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*Pharm III > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

co-morbid conditions w/ schizophrenia

A

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

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2
Q

positive symptoms of schizophrenia

A

hallucinations
delusions
bizarre behavior
paranoia

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3
Q

negative symptoms w/ schizophrenia

A 
avolition
alogia
affective flattening
asociality
anhedonia
attentional impariemnt
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4
Q

cognitive symptoms w/ schizophrenia

A

difficulties w/ concentration
memory
executive function
decision making

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5
Q

how does doapmine antagonism help w/ schizophrenia

A

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

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6
Q

2 types of first generation antipsychotics

A

phenothiazines

non-phenothiazies (haloperidol)

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7
Q

less potent antipsychotics have what

A

less potent D2 antagonistm

more ach, alpha-antagonisms, sedation

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8
Q

what drugs ahve low potency antipsychotics

A

chlorpromazine
thioridazine
mesoidazine

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9
Q

what drugs are medium potency antipsychotics

A

Perphenazine, loxapine, molindone

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10
Q

what drugs are high potency first gen antipsychotics

A

Fluphenazine, haloperidol, thiothixene, trifluoperazine

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11
Q

what are the 2nd generation antipsychotics

A 
Aripiprazole (Abilify®)
Clozapine (Clozaril®) 
Olanzapine (Zyprexa®
Quetiapine (Seroquel®)
Risperidone (Risperdal®)
Ziprasidone (Geodon®)
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12
Q

second generation atypical block what more than dopamine

A

5-HT which is good for positive symptoms

also release dopamine which helps w/ positive sx

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13
Q

what other pathways do antipsychotics block

A

adrenergic
cholinergic
and histamine-binding receptors

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14
Q

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

A

dopamine (but really narrow window)

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15
Q

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

A

olanzapine

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16
Q

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

A

clozapine

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17
Q

benefits of second gen antipsychotics (atypicals)

A

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

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18
Q

with first gen. antipsychotics what should you begin

A

prophylactic anticholingerics (high potency meds)

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19
Q

it patient has agitation w/ antipsychotics what can you add

A

lorazepam

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20
Q

ADRs w/ antipsychotics (neuro)

A

extrapyramidal symptoms

21
Q

what are alpha-adrenegic effects w/ antipsychotics

A

orthostasis

EKG

22
Q

hematologic effects w/ antipsychotics

A

angranulocytosis

23
Q

problem w/ atypical antipsychotics

A

causes a lot of the none neuro effects

24
Q

what are EPS?

A 
acute dysnotnia
parkinson-like symptoms
akathisia
tardive dyskinesia
neuroleptic malignant syndrome
25
Q

Muscle spasm face, neck, trunk, eye, larynx

Early in Tx., young males

A

acute dystonias

26
Q

tx for acute dystonias

A

benadryl or cogentin

prevention- bneztropine

27
Q

Subjective feeling of restlessness

Unable to sit still, pacing

A

akathisia

28
Q

tx for akathisia (SSRI can cause this too)

A

propranolol (not in asthma, DM)

29
Q

Slow choreo-athetotic movements

Oro-facial muscles

A

Tardive Dyskinesias

30
Q

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

A

Neuroleptic malignant syndrome

31
Q

risks of NMS

A

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

32
Q

Tx for NMS

A

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

33
Q

what anitpsychotics doesn’t have an antiemtic effects

A

thioridazine

34
Q

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

A

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

35
Q

what does alpha-adrenergic blockade cause

A

orthostatic HPOTN
light-headeness
poikilothermia (body temp varies)

36
Q

what 2 drugs antagonize H1 receptorsedation

A

chlorpromazine

cloazpine

37
Q

with antipsychotics how long does it take to get steady state

A

5-7 days

1/2 life of 24 hours

38
Q

what is the main atypical antipsychotic

A

clozapine

39
Q

what does clonzapine block

A

blocks 5-HT and alpha but weak dopamien blocker

40
Q

benefits of clonzapine

A

lack of ECP symptoms

help w/ negative symptoms

41
Q

BBW w/ clonzapine

A

agranulocytosis- need to monitor CBC

42
Q

when do you stop clonzapine

A

If WBC <2000

43
Q

what can’t you combine clonzapine w/?

A

carbamazepine or other bone marrow suppressors

44
Q

ADRs w/ clozapine

A 
seation
dizziness, orthostatis HPOTN
hypersalivation
wt. gain
lower seizure threshold
45
Q

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

A

Risperidone

46
Q

need bid, tid

t1/2 5 hrs; low EPS; contraindicated in pts with cardiac arrhythmias; minimal weight gain

A

Ziprasidone

47
Q

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

A

Olanzapine

48
Q

consistant ADR w/ atypical neuroleptics

A

weight gain

*Pharm III (8 decks)

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