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Pnt Exam 2 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

Schizophrenia abnormalities in what 5 domains

A 
delusions
hallucinations
disorganized thinking and speech
grossly disorganized and abnoraml motor behavior
negative symptoms
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2
Q

schizophrenia is more common in what gender

A

equal

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3
Q

onset on schizophrenia

A

men - early 20s

women late 20s to early 30s

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4
Q

positive symptoms of schizophrenia

A 
hallucinations
delusions
disorganized speech
unusual behavior 
combativeness and agitation
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5
Q

negative symptoms of schizophrenia

A 
blunted affect
alogia
anhedonia
avolition
asociality 
loss of emotional connectedness
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6
Q

define alogia

A

no spontaneous talking

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7
Q

define anhedonia

A

inability to experience pleasure

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8
Q

define avoloition

A

lack of drive

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9
Q

cognitive impairments seen in schizophrenia

A

impaired attention
impaired working memory
impaired executive function

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10
Q

features associated with schizophrenia

A 
inappropriate affect
dysphoric mood (depression, anger, anxiety) 
disturbed sleep pattern
lack of interest in food 
anosognosia
hostility and aggression
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11
Q

define anosognosia

A

lack insight or awareness of disorder

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12
Q

to be diagnosed schizophrenic a patient must have 2+ or these for at least 1 month

A 
delusions
hallucinations
disorganized speech 
grossly disorganized or catatonic behavior
negative symptoms
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13
Q

to be diagnosed with schizophrenia how long must symptoms be present

A

6 months

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14
Q

define catatonia

A

marked psychomotor disturbance that may involve decreased motor activity, depressed engagement during interview or exam, or excessive and peculiar motor activity

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15
Q

catatonia is 3+ of the following symptosm

A 
stupor
catalepsy
waxy flexibility 
mutism 
negativism 
posturing
mannerism
stereotypy
agitation
grimacing
echolalia
echopraxia
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16
Q

other psychiatric illness to rule out for diagnosis of schizophrenia

A 
major depression
schizoaffective disorder
brief reactive psychosis
schizophreniform disorder
delusional disorder
induced psychotic disorder
panic disorder
depersonalization disorder
OCD
personality disorders
factitious disorders
malingering
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17
Q

general medical illnesses to rule out for schizophrenia

A 
temporal lobe epilepsy
tumor, stroke, brain trauma
endocrine/metabolic disorders
B12 deficiency 
infections (neurosyphallis) 
autoimmune
toxins (heavy metal poisining)
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18
Q

Drugs to rule out for schizophrenia

A 
stimulants
hallucinogens
anticholingerics
alcohol withdrawal 
barbituate withdrawal 
phencyclidine
ketamine
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19
Q

black box warning on all atypical antipsychotics

A

increased mortality with dementia related psychosis

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20
Q

What is the principle difference between typical and atypical antipsychotics

A

type and severity of AEs including antihistaminic, antiserotoninergic, anti dopaminergic, anticholinergic, anti alpha 1 adrenergic

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21
Q

typical or atypical: aripiprazole

A

atypical

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22
Q

typical or atypical: asenapine

A

atypical

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23
Q

typical or atypical: clozapine

A

atypical

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24
Q

typical or atypical: iloperidone

A

atypical

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25
Q

typical or atypical: lurasidone

A

atypical

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26
Q

typical or atypical: olanzapine

A

atypical

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27
Q

typical or atypical: paliperidone

A

atypical

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28
Q

typical or atypical: quetiapine

A

atypical

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29
Q

typical or atypical: risperidone

A

atypical

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30
Q

typical or atypical: ziprasidone

A

atypical

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31
Q

aripiprazole brand name

A

abilify

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32
Q

asenapine brand name

A

saphris

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33
Q

clozapine brand name

A

clozaril

fazaclo

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34
Q

iloperidone brand name

A

fanapt

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35
Q

lurasidone brand name

A

latuda

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36
Q

olanzipine brand name

A

zyprexa
zydus
relprevv

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37
Q

paliperidone brand name

A

invega

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38
Q

quetiapine brand name

A

seroquel

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39
Q

risperidone brand name

A

risperdal

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40
Q

ziprasidone brand name

A

geodon

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41
Q

All typical antipsychotics pregnancy category

A

C

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42
Q

typical or atypical: chlorpromazine

A

typical

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43
Q

typical or atypical: fluphenazine

A

typical

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44
Q

typical or atypical: thioridazine

A

typical

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45
Q

typical or atypical: perphenazine

A

typical

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46
Q

typical or atypical: trifluoperazine

A

typical

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47
Q

typical or atypical: haloperidol

A

typical

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48
Q

typical or atypical: pimozide

A

typical

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49
Q

typical or atypical: thiothixene

A

typical

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50
Q

chlorpromazine brand name

A

thorazine

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51
Q

fluphenazine brand name

A

prolixin

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52
Q

thioidazine brand name

A

mellaril

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53
Q

perphenazine brand name

A

trilafon

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54
Q

trifluoperazine brand name

A

stelazine

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55
Q

haloperidol brand name

A

haldol

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56
Q

pimozide brand name

A

orap

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57
Q

thiothixene brand name

A

navane

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58
Q

usual dosage range of aripirazole

A

15-30 mg /day

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59
Q

max dosage of aripiprazole

A

30 mg/day

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60
Q

usual dosage range of olanzepine

A

15-20 mg/day

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61
Q

max dosage of olanzepine

A

30-40 mg/day (manufacturer says 20)

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62
Q

usual dosage range of quetiapine

A

300-800 mg/day

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63
Q

max dosage of quetiapine

A

800 mg/day (see 1000-1200 in practice)

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64
Q

usual dosage of risperidone

A

3-6mg/day

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65
Q

max dosage of risperidone

A

6-8 mg/day

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66
Q

usual dosage of ziprasidone

A

100-120 mg/day

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67
Q

max dosage of ziprasidone

A

160-240 (200)

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68
Q

starting dose of aripiprazole and frequency

A

10-15 mg/day given once daily

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69
Q

AEs of aripiprazole

A 
headache
dizziness
weight gain
agitation
anxiety 
insomnia
somnolence
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70
Q

aripiprazole pregnancy category

A

C

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71
Q

Drug interactions with aripiprazole

A 
metoclopropamide
fluoxetine/paroxetine
quinidine
carbamazepine
valproic acid
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72
Q

Aripiprazole shouldn’t be given with this medicaiton

A

metoclopropamide

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73
Q

aripiprazole dose should be decreased 50% with this medication/s

A

fluoxetine
paroxetine
quinidine

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74
Q

apriprazole dose should be doubled with this medication

A

carbamazepine

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75
Q

ariprazole dosage forms

A

PO or IM

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76
Q

aripriprazole frequency

A

QD or Q month (IM)

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77
Q

A poor CYP 2D6 metabolizer should get what dose of abilify maintena

A

300 mg

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78
Q

what is the normal dose of abilify maintena

A

400 mg

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79
Q

what is the dose of abilify maintena for a cyp2D6 poor metabolizer taking CYP3A4 inhibitors

A

200 mg

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80
Q

What is the dose of abilify maintena for those taking 400 mg normally on stong cyp 2D6 or cyp 3A4 inhibitors for > 14 days

A

300 mg

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81
Q

What is the dose of abilify maintena for those taking 400 mg normally on stong cyp 2D6 AND cyp 3A4 inhibitors for > 14 days

A

200 mg

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82
Q

What is the dose of abilify maintena for those taking 400 mg normally on stong cyp 3A4 inducers for > 14 days

A

Avoid use

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83
Q

What is the dose of abilify maintena for those taking 300 mg normally on stong cyp 2D6 or cyp 3A4 inhibitors for > 14 days

A

200 mg

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84
Q

What is the dose of abilify maintena for those taking 400 mg normally on stong cyp 2D6 and cyp 3A4 inhibitors for > 14 days

A

160 mg

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85
Q

What is the dose of abilify maintena for those taking 400 mg normally on stong cyp 3A4 inducers for > 14 days

A

avoid use

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86
Q

how does aripiprazole interact with metoclopropamide

A

increased risk f EPS

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87
Q

how does aripiprazole interact with fluoxetine/paroxetine

A

increased aripiprazole concentration

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88
Q

how does aripiprazole interact with quinidine

A

increased aripiprazole concentration

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89
Q

how does aripiprazole interact with carbamazepine

A

increased aripiprazole clearance

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90
Q

how does aripiprazole interact with valproic acid

A

decreased aripiprazole concentration

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91
Q

How to calculate ANC

A

total WBC * (% neutrophils + % bands) /100

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92
Q

Asenapine dose for schizophrenia

A

5 mg BID

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93
Q

Asenapine dosage form

A

sublingual!

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94
Q

AEs of asenapine

A

weight gain, hyperglycemia, EPS, insomnia, somnolence, orthostatic hypotension, prolonged QTC, HA, dizziness, increased triglycerides/cholesterol, increased prolactin levels, increased LFTs

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95
Q

Asenapine pregnancy category

A

C

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96
Q

Drugs to avoid with asenapine

A 
Quinolone antibiotics
Phenothiazines
TCAs
Pimozide
Class IA and III antiarhytmics
Quetiapine
Haloperidol
Risperidone
Ziprasidone
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97
Q

Why avoid drugs with asenapine

A

increased QTC

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98
Q

Clozapine dose

A

12.5 BID increased gradually by 25-50 mg to 300 mg by day 14.

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99
Q

Clozapine max dose

A

900 mg /day

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100
Q

Black box warning with clozapine

A

agranulocytosis
myocarditis
seizures

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101
Q

AEs with clozapine

A 
drowsiness, dizziness
hypersalivation
orthostatic hypotension
tachycardia
hyperglycemia
weight gain
increased triglycerides/cholesterol
constipation
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102
Q

clozapine pregnancy cat

A

B

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103
Q

Clozapine interaction with benzos

A

delirium, sedation

resp. collapse

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104
Q

clozapine interaction with smoking

A

decreased clozapine concentration

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105
Q

clozapine interaction with carbamazepine

A

increased risk of bone marrow depression

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106
Q

What medications should be avoided with clozapine

A

carbamazepine
ritonavir
tramadol

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107
Q

clozapine interaction with ritonavir

A

increased clozapine concentration

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108
Q

clozapine interaction with tramadol

A

increased risk of seizure

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109
Q

How often is CBC drawn with clozapine

A

QW x 6 months,
QOW for months 7-12,
1 QM after 12 months,
QW x 1 month after d/c

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110
Q

Risk factors for agranulocytosis with clozapine

A

female,
40+
low initial WBC

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111
Q

signs/symptoms of agranulocytosis

A 
malaise
fatigue
fever/chills
arthralgias
myalgias
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112
Q

Iloperidone dose

A

1 mg BID day 1, 2 mg BID day 2, 4 mg BID day 3, 6 mg BID day 4, target dose of 12-24 mg BID

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113
Q

AEs of iloperidone

A 
dizziness,
dry mouth
nasal congestion
orthostatic hypotension
weight gain
tachycardia
hyperglycemia
increased prolactin levels 
neutropenia/leucopenai
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114
Q

which medications should be avoided with iloperidone

A

class 1A and II antiarrhythmics
quinolone antibiotics
phenothiazine antipsychotics

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115
Q

Iloperidone pregnancy cat

A

c

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116
Q

Lurasidone dose

A

40 mg QD w/food.

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117
Q

lurasidone max dose

A

80 mg/day

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118
Q

Lurasidone pregnancy cat

A

B

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119
Q

AEs of lurasidone

A 
somnolence
akathisia
nausea
parkinsonism
agitation
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120
Q

lurasidone should be avoided with what medications

A

ketoconazole

rifampin

121
Q

lurasidone interaction with ketoconazole

A

increased lurasidone levels

122
Q

lurasidone interaction with rifampin

A

decreased lurasidone levels

123
Q

Olanzapine dose

A

5-10 mg initially. target 10 mg/day up to 30-40 mg/day

124
Q

long acting injection of olanzipine brand name

A

relprevv

125
Q

dosing of relprevv for the first 8 weeks if the target oral dose is 10 mg

A

210 mg Q2 weeks or 405 mgQ4 weeks

126
Q

dosing of relprevv for the first 8 weeks if the target oral dose is 15mg

A

300 mg Q 2 week

127
Q

dosing of relprevv for the first 8 weeks if the target oral dose is 20 mg

A

300 mg Q 2 weeks

128
Q

dosing of relprevv for the after 8 weeks if the target oral dose is 10 mg

A

150 mg Q 2 weeks or 300 mg Q 4 weeks

129
Q

dosing of relprevv for the after 8 weeks if the target oral dose is 15 mg

A

210 Q 2 weeks or 405 Q 4 weeks

130
Q

dosing of relprevv for the after 8 weeks if the target oral dose is 20 mg

A

300 mg Q 2 weeks

131
Q

AEs of olanzipine

A

sedation, weight gain, dry mouth, increased LFTs,

orthostatic hypotension, hyperglycemia, increased triglycerides/cholesterol, increased prolactin, tachycardia

132
Q

olanzipine pregnancy cat

A

C

133
Q

olanzepine interaction with smoking

A

decreased olanzepine concentration -> adjust dose

134
Q

olanzepine interaction with caffeine

A

inreased olanzepine concentration -> may require dec. dose

135
Q

olanzepine should be avoided with what medications

A

alcohol, benzos, clomipramine

136
Q

olanzepine interaction with clomipramine

A

increased risk of seizures

137
Q

olanzepine interaction with alcohol/benzo

A

orthostatic hypotension

138
Q

paliperidone is the active metabolite of what

A

risperidone

139
Q

paliperidone AEs

A

sedation, dizziness, increased prolactin, hyperglycemia, weight gain

140
Q

Paliperidone preg cat

A

C

141
Q

Paliperidone dose

A

6 mg PO QD

142
Q

paliperidone dose in moderate renal impairment

A

3 mg PO QD

143
Q

paliperidone max dose

A

12 mg QD

144
Q

Invega Sustenna is injected where

A

deltoid/glute

145
Q

Invega sustenna dose if on 3 mg daily oral

A

39-78 mg

146
Q

Invega sustenna dose if on 6 mg daily oral

A

117 mg

147
Q

Invega sustenna dose if on 12 mg daily oral

A

234 mg

148
Q

How often is invega sustenna injected

A

Q4 weeks

149
Q

Avoid paliperidone with what drugs

A

Class 1A, III anti arrhythmics

Quinolone antibiotics

150
Q

Why avoid paliperidone with other drugs

A

increased QTC

151
Q

Risperidone dose

A

0.5 mg BID to 3 mg BID

152
Q

AEs of risperidone

A

sedation, dizziness, tachycardia, sexual dysfunction, rhinitis, nausea, menstrual disturbances, weight gain, hyperglycemia, increased prolactin levels

153
Q

Risperidone interaction with antihypertensives

A

inceased orthostasis -> monitor BP

154
Q

Risperidone preg. Cat

A

C

155
Q

Risperidone consta starting dose

A

25 mg Q 2 weeks

156
Q

risperidone consta oral supplementation is given how long

A

first 3 weeks

157
Q

Where is risperidone consta injected

A

IM upper outer gluteal quadrant

158
Q

Quetiapine IR dose

A 
25 mg BID day 1 
50 mg BID day 2
100 mg BID day 3 
100 mg AM + 200 mg PM day 4 
increase up to 800 mg/day as needed
159
Q

Quetiapine ER dose

A

300 mg QD in evening up to 400-800 /day

160
Q

AEs of quetiapine

A

somnolence, agitation, weight gain, dizziness, orthostatic hypotension, increased triglycerides, hyperglycemia

161
Q

quetiapine preg cat

A

C

162
Q

Quetiapine drug interactions

A

3A4 inhibitors (ketoconazole, erythromycin)

163
Q

Ziprasidone dose

A

20 mg BID to 80 BID

164
Q

ziprasidone dose IM for acute psychotic agitation

A

10 mg @ 2 hour intervals or 20 mg @ 4 hour intervals

165
Q

max ziprasidone IM dose

A

40 mg

166
Q

Ziprasidone effect on weight

A

neutral

167
Q

ziprasidone effect on prolactin levels

A

none

168
Q

AEs of ziprasidone

A

dyspepsia, constipation, nausea, abdominal pain, increase QTC, hyperglycemia

169
Q

Ziprasidone drugs to avoid

A 
quinolone antibiotics
macrolide antibiotics
azole antifungals
TCA
Phenothiazines
Clindamycin
Class 1A, III antiarrhythmics
170
Q

Why avoid drugs with ziprasidone

A

increased QTC

171
Q

Ziprasidone preg Cat

A

C

172
Q

Which atypical antipsychotics cause the most sedation

A

clozapine

lurasidone, olanzapine, quetiapine

173
Q

Which atypical antipsychotics cause the most EPS

A

paliperidone, risperidone, ziprasidone

174
Q

Which atypical antipsychotics cause the most anticholinergic effect

A

clozapine, iloperidone

175
Q

Which atypical antipsychotics cause the least anticholinergic effects

A

aripiprazole, asenapine, ziprasidone

176
Q

Which atypical antipsychotics cause the most orthostasis

A

clozapine, iloperidone

177
Q

which atypical antipsychotics cause the least orthostasis

A

aripiprazole, ziprasidone

178
Q

which atypical antipsychotics cause the most weight gain

A

clozapine, olanzapine

179
Q

which atypical antipsychotics cause the least weight gain

A

aripiprazole, lurasidone, ziprasidone

180
Q

which atypical antipsychotics cause the more increase in prolactin levels

A

riperidone, paliperidone

181
Q

which atypical antipsychotics have negligible effects on glucose

A

aripiprazole, asenapine, iloperidone, lurasidone, ziprasidone

182
Q

which atypical antipsychotics have increased effects on lipids

A

clozapine, olanzapine

183
Q

which atypical antipsychotics have negligible effect on QTC

A

aripiprazole, paliperidone, risperidone

184
Q

baseline monitoring for all atypical antipsychotics

A

AIMS, CBC, Chem 7, TFTs, Lipids, A1C, EKG, BP, Pulse, Wt, Pregnancy test, BMI

185
Q

Baseline monitoring for quetiapine

A

atypical antipsychotics + eye exam

186
Q

Basline monitoring for ziprasidone

A

atypical antipsychotics + hypo mg++ and K+

187
Q

monitoring for all atypical antipsychotics monthly

A

resolution of symptoms, BP, pulse, Wt, BMI

188
Q

monitoring for all atypical antipsychotics quarterly

A

lipid panel, fasting glucose, a1C

189
Q

monitoring for all atypical antipsychotics twice a year

A

AIMS

190
Q

monitoring for quetiapine twice a year

A

AIMS + eye exam

191
Q

Monitoring for all atypical antipsychotics annually

A

EKG, Chem 7, TFTs, CBC

192
Q

Monitoring for clozapine at baseline

A

AIMS, CBC with diff, Chem 7, TFTs, Lipids, A1C, EKG, BP, Pulse, weight, Pregnancy test

193
Q

What antipsychotics are preg cat B

A

clozapine, lurasidone

194
Q

monitoring for clozapine for first 2 weeks

A

daily BP + pulse

195
Q

monitoring for clozapine weekly for first 6 months

A

WBC+ ANC
weight
if > 5% weight gain = FBS, vitals, resolution of symptoms

196
Q

monitoring for clozapine biweekly for months 6-12

A

WBC+ANC

197
Q

monitoring for clozapine every 4 weeks for months 12+

A

WBC+ANC

198
Q

monitoring for clozapine monthly

A

BP, pulse

199
Q

monitoring for clozapine quarterly

A

lipids, glucose, A1C

200
Q

monitoring for clozapine twice a year

A

AIMS

201
Q

monitoring for clozapine annually

A

EKG, CBC, chem 7, TFTs

202
Q

Pregnancy cat for all typical antipsychotics

A

C

203
Q

name high potentcy typical antipsychotics

A

thiothixene, haloperidol, fluphenazine

204
Q

name low potentcy typical antipsychotics

A

chlorpromazine

205
Q

high potentcy antipsychotics have more what

A

EPS

206
Q

low potency antipsychotics have more what

A

sedation, hypotension, and anticholinergic effects

207
Q

baseline monitoring for typical antipsychotics

A

AIMS, CBC, chem 7, TFTs, A1C, EKG, BP, pulse, temp, weight, BMI, pregnancy

208
Q

monitoring for typical antipsychotics monthly

A

resolution of symptoms, BP, pulse, weight, BMI

209
Q

monitoring for typical antipsychotics quarterly

A

A1C

210
Q

monitoring for typical antipsychotics twice a year

A

AIMS

211
Q

monitoring for typical antipsychotics annually

A

EKG, chem 7, CBC, eye exam if doses > 2000 mg/day

212
Q

monitoring for fluphenazine annually

A

EKG, chem 7, CBC

213
Q

5 indicators of a good response for schizophrenia

A 
acute onset
good premorbid adjustment
late age of onset (late 20s) 
short duration of illness
presence of precipitating factors
214
Q

3 indicators of a poor response for schizophrenia

A

primarily negative symptoms
cognitive deficits
dual diagnosis

215
Q

5 indicators for hospitalization

A 
risk of harm to others?
risk of suicide
risk of accidental injury
severe disorganization
severe psychotic symptoms (catatonia)
216
Q

treatment goals for the first 7 days of hospitalization

A

decrease agitation
decrease hostility and aggression
normalize eating and sleeping

217
Q

how long to treat first psychotic episode

A

until remission of symptoms plus 24 months

218
Q

how long to treat those with multiple psychotic episodes

A

usually life long therapy

5 years then consider lower dose

219
Q

aburpt discontinuation of antipsychotics leads to what symptoms

A 
salivation
lacrimation
insomnia
vivid dreams
N/V/diarrhea
sweating
rebound cholinergic outflow - SLUD
220
Q

factors that favor a more gradual taper of antipsychotics

A 
history of violence/aggression
suicide attempts
high doses
severe course of illness
switching to or from clozapine
221
Q

conversion from oral fluphenazine to depot injection dose

A

1.2 x total daily dose to nearest 12.5 mg weekly for 4-6 weeks

222
Q

conversion from oral haloperidol to depot injection dose

A

10 x total daily dose to nearest 50 mg monthly (max dose 100 mg) if higher than 100 mg given rest 4-7 days later

223
Q

given oral dose how long after starting depot for haloperidol

A

first month

224
Q

given oral dose how long after starting depot for fluphenazine

A

first week

225
Q

fluphenazine depot dose

A

25-50 mg Q 2 weeks

226
Q

haloperidol depot dose

A

150 mg Q 4 weeks

227
Q

mood stabilizers used to augment antipsychoticss

A

lithium, valproic acid, carbamazepine, gabapentin, lamotrigine

228
Q

SSRIs used to augment antipsychotics

A

paroxetine, fluoxetine, sertraline, fluvoxamine, citalopram

229
Q

adequate trial of propranolol to augment antipsychotics

A

6-8 weeks

230
Q

what is considered an adequate trial of an antipsychotic

A

6-8 weeks at upper end of dosage range

231
Q

Medications to consider with new diagnosis of schizophrenia

A 
single atypical antipsychotic
aripiprazole
olanzapine
quetiapine
risperidone
ziprasidone
232
Q

medications to consider if failed first schizophrenia therapy

A

different atypical or typical antipsychotic

233
Q

medication to consider if failed two schizophrenia therapies

A

clozapine

234
Q

AEs of typical antipsychotics

A

sedation, EPS, anticholinergic, orthostasis, weight gain, increased prolactin

235
Q

Which atypical causes the most sedation

A

clozapine

236
Q

Which atypicals cause moderate sedation

A

lurasidone
olanzipine
quetiapine

237
Q

Which atypicals cause moderate EPS

A

paliperidone
risperidone
ziprasidone

238
Q

which atypicals have negligible effects on EPS

A

aripiprazole

iloperidone

239
Q

Which atypicals have neglible anticholinergic effects

A

aripiprazole
asenapine
ziprasidone

240
Q

which atypicals have the most anticholinergic effects

A

clozapine

241
Q

which atypicals have moderate anticholinergic effects

A

iloperidone

olanzipine

242
Q

Which atypicals have the most orthostasis

A

clozapine

iloperidone

243
Q

which atypicals have low orthostasis

A

aripiprazole

ziprasidone

244
Q

which atypicals have the most weight gain

A

clozapine

olanzipine

245
Q

which atypicals have the least weight gain

A

aripiprazole
lurasidone
ziprasidone

246
Q

which atypical has no effect on prolactin

A

aripiprazole

247
Q

which atypicals have the most effects on prolactin

A

paliperidone

risperidone

248
Q

Which atypicals have neglible effect on glucose

A 
aripiprazole
asenapine
iloperidone
lurasidone
ziprasidone
249
Q

which atypicals have moderate effect on glucose

A

clozapine

olanzipine

250
Q

which atypicals have neglible effects on lipids

A 
aripiprazole
asenapine
iloperidone
lurasidone
ziprasidone
251
Q

which atypicals have the most effect on lipids

A

clozapine

olanzipine

252
Q

which atypical has a moderate effect on lipids

A

quetiapine

253
Q

which atypicals have negligable effects on QTC

A

aripirazole
paliperidone
risperidone

254
Q

which typical antipsychotics are phenothiazines

A 
chlorpromazine
fluphenazine
thioridazine
perphenazine
trifluoperazine
255
Q

which typical antipsychotics are butyrophenones

A

haloperidole

256
Q

which typical antipsychotics are diphenylbutylpiperadines

A

pimozide

257
Q

which typical antipsychotics are thioxanthenes

A

thiothixene

258
Q

which typical antipsychotics are high potency

A

fluphenazine
haloperidol
thiothixene

259
Q

which typical antipsychotics are low potency

A

chlorpromazine

260
Q

which typical antipsychotics are medium potency

A

perphenazine

261
Q

which augmenters are used for mood stabilization (labile mood and aggression)

A 
lithium
valproic acid
carbamazepine
gabapentin
lamotrigine
262
Q

how long is an adequate trial of an augmenter

A

2 weeks

EXCEPTION propranolol 6-8 weeks

263
Q

which SSRIs are used to augment antipsychotics

A 
paroxetine
fluoxetine
fluvoxamine
citalopram
sertraline
264
Q

When is propranolol used to augment antipsychotics

A

aggressive especially in demented

265
Q

which antipsychotics should be started after diagnosis of schizophrenia

A 
aripiprazole
olanzapine
quetiapine
risperidone
ziprasidone
266
Q

After a patient fails one atypical antipsychotic in schizophrenia what should be started

A

any antipsychotic

267
Q

when should clozapine be started

A

after failing 2 antipsychotics

268
Q

which typical antipsychotics cause high sedation

A

chlorpromazine

thioridazine

269
Q

which typical antipsychotics cause moderately high sedation

A

lozitane

270
Q

which typical antipsychotics cause moderate sedation

A

perphenazine

trifluoperazine

271
Q

which typical antipsychotics cause low sedation

A

thiothixene
fluphenazine
haloperidol

272
Q

which typical antipsychotics cause high EPS

A

fluphenazine
haloperidol
perphenazine
thiothixene

273
Q

which typical antipsychotics cause moderately high EPS

A

chlorpromazine
loxitane
thioridazine
trifluoperazine

274
Q

which typical antipsychotics cause high anticholinergic effects

A

thioridazine

275
Q

which typical antipsychotics cause moderately high anticholinergic effects

A

chlorpromazine

276
Q

which typical antipsychotics cause moderate anticholinergic effects

A

loxitane

perphenazine

277
Q

which patients have higher incidence of acute dystonic reactions

A

male
> 40
high potency typical

278
Q

what is given to treat acute dystonic reactions

A

benztropine 2 mg IV or lorazepam 2 mg IM

279
Q

define acute dystonic reactions

A

acute muscle rigidity of face, neck, tongue

280
Q

when is an acute dystonic reaction likely to occur

A

first week of treatment

281
Q

when is akathisia likely to occur

A

within the first 3 months

282
Q

define akathisia

A

inability to sit still

283
Q

how to you manage antipsychotic induced akathisia

A

lower dose, switch to atypical AP, or beta blocker (atenolol 50 mg/day)

284
Q

how to manage AP induced akinesia

A

decrease dose or d/c

285
Q

define akinesia

A

lack of spontaneous activity

286
Q

when is pseudo parkinsonism likely to occur

A

1-2 weeks after start up to 3 months

287
Q

who is more likely to get pseudo parkinsonism

A

female

older

288
Q

how to mange AP induced pseudo parkinsonism

A

atypical or bentropine 1 -4 mg BID

289
Q

What is neuroleptic malignant syndrome

A 
fever
altered conciousness
autonomic dysfunction
lead pipe rigidity
lactic acidosis, renal failure, rhabdomylisis
290
Q

how to treat NMS

A

stop AP
ICU
supportive care

291
Q

which is more likely to get NMS

A 
high potency antipsychotics
depot antipsychotics
dehydrated
physical exhaustion
organic mental disorders
292
Q

When does tardive dyskinesia occur

A

months to years

293
Q

define tardive dyskinesia

A

abnormal involuntary movements; irreversible

294
Q

risk factors for tardive dyskinesia

A 
older
organic mental disorder
DM
mood disorders
Female
long term use
daily dosage
295
Q

how to treat tardive dyskinesia

A

prevent -> regular AIMS (Q6Mo)

clonazepam?

296
Q

Which typical antipsychotics lower seizure threshold

A

phenothizaines

clozapine + chlorpromazine

297
Q

Typical antipsychotics should be used with caution with what other medications due to increased orthostasis

A

antihypertensives

298
Q

Oral anticoagulants should be avoided with which typical antipsychotics

A

phenothiazines

Pnt Exam 2 (11 decks)

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