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Pharmacy Year 3 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

What are the usual ages of onset in men and women?

A

20-28 years in men

26-32 years in women

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2
Q

How is schizophrenia diagnosed?

A

Questionnaires

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3
Q

What may be seen on a brain scan of a patient with schizophrenia?

A

Ventricular dilation - possibly due to loss of brain tissue

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4
Q

What are the risk factors for schizophrenia?

A

Genetics - number of susceptible genes usually affecting synaptic function
Environmental - Prenatal problems, obstetric complications, urban/city births, stressful events, drug abuse

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5
Q

When do schizophrenia symptoms usually start to appear?

A

When a number of risk thresholds have been crossed

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6
Q

What are the positive symptoms of schizophrenia?

A

“Added”
Hallucinations, delusions, disorganised speech
From increase in dopamine in mesolimbic pathway

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7
Q

What are the negative symptoms of schizophrenia?

A

“Taken away”
Decreased emotions, motivation and interests
Less thoughts, speech, pleasure
Thought to do with the cortex

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8
Q

What are the potential cognitive deficits of schizophrenia?

A

Lack of attention
Loss of working and verbal memory
Loss of executive function

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9
Q

What is the dopamine theory for schizophrenia?

A

Increased dopamine in subcortical pathways leads to psychosis
D2 receptors are inhibitory, increased dopamine increases inhibition leading to psychosis

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10
Q

What is the downside of using D2 antagonists for psychosis?

A

Dopamine level remains the same so if antagonist is withdrawn, psychosis comes back

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11
Q

What is the glutamate theory for schizophrenia?

A

Glutamate activates NMDA receptors which activates GABA neurones
Glutamate stimulates dopamine neurones, GABA action modulates release
Hypofunction of NMDA receptors results in lack of GABA so increased dopamine

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12
Q

What could be causes of NMDA hypofunction?

A

Genetic and non-genetic factors in early development

Phencyclidine

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13
Q

What would be tried first for schizophrenia treatment?

A

CBT - Before or synergistic with antipsychotic treatment

Arts therapy may be tried for negative symptoms

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14
Q

How should antipsychotic trialling work?

A

Try optimal dose for 4-6 weeks

Advise patient they may take 2-3 weeks to work and not to stop taking

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15
Q

What may be a side effect of the dopamine increase and what should be done to treat it?

A

Prolactin increase

Give aripiprazole or a dopamine agonist or use alternative antipsychotic

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16
Q

What are the QT wave limits for patients using antipsychotics?

A

440ms for men

470ms for women

17
Q

When may depot formulations be used?

A

Patient preference

If issues with compliance

18
Q

Why should caffeine and smoking be avoided when using antipsychotics?

A

Smoking induces CYP1A2

Caffeine competitively inhibits CYP1A2

19
Q

What is the MoA for typical antipsychotics?

A

High affinity for D2 receptor - antagonist

20
Q

What is the MoA for atypical antipsychotics?

A

High affinity for serotonin (5-HT2) receptors but also acts as antagonist at D2 receptors

21
Q

What is the main difference in efficacy of typical and atypical antipsychotics?

A

Atypical antipsychotics may also have an effect on negative symptoms due to 5-HT2 action

22
Q

What are the main side effects of typical antipsychotics?

A 
Motor control impairments:
Muscle spasms
Pseudo-parkinsonism
Restlessness
Lip smacking or chewing
Tongue protrusion
23
Q

When may anticholinergics be used with typical antipsychotics?

A

Muscle spasms and pseudo-parkinsonism

24
Q

Give some examples of typical antipsychotics

A 
Haloperidol
Chlorpromazine
Trifluoperazine
Perphenazine
Flupenthixol
Zuclopenthixol
Sulpiride
25
Q

What are the main side effects of atypical antipsychotics?

A 
Metabolic side effects:
Increased weight
Increased blood glucose
Increased lipid levels
Agranulocytosis
26
Q

Give some examples of atypical antipsychotics

A 
Quetiapine
Olanzapine
Clozapine
Asenapine
Risperidone
Paliperidone
Lurasidone
Amisulpride
Aripiprazole
27
Q

What are the brands of clozapine available?

A

Denzapine
Clozaril
Zaponex

28
Q

What are the monitoring requirements for clozapine?

A

WBC checks weekly for 18/52, fortnightly for weeks 18-52 and every 4 weeks after a year
BP
Pulse
Temperature

29
Q

What is the traffic light system for clozapine?

A

Green - Within normal levels, continue as normal
Amber - WBC 3.0-3.5 x10^9 or neutrophils 1.5-2.0 x 10^9, continue but monitor twice a week
Red - Below min amber levels, stop clozapine and monitor for infection signs

30
Q

How should clozapine be initiated?

A

Start at 12.5mg and slowly titrate up to max 300mg daily

If more than 300mg needed increase by 50-100mg weekly

31
Q

What are the clozapine dose targets in male and female non-smokers and smokers?

A

250mg/day female non-smokers
350mg/day male non-smokers
450mg/day female smokers
550mg/day male smokers

Pharmacy Year 3 (15 decks)

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