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Schizophrenia Flashcards

1
Q

Paliperidone (Invega), Risperidone (Risperdal)

Dose, metabilism how to take blah blah blah

A
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2
Q

What atypicals are highest for weight gain? What are the lowest?

A

Clozapine, Olanzapine

Aripiprazole, Lurasidone, Ziprasidone

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3
Q

How can Akathisia be treated?

A
  • Reducing the dose of the AP
  • You can switch to a low dose AP or SGA
  • Beta blockers like propranolol can help
  • Benzos
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4
Q

FGA, and SGAs both have effects on other receptors besides Dopamine and 5-HT2a what are the other receptors?

A
  • Muscarinic (cholinergic) receptors
  • A1 receptors
  • Histamine
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5
Q

What are the positive symptoms of schizophrenia?

A
  • Delusion
  • Hallucination
  • Disorganized speech
  • Unusual behavior
  • Hostility, agitation, combativeness
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6
Q

Talk about Asenapine, Iloperidone, Lurasidone?

Dose, metabilism how to take blah blah blah

A
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7
Q

Comparison of Typical APs

A
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8
Q

Drugs can induce psychosis what are the illicit ones?

A

Cocaine, PCP, Amphetamines, Mary Jane, LSD, Ketamine

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9
Q

Residual signs and symptoms

A
  • Anxiety
  • Suspicousness
  • Lack of motivation
  • poor insight and judgement
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10
Q

What is the nonpharmacologic treatment for schizophrenia?

A
  • Psychsocial rehab programs
  • case management
  • support groups
  • psychotherapy
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11
Q

What are some SEs of histamine and what is its therapeutic effects?

A
  • Sedation and weight gain
  • Sedation is its therapeutic effects
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12
Q

Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon)

Dose, metabilism how to take blah blah blah

A
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13
Q

For SGAs when do you monitor

Weight

Waist

Glucose

Hyperlipidemia

A
  • monthly for first 3 months then quarterly
  • ANual
  • 3 months then anually if normal
  • 3 months then anually if normal

SKIPPED other ones

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14
Q

What differientates between a good a bad prognosis?

A
  • 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
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15
Q

Symptoms for Neuroleptic Malignant Syndrome?

A

FEVER

Fever

Encephalopathy

Vital unstable

Elevated Enzymes (CK)

Rigidity

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16
Q

Aripiprazole (Abilify), Brexipiprazole (Rexulti), Cariprazine (Vraylar)

Dose, metabilism how to take blah blah blah

A
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17
Q

Negative symptoms?

A
  • Blunted/flat affect
  • Avolition (no motivation)
  • Anhedonia (lack of pleasure)
  • Poverty of Speech (Alogia)
  • Psychotomotor retardation
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18
Q

What atypicals are indicated for Irritability in Autism?

A
  • Apripirazole
  • Risperidone
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19
Q

The onset of schixophrenia in females occurs?

A

in their late 20s

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20
Q

Thiordazine cause?

This makes it a unlikely choice when chosing an antipsychotic

A

QTC Prlongation it can cause sudden death!

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21
Q

What are the social and occupational symptoms of schizophrenia?

A
  • Isolation
  • Decrease self-care
  • poor hygiene
  • Dirty unkept
  • Difficulty with family and social relationships
  • Employment difficulties
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22
Q

Comparison of Atypical APs

EPS?

Akathisia?

Wt gain?

Hyperprolactin?

QTC

Ortho

Sedation

A
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23
Q

Excluding aripiprazole, brexipiprazole, cariprazine

What are the other atypical antipsychotic mechanism of action?

A

5-HT2a/ Dopamine D2 antagonist

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24
Q

tardive dyskinesia?

A
  • Facial movements
  • tongue
  • lip
  • neck and trunk
  • limb
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25
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?
26
The mesocortical system is responsible for the ____ symptoms of schizophrenia?
negative
27
The onset of schizophrenia in males usually occurs?
In their early 20s
28
Treatment for NMS?
Discontinue the AP, dopamine agonist, dantrolene IV or PO
29
What side effects are greater in SGAs compared to FGAs?
* Weight gain * DM * Hyperlipidemia All of these are related
30
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
31
What are Extrapyramidal side effects? What other drugs can cause these?
* Dystonia * Akathasia * Pseudoparkinsonism * Tardive Prochloperazine, Promethazine, Metoclopramide
32
What atypicals are approved for the treatment of bipolar disorder?
* Apriprazole * Olanzapine * Ziprasidone * Lurasidone * Quentiapine
33
Typical antipsychotics are dopamine antagonists, what are their common side effects?
* Hyperprolactinemia is very common * EPS * Akathisia (agitation, distress, restlessness)
34
What SE is specific for Olanzapine Long acting injection?
Sedation delirium syndrome
35
Muscarinic receptor SEs and therapeutic effect?
* Dry mouth * Constipation * Blurred vision * Urinary rentention Relief of EPS SEs
36
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
37
Neuroleptic Malignant Syndrome?
* Very rare can occur all throughout FGA treatment
38
In the active stage of schizophrenia?
Patients have full blown schizophrenia
39
What SE is specific for Asenapine?
severe allergic rx (anaphylaxis, angioedema, rash, etc.)
40
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
41
What SE is specific for Clozapine?
– agranulocytosis, myocarditis
42
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.
43
Ziprasidone, Olanzapine?
Severe skin reaction with Eosinophilia and Systemic Symptoms DRESS
44
What side effects are greater in FGAs compared to SGAs?
* EPS * Neuroleptic malignant syndrome
45
What are the short term goals schizophrenia treatment?
* Prevent harm to self and others * Improve social functioning * Reduce acute symptoms
46
What a typical drugs are approved for the treatment of bipolar mania?
* Apiprozole * Asenapine * Cariprazine * Olanzapine * Quetiapine * Risperidone * Ziprasidone
47
What SE is specific for Aripiprazole?
impulse control behaviors
48
Alpha 1? SE and Therapeutic effect?
* Orthostatic hypotension * Reflex tachycardia No therapeutic benefit!
49
What are the two high potency typical?
* Fluphenazine (Prolixin) * Haloperidol (Haldol)
50
How is dystonia treated?
* IM or IV anticholinergics or benzodiazepines * Benztropine (cogentin) 2 mg IM * Diphenhydramine 50 mg IM
51
Lurasidone is metabolized by? What do you have to take it with?
CYP3A4 Take with food 350 cals
52
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
53
Risk factors for TD?
Age, Female, duration of AP, and FGA
54
\_\_\_\_\_ is the most effective antipsychotic
Clozapine
55
Drugs can induce psychosis what are the non illicit ones?
* Dopamine agonists (levo/carbodopa) * Anticholinergics * Steroids
56
What are the stages of schizophrenia?
* Prodromal * Active * Residual
57
What atypicals are approved for Adjunct Depression?
* Apriprazole * Brexipiprazole * Quetiapine ER
58
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
59
In the residual stage of schizophrenia patients symptoms begin to?
Subside
60
What atypicals are most likely to cause QTC prolongation?
Ziprazidone, Iloperidone
61
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
62
What are the two low potency typical antipsychotics?
* Chlorpromazine (Thorazine) * Thioridazine (Mellaril)
63
What atypicals are most likely to cause EPS, and Hyperprolactinemia?
Paliperidone, Respiridone
64
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
65
Akathisia?
* Restless and unable to sit still
66
Explain the dopamine hypothesis?
Pathophysiology of schizophrenia that involves hyperactivity of the limbic system
67
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

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