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Diagnosis_Management 1 > Schizophrenia and atypical antipsychotics > Flashcards

Schizophrenia and atypical antipsychotics Flashcards

1
Q

circumstantiality

A

apparently unnecessary detail and irrelevant remarks make it take forever to get to the point

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2
Q

tangential thinking

A

moving from thought to thought without ever getting to the point. thoughts are somewhat connected to

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3
Q

perseverative thinking

A

continuous negative thinking about future or past events

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4
Q

neologisms

A

new word, expression, or usage

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5
Q

echolalia

A

repetition of another’s speech

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6
Q

verbigeration

A

compulsive repetition of meaningless words, phrases, or sentences

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7
Q

loss of ego boundaries

A

no sense of where they end and something else begins

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8
Q

types of ego boundary loss

A

ideas of reference
thought control
thought broadcasting
fused with an external object
disintegrated and fused with the universe

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9
Q

thought broadcasting

A

thinking others can read their mind or they can broadcast thoughts through TV or radio

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10
Q

cenesthetic hallucinations

A

sensation of an altered state of bodily organs like burning in the brain or pushing in the blood vessels

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11
Q

what is the leading cause of death among schizophrenics

A

suicide

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12
Q

risk factors for violent/impulsive behavior in schizophrenics

A

persecutory delusions
previous episodes of violence
neurologic deficits

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13
Q

what are the 3 subgroupings of symptoms for schizophrenia

A

positive sx
negative sx
cognitive sx

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13
Q

quick way to remember difference between positive and negative symptoms

A

positive sx are abnormal behavior
negative sx are the absence of normal behavior

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14
Q

which two antipsychotics cause the most weight gain and development of DM

A

olanzapine and clozapine

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15
Q

what are some labs you should check prior to prescribing antipsychotics

A

weight/height = BMI
waist circumference
BP
fasting plasma glucose
fasting lipids

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16
Q

main indications for antipsychotic use

A

schizophrenia and schizoaffective
mood disorders

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17
Q

other indications for antipsychotic usage

A

aggressive/violent behavior
AIDS dementia
Autism
Tourette’s
Huntington’s
Lesch-Nyhan syndrome

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18
Q

Indications for clozapine other than failed treatments

A

severe TD
low threshold for EPS

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19
Q

what increases the effectiveness of clozapine

A

risperidone

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20
Q

indications for risperidone

A

-acute and maintenance of schizophrenia
-acute manic/mixed episodes of bipolar 1
-irritability associated w/ autism

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21
Q

half life for risperidone

A

20 hours

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22
Q

when does risperidone reach peak plasma levels

A

1 hour for parent and 3 hours for metabolite

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23
Q

available formulations for risperidone

A

oral solution
disintegrating tablet
depot
PO

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24
Q

how should you start depot of risperidone

A

give PO with depot for first few weeks

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25
Q

dosage for PO risperidone

A

1-2mg at hs which can be increased to 4mg

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26
Q

what can happen with risperidone SSRI combo

A

marked elevation in prolactin

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27
Q

what drugs inhibit CYP2D6 and should not be given with risperidone

A

paroxetine
fluoxetine

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28
Q

other name for risperidone

A

risperidal

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29
Q

other name for paliperidone

A

invega

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30
Q

indications for paliperidone

A

acute/maintenance of schizophrenia
acute schizoaffective disorder
adjunct to mood stabilizers
adjunct to antidepressants

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31
Q

peak plasma and steady state for paliperidone

A

24 hours and 4-5 days

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32
Q

recommended dosage for paliperidone

A

6mg daily with or w/o food

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33
Q

half life of IM paliperidone

A

24-49 days

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34
Q

how do you initiate IM paliperidone

A

first 2 in deltoid then you can alternate between deltoid and gluteal

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35
Q

indications for olanzapine

A

schizophrenia
acute tx of manic/mixed episodes in bipolar 1
maintenance of bipolar 1

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36
Q

other name for olanzapine

A

zyprexa

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37
Q

how can zyprexa be used for bipolar 1

A

as monotherapy
adjunct to valproate or lithium
combo w/ fluoxetine (Symbyax)

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38
Q

zyprexa as monotherapy for tx resistant depression

A

No

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39
Q

peak concentration of olanzapine

A

5 hours

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40
Q

half-life of olanzapine

A

31 hours
daily dosing

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41
Q

available formulations of olanzapine

A

disintegrating tablet
IM
PO

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42
Q

what should you not administer with olanzapine

A

benzodiazepines

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43
Q

starting dose for PO olanzapine

A

5-10mg

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44
Q

starting dose for olanzapine in acute mania

A

10-15mg

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45
Q

how fast can you titrate olanzapine

A

weekly intervals

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46
Q

why would you use an IM olanzapine

A

acute agitation

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47
Q

what is the name of olanzapine depot

A

Relprevv

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48
Q

where do you administer relprevv

A

gluteal only
not approved for deltoid

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49
Q

how often do you give relprevv and how do you monitor

A

q2-4 weeks
monitor for 3 hours post injection d/t risk of delirium sedation

50
Q

other name for quetiapine

A

seroquel

51
Q

indications for quetiapine

A

-schizophrenia
-acute mania in bipolar 1
-monotherapy for depression associated with bipolar 1
-maintenance for bipolar 1
-adjunct to antidepressants for MDD

52
Q

peak plasma and steady state for quetiapine

A

1-2 hours and 7 hours

53
Q

how often do you dose quetiapine

A

2-3x daily

54
Q

dosage for quetiapine

A

start 25mg BID and increase by 25-50mg q2-3 days up to 300-400mg daily

55
Q

why can quetiapine be dosed daily if it has a short half-life

A

receptor occupancy remains when concentration has markedly declined

56
Q

dosage of quetiapine for insomnia

A

25-300mg

57
Q

when should you dose quetiapine

A

evening with food

58
Q

when should you NOT give quetiapine

A

-with other drugs that increase QT interval
-hx of cardiac arrythmia
-hypokalemia or hypomagesemia

59
Q

which antipsychotic other than clozapine is least likely to cause EPS

A

quetiapine

60
Q

other name for ziprasidone

A

geodon

61
Q

indications for ziprasidone

A

schizophrenia
monotherapy for acute manic/mixed episode of bipolar 1
adjunct to lithium or valproate

62
Q

peak plasma and steady state for ziprasidone

A

2-6 hours and 1-3 days
BID dosing

63
Q

what doubles bioavailability of ziprasidone

A

food

64
Q

peak concentration and half life of ziprasidone IM

A

1 hour and 2-5 hours

65
Q

available formulations of ziprasidone

A

PO
IM

66
Q

dosage of IM ziprasidone

A

10mg q2h
or
20mg q4h
Max daily dose is 20mg

67
Q

initial dose of PO ziprasidone

A

40mg

68
Q

what drugs interact with ziprasidone

A

ones that prolong QT interval

69
Q

the other name for aripiprazole

A

abilify

70
Q

indications for aripiprazole

A

schizophrenia
acute manic/mixed and maintenance for bipolar 1
adjunct to antidepressants for MDD
irritability associated w/ autism

71
Q

peak concentration and half-life of aripiprazole

A

3-5 hours and 75 hours
once daily dosing

72
Q

how does aripiprazole work

A

as a modulator rather than a blocker

73
Q

can you give aripiprazole as an adjunct to lithium or valproate? why?

A

No because interaction prevents them from reaching steady state

74
Q

starting dose for aripiprazole

A

10-15mg but 5mg may improve tolerability

75
Q

weight gain, prolactin, QT interval with aripiprazole

A

not significantly effected

76
Q

other name for asenapine

A

saphris

77
Q

indications for asenapine

A

schizophrenia
acute/mixed episodes of bipolar 1 with or w/o psychotic features

78
Q

peak plasma concentration of asenapine

A

1 hour

79
Q

route of asenapine

A

SL because bioavailability so low with digestion

80
Q

dosage of asenapine for schizophrenia

A

5mg BID

81
Q

dosage of asenapine for bipolar

A

10mg BID

82
Q

asenapine effect on QT interval and prolactin

A

elevate and prolong

83
Q

other name for clozapine

A

clozaril

84
Q

indications for clozapine

A

schizophrenia
sever psychotic depression
huntington’s disease
idiopathic parkinson’s disease
tx resistant mania

85
Q

peak levels and steady state of clozapine

A

2 hours and less than 1 week

86
Q

half-life of clozapine

A

12 hours

87
Q

initial dosage of clozapine

A

25mg once or twice daily

88
Q

titration of clozapine

A

can increase by 25mg q2-3 days up to 300mg daily in divided doses

89
Q

clozapine and lithium

A

increased risk for seizures

90
Q

monitoring of clozapine

A

weekly WBC for first 6 months then q 2 weeks

91
Q

when to dc clozapine

A

WBC<3000
or
granulocyte <1500

92
Q

other name for iloperidone

A

fanapt

93
Q

indications for iloperidone

A

schizophrenia in adults

94
Q

does clozapine prolong QT interval

A

yes

95
Q

titration of clozapine

A

comes in titration pack
effective dose reached in 4 days
start 1mg and increase by 1mg each day for 4 days

96
Q

other name for lurasidone

A

latuda

97
Q

indications for lurasidone

A

schizophrenia

98
Q

titration of lurasidone

A

not required

99
Q

dosage and range of lurasidone

A

start at 40mg
effective 40-120mg

100
Q

adjustments to lurasidone for renal and hepatic impairment

A

renal NTE 80mg daily
hepatic NTE 40mg daily

101
Q

other name for lumateperone

A

caplyta

102
Q

how long until you have to restart titration of an atypical

A

if you miss for 36 consecutive hours

103
Q

what drugs need tapered down when discontinuing to avoid cholinergic rebound

A

olanzapine and clozapine

104
Q

which atypical requires informed consent

A

clozapine

105
Q

which atypicals lack anticholinergic effects

A

risperidone, ziprasidone, and quetiapine

106
Q

how do you mitigate the risk of cholinergic rebound

A

give anticholinergic temporarily while weening off antipsychotic

107
Q

which atypical can you give if there has been agranulocytosis with clozapine

A

olanzapine

108
Q
A
109
Q

what is considered late onset schizophrenia

A

after age 45

110
Q

diagnostic rating scales for schizophrenia

A

PANSS (+ and - sx scale)
BPRS (brief psychiatric rating scale)

111
Q

rating scales to track EPS

A

SAS (Simpson Angus scale)
AIMS
BARS (Barnes akathisia rating scale)

112
Q

what typically predicts patients course of schizophrenia

A

pattern during first 5 years

113
Q

schizophrenic sx categories severity over time

A

positive sx tend to get less severe
negative sx tend to get more severe

114
Q

antipsychotics most likely to cause EPS

A

risperidone
olanzapine
ziprasidone

115
Q

which antipsychotic can actually decrease severe tardive dyskinesia

A

clozapine

116
Q

when would you consider using clozapine

A

after treatment failure of 2 other antipsyhotics

117
Q

what is an adequate trial of antipsychotic medication

A

4-6 weeks

118
Q

seasonality of birth r/t schizophrenia

A

more likely to be born in winter or early spring

119
Q

what prenatal infection can predispose to schizophrenia

A

prenatal exposure to the flu

120
Q

dopamine hypothesis of schizophrenia

A

sx result from dopamine excess

121
Q

serotonin hypothesis of schizophrenia

A

serotonin excess can cause + and - sx AEB increased efficacy of meds with robust serotonergic activity

122
Q

cognitive remediation

A

computer exercises to influence neural networks and improve cognition

123
Q

GABA in schizophrenia

A

patients can have a loss of GABA neurons in the hippocampus which leads to an increase in dopamine activity as GABA has regulatory effect on dopamine

Diagnosis_Management 1 (16 decks)

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