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P&T > Schizophrenia and Bipolar > Flashcards

Schizophrenia and Bipolar Flashcards

0
Q

The most common cause of chronic psychosis

A

schizophrenia

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1
Q

Mental state in which the individual appears to have lost touch with reality

A

Psychosis

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2
Q

A belief not based on fact or reality

A

delusion

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3
Q

3 classes of symptoms seen in schizophrenia

A
  1. positive symptoms
  2. negative symptoms
  3. cognitive impairment
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4
Q

2 most consistent anatomical correlations to schizophrenia

A
  1. decreased brain volume (decreased brain volume)

2. enlarged ventricles

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5
Q

Area of the brain that is important in higher cognitive function and working memory and has decreased metabolic activity in schizophrenia

A

prefrontal cortex

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6
Q

First drug discovered to treat schizophrenia

A

chlorpromazine

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7
Q

Neurotransmitter most commonly associated with schizophrenia

A

dopamine

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8
Q

Antagonism at this receptor in the striatum is thought to increase striatal DA release and may help to counteract D2 blockade, theory for why SGAs have less EPS than FGAs

A

5HT2A receptor

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9
Q

Mechanism of antipsychotic drugs

A

D2 dopamine receptor antagonists

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10
Q

involuntary movements usually to the face and tongue but also to the trunk and limbs that develops after months to years of antipsychotic therapy and can be irreversible

A

tardive dyskinesia

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11
Q

A perception disturbance in sensory experiences of the environment

A

Hallucination

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12
Q

Brain system involved in the negative symptoms of schizophrenia

A

mesocortical

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13
Q

Drug that marked the transition the SGAs and differed from FGAs in its significant decrease in motor SEs

A

Clozapine

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14
Q

Assigning importance to things that aren’t important

A

aberrant salience

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15
Q

Antipsychotic that is a D2 receptor partial agonist and acts as a dopamine stabilizer

A

aripiprazole

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16
Q

Antipsychotic that has proven to be superior in treatment resistant patients

A

clozapine

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17
Q

A person diagnosed with schizophrenia must have at least 2 of the following 3 things

A
  1. delusions
  2. hallucinations
  3. disorganized speech
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18
Q

Length of symptoms needed for diagnosis of schizophrenia

A

6 months

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19
Q

2 low potency SGAs

A
  1. clozapine

2. quetiapine

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20
Q

Inhibition of these 2 receptors is thought to be lead to weight gain associated with antipsychotics

A

H1 and 5HT2C

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21
Q

Diagnosis of symptoms of schizophrenia have occurred for less than 6 months

A

schizophreniform disorder

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22
Q

schizophrenia + bipolar disorder

A

schizoaffective disorder

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23
Q

Symptom of psychosis that responds best to medications

A

hallucinations

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24
Q

Most common form of hallucination

A

auditory

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25
Q

minimum length of antipsycholic drug therapy for schizophrenia

A

1-2 years, usually lifelong

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26
Q

3 medium potency FGAs

A
  1. loxapine
  2. perphenazine
  3. thiothixene
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27
Q

3 extrapyrimidal SEs that result from disruption of DA signaling in the substantia nigra to the striatum, important for motor function

A
  1. akathisia (uncontrollable restlessness)
  2. dystonia (involuntary movements)
  3. parkinsonism (bradykinesia, tremor)
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28
Q

4 medications that can be used adjunctively in schizophrenia if aggression or hostility is present

A

lamotrigine, divalproex, topiramate, lithium

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29
Q

2 characteristics of drugs that have the highest risk of movement disorders

A
  1. high potency

2. slow dissociation (most FGAs)

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30
Q

SGA that has the highest risk of akathisia

A

aripiprazole

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31
Q

antagonism at this receptor results in side effects such as blurred vision, urinary retention, dry mouth, and constipation

A

M1

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32
Q

Antagonism at this receptor leads to sedation SE of antipsychotics

A

H1

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33
Q

3 high potency FGAs

A
  1. trifluoperazine
  2. fluphenazine
  3. haloperidol
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34
Q

The most activating antipsychotic (take in the morning)

A

aripiprazole

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35
Q

Potency of meds that have the most anticolinergic SEs and sedation

A

low potency

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36
Q

antagonism of this receptor results in hypotension SE of antipsychotics

A

alpha-1

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37
Q

antipsychotics that have the highest risk of hypotension

A

low potency and lloperidone

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38
Q

Minimum time needed to see full effect of antipsychotics

A

12 weeks

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39
Q

Antipsychotics that have the highest risk of hyperprolactinemia

A

FGAs and risperidone/paliperidone

40
Q

3 receptors that are involved in metabolic issues associated with SGAs

A

5HT2C, M3 and H1

41
Q

2 SGAs that have the highest risk of Torsades de Pointes

A
  1. ziprasidone

2. Iloperidone

42
Q

Symptoms of schizophrenia that are new mental phenomena which unaffected people do not normally experience (hallucinations, delusions)

A

Positive symptoms

43
Q

2 SGAs that have the highest risk of metabolic issues

A
  1. clozapine

2. olanzapine

44
Q

5 SGAs that have intermediate risk of metabolic issues

A

quetiapine, risperidone, paliperidone, Iloperidone, asenapine

45
Q

3 most important antipsychotics to not abruptly discontinue

A
  1. clozapine
  2. quetiapine
  3. Ilperidone
46
Q

FGA that has an intermediate risk of metabolic issues

A

chlorpromazine

47
Q

3 SGAs that have a low risk of metabolic SEs

A

ziprasidone, lurasidone, aripiprazole

48
Q

All FGAs have a higher risk of Torsades de Pointes than SGAs but this FGA has the highest risk

A

Thioridazine

49
Q

3 antipsychotics included in FDA warning for increased incidence of stroke in elderly patients with dementia

A
  1. risperidone
  2. olanzapine
  3. aripiprazole
50
Q

Dietary restriction with ziprasidone

A

take with at least 500 calories

51
Q

4 drug characteristics that lead to increased risk of neuroleptic malignant syndrome

A
  1. high dose
  2. high potency
  3. IV
  4. dehydration
52
Q

Antipsychotic that has the highest risk of seizures

A

clozapine

53
Q

4 SEs that clozapine has the highest incidence of

A
  1. metabolic changes
  2. sedation
  3. constipation
  4. sialorrhea (drooling)
54
Q

Antipsychotic that has the lowest risk of seizures

A

Quetiapine

55
Q

2 SEs that clozapine has the lowest incidence of

A
  1. movement disorders

2. NMS

56
Q

2 drugs that can be used IM to treat dystonia

A
  1. benztropine

2. benadryl

57
Q

Antipsychotic that is technically a FGA but has some 5HT2A activity and is often used in children

A

loxapine

58
Q

Rare but life-threatening SE of antipsychotics that involves fever, encephalopathy, unstable vitals, elevated enzymes and muscle rigidity

A

Neuroleptic malignant syndrome

59
Q

Schedule for CBC monitoring with clozapine

A

weekly for 6 months, then every 2 weeks for 6 months then monthly thereafter

60
Q

2 antipsychotics that are long acting injections given every 1-4 weeks and are good for poor adherance

A
  1. fluphenazine decanoate

2. haloperidol decanoate

61
Q

A potentially fatal drop in WBC associated with clozapine

A

agranulocytosis

62
Q

Enzyme that tobacco induces and cloazpine is a substrate

A

CYP1A2

63
Q

5 black-box warnings for clozapine

A
  1. agranulocytosis
  2. seizures
  3. myocarditis
  4. orthostasis
  5. antipsychotics in elderly
64
Q

Dietary restriction with asenapine

A

no food or drink for 10-15 minutes

65
Q

Brain system involved in the positive symptoms of schizophrenia

A

mesolimbic

66
Q

Dietary restriction with lurasidone

A

take with at least 350 calories

67
Q

2 low potency FGAs

A
  1. chlorpromazine

2. thioridazine

68
Q

2 high potency SGAs

A
  1. risperidone

2. paliperidone

69
Q

Symptoms of mania but less severe and episodes are not severe enough to cause marked impairment

A

hypomanic episode

70
Q

Symptoms of schizophrenia in which the individual has a loss of normal mental functions (amotivation, social withdraw)

A

Negative symptoms

72
Q

Route of elimination of lithium

A

kidney

73
Q

therapeutic window of lithium

A

0.6-1.5 mM

74
Q

Cation that lithium mimics in excitable tissues

A

Na+

75
Q

Neurotransmitters whose release is inhibited by lithium

A

NE and DA

76
Q

Second messenger created via PIP2 hydrolysis that activates calcium release from intracellular stores

A

IP3

77
Q

Manic episode + major depressive episode

A

Bipolar I disorder

78
Q

Duration of time in which a persistently elevated, expansive or irritable mood must occur to classify as a manic episode

A

7 days, but if hospitalization is required there is no minimum duration

79
Q

4 AEDs that can be used in the management of bipolar disorder

A

Valproic acid, lamotrigine, carbamazepine, oxcarbazine

80
Q

Only medication used in bipolar disorder that is truly a mood stabilizer

A

Lithium

81
Q

Time required to see initial response in treatment of acute manic episode (see improvements in sleep and agitation first)

A

7-14 days

83
Q

SE that is the reason why lamotrigine must be titrated slowly

A

Stephen-Johnson syndrome

84
Q

Order of increasing risk of mood switch for antidepressants

A

Bupropion < SSRIs < Venlafaxine < MAOIs < TCAs

86
Q

5 drugs that are not recommended as monotherapy for bipolar mania

A
  1. Gabapentin
  2. Lamotrigine
  3. Tiagabine
  4. Topiramate
  5. Verapamil
87
Q

EKG abnormality seen with lithium toxicity

A

flat or inverted T waves

88
Q

Amount of time that the acute phase lasts for bipolar disorder

A

sustained response >4 weeks

89
Q

Time required to see full response in treatment of an acute manic episode

A

4-8 weeks

90
Q

Second messenger generated via hydrolysis of PIP2 that activates protein kinase C

A

DAG

91
Q

The most effective agent for classic euphoric mania

A

Lithium

92
Q

3 SGAs that are both anti-manic and anti-depressive

A
  1. Quetiapine
  2. Lurasidone
  3. Olanzapine + fluoxatine
93
Q

AED that has mostly anti-depressant effects and should not be used as monotherapy for manic episodes

A

Lamotrigine

94
Q

Amount of time the continuation phase lasts in bipolar depression treatment

A

full response for 4-6 months

95
Q

6 medications that have FDA approval for prevention of recurrence of bipolar disorder

A
  1. Lithium
  2. Lamotrigine
  3. Olanzapine
  4. Aripiprazole
  5. Risperdal consta
  6. ziprasidone (adjunct)
96
Q

5 medications that are not recommended for monotherapy in bipolar depression

A
  1. Gabapentin
  2. Aripiprazole
  3. Ziprasidone
  4. Parozetine
  5. Levetiracitam
97
Q

Drug class that tends to be best for disphoric mania

A

AEDs

100
Q

Hypomania + major depressive episode

A

Bipolar II disorder

101
Q

How often a patient on antipsychotic therapy should get an AIMS (abnormal involuntary movement scale) assessment

A

At baseline and every 6 months

102
Q

How often a patient on anti psychotic therapy needs to get a lipid panel and glucose checked

A

every 3 months

P&T (18 decks)

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