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Therapeutics 3 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

What are the positive symptoms of schizophrenia?

A

-hallucinations
-delusions
-disorganized speech/thought
-disorganized, bizarre behavior
-paranoia/suspiciousness

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2
Q

What are the negative symptoms of schizophrenia?

A

-alogia
-affective blunting
-avolition
-anhedonia
-poor grooming, hygiene
-social dysfunction/isolation

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3
Q

What major side effects are associated with first generation antipsychotics?

A

EPS/TD

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4
Q

What major side effects are associated with second generation antipsychotics?

A

metabolic effects

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5
Q

What is the correlation between potency and side effects of first generation antipsychotics?

A

-low potency agents= less D2 blockade= less EPS risk
-high potency agents= more D2 blockade= high EPS risk

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6
Q

What drugs are first generation antipsychotics?

A

chlorpromazine, fluphenazine, haloperidol, loxapine

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7
Q

Describe the Potency, EPS, Sedation, Anticholinergic, and Orthostatic Hypotension SE of Chlorpromazine:

A

potency: low
EPS: low risk
Sedation: high risk
Anticholinergic SE: high
Orthostatic hypotension: mod-high

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8
Q

Describe the Potency, EPS, Sedation, Anticholinergic, and Orthostatic Hypotension SE of Fluphenazine:

A

potency: high
EPS: very high risk
Sedation: low risk
Anticholinergic SE: low
Orthostatic hypotension: low

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9
Q

Describe the Potency, EPS, Sedation, Anticholinergic, and Orthostatic Hypotension SE of Haloperidol:

A

potency: high
EPS: very high risk
Sedation: very low risk
Anticholinergic SE: very low
Orthostatic hypotension: very low

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10
Q

Describe the Potency, EPS, Sedation, Anticholinergic, and Orthostatic Hypotension SE of Loxapine:

A

potency: moderate
EPS: mod risk
Sedation: mod risk
Anticholinergic SE: low
Orthostatic hypotension: low-mod

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11
Q

What formulation of first generation antipsychotics may be useful for acute agitation?

A

immediate acting IM injections (haloperidol lactate)

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12
Q

What are the overall adverse effects of first generation antipsychotics?

A

-CV= QTc prolongation -> risk of torsade’s de pointes
-seizures (lowered seizure threshold, dose-related, rapid titrations)
-prolactin/sexual= menstrual irregularities, gynecomastia, sexual dysfunction (erectile dysfunction, decrease libido)
-sedation
-anticholinergic (dry mouth, blurred vision, constipation, urinary retention, cognitive impairment)

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13
Q

What first generation antipsychotics have the lowest/highest risk of seizures?

A

-LOWEST= haloperidol
-HIGHEST= chlorpromazine

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14
Q

What first generation antipsychotics have the lowest/highest risk of sedation?

A

-LOWEST= haloperidol
-HIGHEST= chlorpromazine

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15
Q

What first generation antipsychotics have the lowest/highest risk of Anticholinergic symptoms?

A

-LOWEST= haloperidol
-HIGHEST= chlorpromazine

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16
Q

What first generation antipsychotic has a warning due to torsade’s de pointes risk?

A

chlorpromazine

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17
Q

What are the 3 main symptoms of Extrapyramidal Symptoms (EPS)?

A

-acute dystonia (severe muscle spasms of the face and throat)
-akathisia (feeling of “inner restlessness”)
-pseudo-parkinsonism (PD- cogwheel rigidity, shuffling gait, etc.)

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18
Q

What is the treatment of EPS, acute dystonia?

A

anticholinergic= benzotropine, diphenhydramine

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19
Q

What is the treatment of EPS, akathisia?

A

propranolol, lorazepam

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20
Q

What is the treatment of EPS, pseudo-parkinsonism?

A

benztropine, amantadine

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21
Q

What is Tardive Dyskinesia and how is it monitored and treated?

A

TD is a late onset movement disorder due to long-term D2 blockade which may be irreversible. can be monitored via AIMS which is important because there is no treatment but Vmat2 inhibitors may provide some relief.

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22
Q

What is Neuroleptic Malignant Disorder (NMS) and how is it treated?

A

a potential fatal syndrome associated with antipsychotic use that is categorized by symptoms, such as: muscle rigidity, hyperthermia, autonomic dysfunction, mental status changes. Treatment includes stopping offending agent and bromocriptine, sodium dantrolene. Treatment with antipsychotic is okay to continue but NEVER with same agent.

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23
Q

What are the uses of Clozapine?

A

-FDA APPROVED for treatment resistant schizophrenia, only used after failure of 2 antipsychotics
-superior for reduction of suicide attempts
-effective for the management of aggression and violent behavior, and potential anti-hostility effects

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24
Q

What is unique about Chozapine’s dosing?

A

must be titrated, but if the patient misses doses > 48 hours the titration must be started from the beginning

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25
Q

What drugs are metabolized via CYP1A2 and smoking cigarettes may effect dosing?

A

-clozapine
-olanzapine

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26
Q

What is the black box warning of Clozapine?

A

-seizures
-AGRANULOCYTOSIS, REMS program= monitor absolute neutrophil count (ANC)
-myocarditis/cardiomyopathy (promptly discontinue)
-orthostatic hypotension
-increased mortality in dementia patients

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27
Q

What are the adverse effects of Clozapine?

A

sialorrhea (drooling) and severe constipation (could progress to life threatening!)

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28
Q

What is the use of Risperidone?

A

schizophrenia (adults & adolescents) and bipolar disorder
second to clozapine

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29
Q

What are the adverse effects of Risperidone?

A

somnolence, EPS, syncope, orthostasis, HYPERPROLACTEMIA/GYNECOMASTIA (may be 2nd line for males)

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30
Q

What is the use of Olanzapine?

A

schizophrenia, bipolar disorder, acute agitation associated with bipolar mania or schizophrenia

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31
Q

What are the adverse effects of Olanzapine?

A

-metabolic effects= weight gain, DM (avoid in children)
-EPS
-constipation
-dizziness
-postural hypotension

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32
Q

What is the use of Quetipine?

A

schizophrenia, bipolar disorder
behind clozapine and olanzapine due to metabolic effects

33
Q

What are the adverse effects of Quetiapine?

A

-somnolence
-dry mouth
-sedation
-orthostatic hypotension

34
Q

What are the uses of Ziprasidone?

A

schizophrenia, bipolar disorder, acute agitation in schizophrenia

35
Q

What is unique dosing requirements for Ziprasidone?

A

must be taken with a 500 calorie meal

36
Q

What is the warning associated with Ziprasidone?

A

QTc prolongation

37
Q

What are the uses of Aripiprazole?

A

schizophrenia and bipolar disorder

38
Q

What is the FDA warning on Aripiprazole?

A

increased compulsive behaviors

39
Q

What drug mitigates hyperprolactinemia due to partial D2 agonism?

A

Aripiprazole

40
Q

What are the uses of Paliperidone?

A

schizophrenia and schizoaffective disorder

41
Q

What are the unique kinetics of Paliperidone?

A

-active metabolite of risperidone
-does not undergo first pass metabolism= favorable option in patients with hepatic dysfunction

42
Q

What are the clinical pearls of Paliperidone?

A

OROS formulation= tablet may be found in stool, avoid in GI dysfunction (GI narrowing, stricture)

43
Q

What are the adverse effects of Paliperidone?

A

hyperprolactinemia, caution GI blockage

44
Q

What are the uses of Iloperidone?

A

schizophrenia

45
Q

What drug should be avoided in severe hepatic impairment?

A

-iloperidone
-asenapine
-lumateperone
caution with use of ziprasidone, olanzapine

46
Q

What are the adverse effects of Iloperidone?

A

orthostasis, QTc prolongation

47
Q

What drugs can cause QTc prolongation?

A

-ziprasidone
-iloperidone

48
Q

What is unique about Iloperidones dosing?

A

titration need to minimize orthostasis, if patient missed >3 days of therapy titration must be restarted

49
Q

What is unique about the formulations of asenapine?

A

only available as SL or transdermal patch

50
Q

What is unique about the kinetics of Asenapine?

A

Tmax= 0.5-1.5h (SL), avoid smoking/eating/drinking for 10 mins after SL administration, high clearance drug (CONTRAINDICATED in severe hepatic impairment)

51
Q

What are the adverse effects of Asenapine?

A

-sedation
-somnolence
-hypoesthesia and dysgeusia (SL formulation)

52
Q

What drug is preferred in pregnancy?

A

Lurasidone

53
Q

What is the unique dosing recommendations of Lurasidone?

A

take with at least 350 calories

54
Q

What are the adverse effects of Lurasidone?

A

-akathisia
-EPS
-agitation
less risk of weight gain

55
Q

What drugs should be avoided in renal impairment?

A

-cariprazine

56
Q

What are the unique kinetics of Cariprazine?

A

longest 1/2 life of all second generation antipsychotics

57
Q

What are the adverse effects of Cariprazine?

A

-akathisia
-EPS
-activating > sedating= insomnia

58
Q

What are the adverse effects of Brexpiprazole?

A

-headache
-akathisia
-tremor
-diarrhea
-dizziness
weight gain > aripiprazole, akathisia < aripiprazole

59
Q

What is unique about the dosing of Lumateperone?

A

no titration required

60
Q

What are the adverse effects of Lumateperone?

A

-increased liver function tests (LFTs)
-sedation
-somnolence
-weight loss

61
Q

What second generation antipsychotic has the highest risk of cardiovascular SE?

A

-iloperidone, clozapine= hypotension
-ziprasidone, iloperidone= QT prolongation

62
Q

What second generation antipsychotic has the lowest risk of cardiovascular SE, hypotension?

A

aripiprazole, lurasidone, cariprazine, brexpiprazole

63
Q

What second generation antipsychotic has the lowest risk of cardiovascular SE, QTc prolongation?

A

aripiprazole, lurasidone, lumateperone

64
Q

What second generation antipsychotic has the highest risk of seizures?

A

clozapine, olanzapine, quetiapine

65
Q

What second generation antipsychotic has the lowest risk of seizures?

A

aripiprazole, risperidone

66
Q

What second generation antipsychotic has the highest risk of prolactin/sexual SE?

A

risperidone, paliperidone

67
Q

What second generation antipsychotic has the lowest risk of prolactin/sexual SE?

A

clozapine, quetiapine, aripiprazole, brexpiprazole, cariprazine

68
Q

What second generation antipsychotic has the highest risk of sedation?

A

clozapine, olanzapine (the ‘pines)

69
Q

What second generation antipsychotic has the lowest risk of sedation?

A

aripiprazole/brexpiprazole, iloperidone, risperidone/paiperidone

70
Q

What second generation antipsychotic has the highest risk of anticholinergic SE?

A

clozapine, olanzapine, quetiapine

71
Q

What second generation antipsychotic has the lowest risk of anticholinergic SE?

A

asenapine, lurasidone, lumateperone, cariprazine, brexpiprazole

72
Q

What second generation antipsychotic has the highest risk of EPS?

A

paliperidone and risperidone

73
Q

What second generation antipsychotic has the highest risk of EPS, acute dystonia?

A

risperidone/paliperidone > lurasidone, asenapine

74
Q

What second generation antipsychotic has the highest risk of EPS, akathisia?

A

lurasidone> cariprazine> aripiprazole

75
Q

What second generation antipsychotic has the highest risk of EPS, pseudo-parkinsonism?

A

risperidone/paliperidone, cariprazine, lurasidone

76
Q

What second generation antipsychotic has the highest risk of dyslipidemia?

A

olanzapine

77
Q

What second generation antipsychotic has the highest risk of diabetes?

A

clozapine, olanzapine

78
Q

What second generation antipsychotic has the highest risk of weight gain?

A

clozapine, olanzapine

79
Q

What is the black box warning of long-acting injection, olanzapine (RELPREVV)?

A

post-injection delirium/sedation syndrome (REMS program)

Therapeutics 3 (14 decks)

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