Schizophrenia Flashcards
Paliperidone (Invega), Risperidone (Risperdal)
Dose, metabilism how to take blah blah blah
What atypicals are highest for weight gain? What are the lowest?
Clozapine, Olanzapine
Aripiprazole, Lurasidone, Ziprasidone
How can Akathisia be treated?
- Reducing the dose of the AP
- You can switch to a low dose AP or SGA
- Beta blockers like propranolol can help
- Benzos
FGA, and SGAs both have effects on other receptors besides Dopamine and 5-HT2a what are the other receptors?
- Muscarinic (cholinergic) receptors
- A1 receptors
- Histamine
What are the positive symptoms of schizophrenia?
- Delusion
- Hallucination
- Disorganized speech
- Unusual behavior
- Hostility, agitation, combativeness
Talk about Asenapine, Iloperidone, Lurasidone?
Dose, metabilism how to take blah blah blah
Comparison of Typical APs
Drugs can induce psychosis what are the illicit ones?
Cocaine, PCP, Amphetamines, Mary Jane, LSD, Ketamine
Residual signs and symptoms
- Anxiety
- Suspicousness
- Lack of motivation
- poor insight and judgement
What is the nonpharmacologic treatment for schizophrenia?
- Psychsocial rehab programs
- case management
- support groups
- psychotherapy
What are some SEs of histamine and what is its therapeutic effects?
- Sedation and weight gain
- Sedation is its therapeutic effects
Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon)
Dose, metabilism how to take blah blah blah
For SGAs when do you monitor
Weight
Waist
Glucose
Hyperlipidemia
- monthly for first 3 months then quarterly
- ANual
- 3 months then anually if normal
- 3 months then anually if normal
SKIPPED other ones
What differientates between a good a bad prognosis?
- Good mainly positive symptoms dominate
- older than the average person to get diagnosed
- Poor
- Patient is younger than average when diagnosed
- (+) FH
- Negative symptoms are big
Symptoms for Neuroleptic Malignant Syndrome?
FEVER
Fever
Encephalopathy
Vital unstable
Elevated Enzymes (CK)
Rigidity
Aripiprazole (Abilify), Brexipiprazole (Rexulti), Cariprazine (Vraylar)
Dose, metabilism how to take blah blah blah
Negative symptoms?
- Blunted/flat affect
- Avolition (no motivation)
- Anhedonia (lack of pleasure)
- Poverty of Speech (Alogia)
- Psychotomotor retardation
What atypicals are indicated for Irritability in Autism?
- Apripirazole
- Risperidone
The onset of schixophrenia in females occurs?
in their late 20s
Thiordazine cause?
This makes it a unlikely choice when chosing an antipsychotic
QTC Prlongation it can cause sudden death!
What are the social and occupational symptoms of schizophrenia?
- Isolation
- Decrease self-care
- poor hygiene
- Dirty unkept
- Difficulty with family and social relationships
- Employment difficulties
Comparison of Atypical APs
EPS?
Akathisia?
Wt gain?
Hyperprolactin?
QTC
Ortho
Sedation
Excluding aripiprazole, brexipiprazole, cariprazine
What are the other atypical antipsychotic mechanism of action?
5-HT2a/ Dopamine D2 antagonist
tardive dyskinesia?
- Facial movements
- tongue
- lip
- neck and trunk
- limb
What is the prodromal stage of schizophrenia?
No obvious symptoms are present but daily function begins to decline
- Pts begin to become withdrawn, suspicious, and have an odd behavior?
The mesocortical system is responsible for the ____ symptoms of schizophrenia?
negative
The onset of schizophrenia in males usually occurs?
In their early 20s
Treatment for NMS?
Discontinue the AP, dopamine agonist, dantrolene IV or PO
What side effects are greater in SGAs compared to FGAs?
- Weight gain
- DM
- Hyperlipidemia
All of these are related
The only treatment for TD is?
Prevention so you have to constantly be checking on the person every 3-6 months if they are on a FGA.
It can be irreversible but if caught early enough you may be able to stop the progression
What are Extrapyramidal side effects?
What other drugs can cause these?
- Dystonia
- Akathasia
- Pseudoparkinsonism
- Tardive
Prochloperazine, Promethazine, Metoclopramide
What atypicals are approved for the treatment of bipolar disorder?
- Apriprazole
- Olanzapine
- Ziprasidone
- Lurasidone
- Quentiapine
Typical antipsychotics are dopamine antagonists, what are their common side effects?
- Hyperprolactinemia is very common
- EPS
- Akathisia (agitation, distress, restlessness)
What SE is specific for Olanzapine Long acting injection?
Sedation delirium syndrome
Muscarinic receptor SEs and therapeutic effect?
- Dry mouth
- Constipation
- Blurred vision
- Urinary rentention
Relief of EPS SEs
Black Box warning for all APs
Increased mortality in all elderly patients with dementia related psychosis
Increased suicidal ideation in adolescents and young adults <25
- APs with bipolar depression or adjunt depression indications
Neuroleptic Malignant Syndrome?
- Very rare can occur all throughout FGA treatment
In the active stage of schizophrenia?
Patients have full blown schizophrenia
What SE is specific for Asenapine?
severe allergic rx (anaphylaxis, angioedema, rash, etc.)
SGA side effects include?
put these drugs in order of causing side effects
Asenapine, Quetiapine, Iloperidone, Ziprasidone, Olanzapine, Clozapine, Resperidone, Lurasidone, Paliperidone, Aripiprazole
Clozapine=Olanzapine>quetiapine=risperidone= paliperidone>iloperidone>asenapine> ziprasidone=aripiprazole=lurasidone
Weight gain, glucose intolerance, DM, lipid abnormalities
What SE is specific for Clozapine?
– agranulocytosis, myocarditis
Positive symptoms of schizophrenia like delusion, hallucination, Disorganized speech, unusual behavior, agitation, hostility, combativeness. Occur in what system and too much of what is released?
Positive symptoms in the mesolimbic system. Occurs when too much dopamine is release in the synapse.
Ziprasidone, Olanzapine?
Severe skin reaction with Eosinophilia and Systemic Symptoms DRESS
What side effects are greater in FGAs compared to SGAs?
- EPS
- Neuroleptic malignant syndrome
What are the short term goals schizophrenia treatment?
- Prevent harm to self and others
- Improve social functioning
- Reduce acute symptoms
What a typical drugs are approved for the treatment of bipolar mania?
- Apiprozole
- Asenapine
- Cariprazine
- Olanzapine
- Quetiapine
- Risperidone
- Ziprasidone
What SE is specific for Aripiprazole?
impulse control behaviors
Alpha 1? SE and Therapeutic effect?
- Orthostatic hypotension
- Reflex tachycardia
No therapeutic benefit!
What are the two high potency typical?
- Fluphenazine (Prolixin)
- Haloperidol (Haldol)
How is dystonia treated?
- IM or IV anticholinergics or benzodiazepines
- Benztropine (cogentin) 2 mg IM
- Diphenhydramine 50 mg IM
Lurasidone is metabolized by?
What do you have to take it with?
CYP3A4
Take with food 350 cals
Long term goals for the treatment of schizophrenia?
- Prevent relapse
- Compliance (big thing)
- Optimize medications and prevent side effects
- Monitor for Tardive Dyskinesia
- Improve quality of life always
Risk factors for TD?
Age, Female, duration of AP, and FGA
_____ is the most effective antipsychotic
Clozapine
Drugs can induce psychosis what are the non illicit ones?
- Dopamine agonists (levo/carbodopa)
- Anticholinergics
- Steroids
What are the stages of schizophrenia?
- Prodromal
- Active
- Residual
What atypicals are approved for Adjunct Depression?
- Apriprazole
- Brexipiprazole
- Quetiapine ER
What are the overall SEs of Antipsychotics?
- Cardiovascular SEs- QTc prolongation, Consider baseline EKG in all patients > 40
- Thioerdazine most, Ziprasidone for
- increase prolactin
- Drowsiness
In the residual stage of schizophrenia patients symptoms begin to?
Subside
What atypicals are most likely to cause QTC prolongation?
Ziprazidone, Iloperidone
What are some ways to treat pseudopaekinsonism?
Anticholinergics
- Benztropine 1-2 mg BID MAX 8 mg/d
- Diphenhydramine 25-50 mg po TID (increase sedation)
- Trihexyphenidyl 2-5 mg PO TID
- 3-4 days to work
Dopamine agonists as well
- Amantidine, Bromocrtiptine
- Can cause anxiety, agitation, and restlessness
What are the two low potency typical antipsychotics?
- Chlorpromazine (Thorazine)
- Thioridazine (Mellaril)
What atypicals are most likely to cause EPS, and Hyperprolactinemia?
Paliperidone, Respiridone
When performing an assessment to see if someone has schizophrenia what tests and various other things should be done?
- Mental Status Exam
- Physical Exam
- Lab workup
- Electrolytes, BUN, Cr
- UDS
- Syphilis test
- Medication assessment
Akathisia?
- Restless and unable to sit still
Explain the dopamine hypothesis?
Pathophysiology of schizophrenia that involves hyperactivity of the limbic system
What is needed to accurately diagnose schizophrenia?
- Duration: Must have continuos signs for at least 6 months
- 2 or more of the following symptoms for a significant portion of 1 month
- Delusions
- Hallucinations
- Disorganized speech
- Catatonic behavior or unusual behavior
- Negative symptoms
- None of these symptoms can be due to a medical disorder or substance abuse
- Mood disorders must be excluded
