Schizophrenia Flashcards
Diagnosis of schizophrenia requires two or more of the following symptoms
Delusions, hallucinations, or disorganized speech over a period of 6 months
___ is a neurotransmitter that slows the progression of schizophrenia
Nicotine. Dopamine is the other neurotransmitter that plays a role in schizophrenia
In schizophrenia, the ___ region of the brain regulates emotions. ___ of this region produces symptoms of schizophrenia
Mesolimbic
Hyperactivity
In schizophrenia, the ___ region of the brain regulates cognitive functioning. ___ of this region produces cognitive deficits
Mesocortical
Hypoactivity
In schizophrenia, the ___ region of the brain regulates motor activity. ___ of this region produces tics and dyskinesia
Nigrostriatal
Hyperactivity
In schizophrenia, the ___ region of the brain inhibits prolactin. ___ of this region increases prolactin and causes amenorrhea in females and gynecomastia in males
Tuberoinfundibular
Hypoactivity
Be able to recognize the second generation (atypical) antipsychotics
Aripiprazole (Abilify) Asenapine (Saphris) Brexpiprazole (Rexulti) Cariprazine (Vraylar) Clozapine (Clozaril) Iloperidone (Fanapt) Lurasidone (Latuda) Olanzapine (Zyprexa) Paliperidone (Invega) Quetiapine (Seroquel) Risperidone (Risperdal) Ziprasidone (Geodon) ***You do not need to know brand names
What are the maximum doses of aripiprazole, olanzapine, and quetiapine
Aripiprazole = 30mg Olanzapine = 20mg Quetiapine = 800mg
Which 3 atypical antipsychotics are partial agonists
Aripiprazole
Brexpiprazole
Cariprazine
All antipsychotics block ___ receptors
Dopamine
Atypical antipsychotics block dopamine and ___ receptors
Serotonin
Side effects (specifically extrapyramindal side effects) are generally more likely with high potency antipsychotics, such as ___ or ___
Haloperidol
Fluphenazine
What medications are used to treat pseudoparkinsonism (“pill-rolling”, tremor, rigidity)?
Benztropine
Trihexyphenidyl
Diphenhydramine
What medications are used to treat dystonias (twisting of the neck)?
Benztropine
Trihexyphenidyl
Diphenhydramine
What medications are used to treat akathisia (restlessness)?
Propranolol
Lorazepam
What medications are used to treat tardive dyskinesia (grimacing, worm-like movement of the tongue)?
Removal or reduction of offending agent
Valbenazine
Deutetrabenazine (If associated with Huntington’s Disease)
Deutetrabenazine has a BBW of ___ and ___
Depression and suicide
What two medications are VMAT 2 Inhibitors?
Valbenazine
Deutetrabenazine
What are side effects of VMAT 2 Inhibitors and what medications are used to treat those side effects?
Neuroleptic Malignant Syndrome (NMS) -
Symptoms include hyperthermia, “cogwheeling”, rhabdomyolysis, diaphoresis
Treat with bromocriptine or dantroline (these increase dopamine)
What is the BBW for antipsychotics?
Increased mortality in elderly
What were the results of the CATIE trial?
Olanzapine is moderately more effective than other atypical antipsychotics and all conventional (1st generation) antipsychotics
Follow-up study showed clozapine to be superior to all other agents in “treatment-resistant schizophrenia”
What is the first line treatment for schizophrenia?
Atypical antipsychotic
What is the second line treatment for schizophrenia?
Switch to a different atypical antipsychotic or consider a conventional antipsychotic
What is the third line treatment for schizophrenia?
Consider clozapine
What is the fourth line treatment for schizophrenia?
Consider adding a second agent or ECT to existing clozapine regimen
Which atypical antipsychotics cause the most weight gain?
CLOZAPINE, OLANZAPINE, paliperidone, quetiapine, risperidone
What are the 3 major side effects of clozapine?
Weight gain, anticholinergic, orthostasis
May or may not cause extrapyramidal symptoms
Which atypical antipsychotics cause the most EPS?
Asenapine, paliperidone, risperidone
Which atypical antipsychotic may cause weight gain OR weight loss?
Ziprasidone
Which atypical antipsychotics cause the most orthostasis?
CLOZAPINE, iloperidone, quetiapine
Aripiprazole, brexpiprazole, and cariprazine can cause increased incidence of ___
Akathisia
What three atypical antipsychotics have the greatest risk for sedation and metabolic effects?
Cariprazine, clozapine, and olanzapine
Clozapine requires blood monitoring. What is the target drug concentration in order to reduce the risk of adverse effects?
350-400 mcg/mL
A dose of clozapine > 600mg can cause ___
Seizures
Sedation, coma, and death have been associated with injectable forms of ___
Olanzapine
A common effect of quetiapine is ___
Sedation - due to anticholinergic properties
think “quiet nap”
Ziprasidone has a BBW for ___
Cardiac abnormalities
IM olanzapine CANNOT be given with IM ___
Lorazepam
