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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
Q

What is the prodromal stage of schizophrenia?

A

No obvious symptoms are present but daily function begins to decline

  • Pts begin to become withdrawn, suspicious, and have an odd behavior?
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26
Q

The mesocortical system is responsible for the ____ symptoms of schizophrenia?

A

negative

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27
Q

The onset of schizophrenia in males usually occurs?

A

In their early 20s

28
Q

Treatment for NMS?

A

Discontinue the AP, dopamine agonist, dantrolene IV or PO

29
Q

What side effects are greater in SGAs compared to FGAs?

A
  • Weight gain
  • DM
  • Hyperlipidemia

All of these are related

30
Q

The only treatment for TD is?

A

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
Q

What are Extrapyramidal side effects?

What other drugs can cause these?

A
  • Dystonia
  • Akathasia
  • Pseudoparkinsonism
  • Tardive

Prochloperazine, Promethazine, Metoclopramide

32
Q

What atypicals are approved for the treatment of bipolar disorder?

A
  • Apriprazole
  • Olanzapine
  • Ziprasidone
  • Lurasidone
  • Quentiapine
33
Q

Typical antipsychotics are dopamine antagonists, what are their common side effects?

A
  • Hyperprolactinemia is very common
  • EPS
  • Akathisia (agitation, distress, restlessness)
34
Q

What SE is specific for Olanzapine Long acting injection?

A

Sedation delirium syndrome

35
Q

Muscarinic receptor SEs and therapeutic effect?

A
  • Dry mouth
  • Constipation
  • Blurred vision
  • Urinary rentention

Relief of EPS SEs

36
Q

Black Box warning for all APs

A

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
Q

Neuroleptic Malignant Syndrome?

A
  • Very rare can occur all throughout FGA treatment
38
Q

In the active stage of schizophrenia?

A

Patients have full blown schizophrenia

39
Q

What SE is specific for Asenapine?

A

severe allergic rx (anaphylaxis, angioedema, rash, etc.)

40
Q

SGA side effects include?

put these drugs in order of causing side effects

Asenapine, Quetiapine, Iloperidone, Ziprasidone, Olanzapine, Clozapine, Resperidone, Lurasidone, Paliperidone, Aripiprazole

A

Clozapine=Olanzapine>quetiapine=risperidone= paliperidone>iloperidone>asenapine> ziprasidone=aripiprazole=lurasidone

Weight gain, glucose intolerance, DM, lipid abnormalities

41
Q

What SE is specific for Clozapine?

A

– agranulocytosis, myocarditis

42
Q

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?

A

Positive symptoms in the mesolimbic system. Occurs when too much dopamine is release in the synapse.

43
Q

Ziprasidone, Olanzapine?

A

Severe skin reaction with Eosinophilia and Systemic Symptoms DRESS

44
Q

What side effects are greater in FGAs compared to SGAs?

A
  • EPS
  • Neuroleptic malignant syndrome
45
Q

What are the short term goals schizophrenia treatment?

A
  • Prevent harm to self and others
  • Improve social functioning
  • Reduce acute symptoms
46
Q

What a typical drugs are approved for the treatment of bipolar mania?

A
  • Apiprozole
  • Asenapine
  • Cariprazine
  • Olanzapine
  • Quetiapine
  • Risperidone
  • Ziprasidone
47
Q

What SE is specific for Aripiprazole?

A

impulse control behaviors

48
Q

Alpha 1? SE and Therapeutic effect?

A
  • Orthostatic hypotension
  • Reflex tachycardia

No therapeutic benefit!

49
Q

What are the two high potency typical?

A
  • Fluphenazine (Prolixin)
  • Haloperidol (Haldol)
50
Q

How is dystonia treated?

A
  • IM or IV anticholinergics or benzodiazepines
    • Benztropine (cogentin) 2 mg IM
    • Diphenhydramine 50 mg IM
51
Q

Lurasidone is metabolized by?

What do you have to take it with?

A

CYP3A4

Take with food 350 cals

52
Q

Long term goals for the treatment of schizophrenia?

A
  • Prevent relapse
  • Compliance (big thing)
  • Optimize medications and prevent side effects
  • Monitor for Tardive Dyskinesia
  • Improve quality of life always
53
Q

Risk factors for TD?

A

Age, Female, duration of AP, and FGA

54
Q

_____ is the most effective antipsychotic

A

Clozapine

55
Q

Drugs can induce psychosis what are the non illicit ones?

A
  • Dopamine agonists (levo/carbodopa)
  • Anticholinergics
  • Steroids
56
Q

What are the stages of schizophrenia?

A
  • Prodromal
  • Active
  • Residual
57
Q

What atypicals are approved for Adjunct Depression?

A
  • Apriprazole
  • Brexipiprazole
  • Quetiapine ER
58
Q

What are the overall SEs of Antipsychotics?

A
  • Cardiovascular SEs- QTc prolongation, Consider baseline EKG in all patients > 40
  • Thioerdazine most, Ziprasidone for
  • increase prolactin
  • Drowsiness
59
Q

In the residual stage of schizophrenia patients symptoms begin to?

A

Subside

60
Q

What atypicals are most likely to cause QTC prolongation?

A

Ziprazidone, Iloperidone

61
Q

What are some ways to treat pseudopaekinsonism?

A

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
Q

What are the two low potency typical antipsychotics?

A
  • Chlorpromazine (Thorazine)
  • Thioridazine (Mellaril)
63
Q

What atypicals are most likely to cause EPS, and Hyperprolactinemia?

A

Paliperidone, Respiridone

64
Q

When performing an assessment to see if someone has schizophrenia what tests and various other things should be done?

A
  • Mental Status Exam
  • Physical Exam
  • Lab workup
    • Electrolytes, BUN, Cr
    • UDS
    • Syphilis test
  • Medication assessment
65
Q

Akathisia?

A
  • Restless and unable to sit still
66
Q

Explain the dopamine hypothesis?

A

Pathophysiology of schizophrenia that involves hyperactivity of the limbic system

67
Q

What is needed to accurately diagnose schizophrenia?

A
  • 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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