asenapine
SGA PK :
1. Abilify : major substrate of? (2)
-caution in ___
2. Asenapine : CI in ?
3. Clozapine : Substrate of? (3)
- Cig smoke or __ decr levels by 50%
-If patient misses >2 days of med, what should u do?
4. Brexpiprazole : Substrate of? (2)
-Caution in potent ___ and ___ inhibs and inducers
5. CAriprazine : Substrate of ? Caution with this enzyme’s inhibs and inducers
- CYP2d6, CYP3a4
-CYP2d6 PM (incr auc 80%) - Severe hepatic impairment
- CYP 1A2, 2D6, 3A4
-CARBAMAZEPINE
-RESTART TITRATION AT 25MG/DAY - CYP2d6 and CYP3a4
-CYP2d6 and 3a4 - CYP 3a4
SGA AE’s : Muscarinic receptor
1. What are the 4 ae’s ?
2. Which drugs high risk vs moderate risk?
HISTAMINE RECEPTOR :
1. 3 ae’s?
2. Which drug has high risk vs mod high risk for weight gain ? (3)
ALPHA RECEPTOR :
1. 3 ae’s?
2. Highest risk ? (2)
3. Moderate High risk ? (3)
4. Low Mod risk ? (4)
- blurred vision, constipation, urinary retention, drowsy!
- High = Clozapine, Olanzapine
Mod = Quetiapine
Cloz >= Olanz > Quetiapine - WEIGHT GAIN, sedation, vasodilation
- Clozapine and Olanzapine
Mod high = Quetiapine - ortho hypo, sedation and priapism
- CLozapine (BBW) , quetiapine
- Iloperidone, risperidone, lurasidone
- Ziprasidone, OLANZAPINE, abilify, asenapine
Hyperprolactinemia : SGA’s
1. Describe the risk relative to FGA’s
2. This is with the exception of which 2 drugs?
3. what drug decr prolactin levels?
EPS :
1. COmpared to FGA’s, whats the risk for SGA’s?
2. Which 2 have highest risk of pt developing EPS?
AKATHISIA
1. Common with the following drugs? (5)
2. Lowest risk with ? (2)
- Lower risk compared to FGA’s
- Risperidone and paliperidone
- Abilify
- LOWER RISK OF DEVEL EPS
- risperidone, paliperidone
- Abilify (Mod high) , asenapine (mod), cariprazine (mod), olanz,(Mod risk) lurasidone (low mod risk )
- Quetiapine, clozapine
Neuroleptic Malignant Syndrome (NMS)
1. Sx’s?
2. Usually develops when ?
3. Tx?
QTC PROLONGATION
4. BBW for which drug ?
5. High risk drugs? (4)
METABOLIC SIDE EFFECTS :
6. Describe the 3 ae’s?
7. High risk drugs (3)
8. Low risk drugs ( 6)
- Muscular rigidity, hyperthermia, alt consciousness, incr bp and HR
- within 10 days of drug initiation or dose incr
- Discontinue antipsych, hydration, amantadine
- Thioridazine
- Chlorpromazine, Haloperidol (high dose and or IV admin) , ziprasidone, iloperidone
- lipid abnorms (incr TG) , glucose intol (hyperglycemia, DM), Weight gain (incr weight circumf)
- Clozapine, Olanz, Quetiapine
- Abilify, brexpip, carip, lumatep, lurasidone, zipras
