Schizophrenia Flashcards by Meg Dolohanty

co-morbid conditions w/ schizophrenia

HTN, DM, cardiac, STDs, substance abuse, smoking

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positive symptoms of schizophrenia

hallucinations
delusions
bizarre behavior
paranoia

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negative symptoms w/ schizophrenia

avolition
alogia
affective flattening
asociality
anhedonia
attentional impariemnt

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cognitive symptoms w/ schizophrenia

difficulties w/ concentration
memory
executive function
decision making

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how does doapmine antagonism help w/ schizophrenia

improvement of positive symptoms
but lead to EPS and hyperprolactinemia
worsens negative symptoms

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2 types of first generation antipsychotics

phenothiazines

non-phenothiazies (haloperidol)

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less potent antipsychotics have what

less potent D2 antagonistm

more ach, alpha-antagonisms, sedation

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what drugs ahve low potency antipsychotics

chlorpromazine
thioridazine
mesoidazine

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what drugs are medium potency antipsychotics

Perphenazine, loxapine, molindone

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what drugs are high potency first gen antipsychotics

Fluphenazine, haloperidol, thiothixene, trifluoperazine

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what are the 2nd generation antipsychotics

Aripiprazole (Abilify®)
Clozapine (Clozaril®) 
Olanzapine (Zyprexa®
Quetiapine (Seroquel®)
Risperidone (Risperdal®)
Ziprasidone (Geodon®)

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second generation atypical block what more than dopamine

5-HT which is good for positive symptoms

also release dopamine which helps w/ positive sx

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what other pathways do antipsychotics block

adrenergic
cholinergic
and histamine-binding receptors

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how well an antipsychotic works at ___ receptor indicates how well it works

dopamine (but really narrow window)

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saturates 5-HT2 receptors; therefore, at clinical doses, muscarinic M1 and histaminergic H1 also likely saturated

olanzapine

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first atypical antipsychotics. benefits of good occupancy at 5-HT, no extra-pyramidal symptoms and still control positive symptoms

clozapine

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benefits of second gen antipsychotics (atypicals)

efficacy for positive symptoms
possible enhanced efficacy for negative and cognitive symptoms
minimal or no effect ton prolactin (except risperidone)

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with first gen. antipsychotics what should you begin

prophylactic anticholingerics (high potency meds)

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it patient has agitation w/ antipsychotics what can you add

lorazepam

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ADRs w/ antipsychotics (neuro)

extrapyramidal symptoms

what are alpha-adrenegic effects w/ antipsychotics

orthostasis

EKG

hematologic effects w/ antipsychotics

angranulocytosis

problem w/ atypical antipsychotics

causes a lot of the none neuro effects

what are EPS?

acute dysnotnia
parkinson-like symptoms
akathisia
tardive dyskinesia
neuroleptic malignant syndrome

Muscle spasm face, neck, trunk, eye, larynx | Early in Tx., young males

acute dystonias

tx for acute dystonias

benadryl or cogentin | prevention- bneztropine

Subjective feeling of restlessness | Unable to sit still, pacing

akathisia

tx for akathisia (SSRI can cause this too)

propranolol (not in asthma, DM)

Slow choreo-athetotic movements | Oro-facial muscles

Tardive Dyskinesias

Medical Emergency, mortality 20% (now 4%) 1. Fever >100.4F / 37.5C 2. Severe EPS: lead-pipe/cogwheel rigidity, sialorrhea, oculogyric crisis 3. Autonomic Dysfunction: BP fluctuations, tachycardia, tachypnea, diaphoresis Also: Alt. consciousness, delirium, leukocytosis (>15.000 WBC), CPK > 300, seizures, arrhythmias, mioglobinuria, ARF

Neuroleptic malignant syndrome

risks of NMS

multiple IM injections high dose of meds or rapidly increased dehydrated lithium use

Tx for NMS

stop ALL antipsycotics give dantrolene (muscle relaxant) bromocriptine (DA agonist) supportive Tx- IV fluids, antipyretics, cooling blanket

what anitpsychotics doesn't have an antiemtic effects

thioridazine

antimuscarinic effects w/ antipsycthoics (more common in lower potency)

Anticholinergic effects include blurred vision, dry mouth, sedation, confusion, inhibit GI and urinary tract smooth muscle constipation and urinary retention

what does alpha-adrenergic blockade cause

orthostatic HPOTN light-headeness poikilothermia (body temp varies)

what 2 drugs antagonize H1 receptorsedation

chlorpromazine | cloazpine

with antipsychotics how long does it take to get steady state

5-7 days | 1/2 life of 24 hours

what is the main atypical antipsychotic

clozapine

what does clonzapine block

blocks 5-HT and alpha but weak dopamien blocker

benefits of clonzapine

lack of ECP symptoms | help w/ negative symptoms

BBW w/ clonzapine

agranulocytosis- need to monitor CBC

when do you stop clonzapine

If WBC <2000

what can't you combine clonzapine w/?

carbamazepine or other bone marrow suppressors

ADRs w/ clozapine

``` seation dizziness, orthostatis HPOTN hypersalivation wt. gain lower seizure threshold ```

low EPS at doses <6 mg/d; Treat agitation in the elderly; Elevates PRL; minimal sedation

Risperidone

need bid, tid | t1/2 5 hrs; low EPS; contraindicated in pts with cardiac arrhythmias; minimal weight gain

Ziprasidone

positive and negative Sx, low EPS, sedation, wt gain, mood stabilizer [dose: 5-20 mg/day]

Olanzapine

consistant ADR w/ atypical neuroleptics

weight gain