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Therapeutics > Schizophrenia & Depression > Flashcards

Schizophrenia & Depression Flashcards

1
Q

what APS are generally 1st used for treatment naive schizophrenia

A

aripiprazole, risperidone, ziprasidone

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2
Q

which 2 APS are usually avoided 1st line

A

clozapine, olanzapine

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3
Q

what is used for treatment resistant schizophrenia

A

clozapine

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4
Q

when is clozapine used ASIDE FROM treatment resistant schizophrenia

A

earlier use for high suicide risk, severe EPS AEs, or hx of violence/sub abuse

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5
Q

which 2 APS may need dose increase in pregnancy? why?

A

clozapine & olanzapine
changes in CYP1A2

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6
Q

APS have this general MOA

A

antagonism of dopamine

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7
Q

what are the first generation APS (9)

A

chlorpromazine, fluphenazine, haloperidol, perphenazine, thioridazine, thiothixene, loxapine, molindone, trifluoperazine

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8
Q

which 3 1st gen APS are a SHORT ACTING injection

A

chlorpromazine, haloperidol, fluphenazine

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9
Q

which 2 1st gen APS are a LONG ACTING injectable

A

fluphenazine, haloperidol

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10
Q

APS all have this BBW

A

increased mortality in elderly with dementia related psychosis

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11
Q

high potency APS have a low risk of ___ and a high risk of ___

A

low anticholinergic risk
high EPS risk

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12
Q

low potency APS have a low risk of ___ and a high risk of ___

A

low EPS risk
high anticholinergic risk

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13
Q

which 2 1st gen APS are low potency

A

chlorpromazine < thioridazine

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14
Q

which 2 1st gen APS are highest potency

A

haloperidol > fluphenazine

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15
Q

aside from schizophrenia, chlorpromazine is also used for

A

acute psychosis

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16
Q

aside from schizophrenia, loxapine is also used for

A

BPD

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17
Q

aside from schizophrenia, trifluoperazine is also used for

A

anxiety

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18
Q

aside from schizophrenia, haloperidol is also used for

A

tourettes, acute psychosis, hyperactive behavior

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19
Q

AEs of 1st gen APS

A

EPS, QTc prolong, blue gray skin, altered thermoregulation

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20
Q

AEs of 2nd gen APS

A

metabolic syndrome, QTc prolongation, blood dyscrasias, seizure, anticholinergic, sedation

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21
Q

which 2nd gen APS can also be used for augmentation in MDD?
what BBW does this also give them?

A

aripiprazole, brexiprazole, olanzapine, quetiapine
BBW suicidality

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22
Q

which 2nd gen APS are available as SHORT ACTING injection

A

olanzapine, ziprasidone

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23
Q

which 2nd gen APS are available as LONG ACTING injection

A

aripiprazole, olanzapine, risperidone, paliperidone

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24
Q

aside from schizophrenia, aripiprazole is also used for

A

BPD, MDD augment, autism sx, tourettes

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25
Q

aside from schizophrenia, brexiprazole is also used for

A

MDD augment, alzheimers dementia agitation

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26
Q

almost all 2nd gen APS can be used for BPD EXCEPT (4)

A

brexiprazole, clozapine, paliperidone, pimavanserin

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27
Q

aside from schizophrenia, risperidone is also used for

A

BPD & autism sx

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28
Q

pimavanserin is a 2nd gen APS indicated for

A

parkinsons psychosis

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29
Q

AE of aripiprazole

A

activating, akathisia, restlessness, impulsivity

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30
Q

for SL asenapine, do not

A

eat or drink for 10 mins

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31
Q

AE of asenapine

A

high QTc risk, skin rxn from patch

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32
Q

what needs to be monitored for after 1st dose of asenapine

A

anaphylaxis risk

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33
Q

which 2 2nd gen APS have very long half lives

A

brexiprazole
cariprazine

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34
Q

AEs of clozapine

A

HIGH METABOLIC RISK, QTc prolong, severe constipation/GI hypomotility, hypersalivation, ANTICHOLINERGIC

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35
Q

avoid using clozapine with what due to severe sedation

A

IM benzo

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36
Q

BBW for clozapine

A

blood dyscrasia, bradycardia, myocarditis, seizure risk at high conc

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37
Q

what reduces serum clozapine & olanzapine due to 1A2

A

smoking

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38
Q

AEs of iloperidone
which AE is usually avoided?

A

orthostatic hypotension, priapism
no prolactin elevation

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39
Q

AE of lurasidone? in those with dementia/PD/Lewy?

A

sedation
neurologic

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40
Q

avoid using olanzapine with what due to high sedation risk

A

IM benzo

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41
Q

AE of olanzapine

A

HIGH METABOLIC RISK, DRESS, QTc, anticholinergic

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42
Q

BBW for olanzapine LAI

A

post injection delirium/sedation syndrome

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43
Q

olanzapine + samidorphan combo has what risk

A

opioid withdrawal

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44
Q

AE of paliperidone

A

QTc risk

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45
Q

avoid pimavanserin in those with

A

renal impairment, conflicting CYPs

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46
Q

AEs of quetiapine

A

metabolic risks, cataract development, anticholinergic, misuse potential

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47
Q

AEs of risperidone

A

prolactin elevation, EPS MORE LIKELY (akathisia)

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48
Q

AEs of ziprasidone

A

DRESS, QTc

49
Q

is an oral challenge always done before starting a LAI APS?

A

yes- detect allergy & know best dose before transition

50
Q

is oral overlap always used for LAI APS?

A

no- only used if coverage needed while LAI kicks in

51
Q

selective alpha 2 adrenergic agonist used for schizophrenia that needs to be administered by a provider due to BP changes

A

dexmedetomidine

52
Q

how can NMS be treated?

A

dopamine agonist

53
Q

how to treat acute dystonia from APS

A

anticholinergics or IM benzo

54
Q

how to treat pseudo-parkinsonism from APS

A

anticholinergics

55
Q

how to treat akathisia from APS

A

B-blockers

56
Q

how to treat tardive dyskinesia

A

d/c drug

57
Q

how does NMS occur? what happens?

A

from DA antagonists
onset 1-3 days
muscle rigidity, hyporeflexia, normal pupils, decreased bowel sounds

58
Q

what are the initial agents used for MDD

A

SSRI, SNRI, bupropion, mirtazapine, vortioxetine

59
Q

how long (minimum) until seeing MDD symptom resolution with treatment

A

2-4 weeks

60
Q

best MDD agents for elderly

A

SSRI best, then bupropion or venlafaxine

61
Q

which 2 MDD agents are approved for younger ages in children

A

fluoxetine and escitalopram

62
Q

what is most commonly used for MDD in pregnancy?
which one cannot be used?

A

SSRIs but NOT PAROXETINE

63
Q

aside from 2nd gen APS, what else can be used for MDD augmentation

A

lithium
triiodothyronine

64
Q

BBW for all antidepressants

A

increased risk of suicidality in those up to age 24, especially in early treatment stages

65
Q

what may be a concern if a MDD agent is working very well in under 2 weeks

A

BPD and precipitation of mania/episodes

66
Q

serious AE causes by serotonin agents with onset <12 hours that causes hyperreflexia, dilated pupils, hyperactive bowel sounds/GI sx, mental changes

A

serotonin syndrome

67
Q

class AEs for SSRIs

A

abnormal bleeding, hyponatremia & SIADH, more energy boosting, sexual dysfunction, QTc prolong, serotonin syndrome

68
Q

most MDD agents may have DDI with which 2 CYPs

A

2D6 and 3A4

69
Q

when d/c SSRI or SNRI, taper to avoid what?
which drug is an exception?

A

avoid discontinuation syndrome- electric shock sensations
not fluoxetine- long t1/2

70
Q

avoid SSRIs in??
modify dose for??

A

avoid- GI bleed, on anticoagulation
dose mod- hepatic impairment

71
Q

citalopram carries a higher risk of

A

QTc prolongation

72
Q

citalopram has dose limitations for what? (3 things)

A

age 60 and older
CYP2C19 interactions
hepatic impairment

73
Q

which drugs are SSRIs? (6)

A

citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline

74
Q

aside from MDD, escitalopram is also used for

A

GAD

75
Q

fluoxetine is able to be dosed how often

A

once a week

76
Q

aside from MDD, fluoxetine can also be used for

A

OCD, panic, PMDD, bulimia, BPI depress episode

77
Q

fluvoxamine is primary used for what type of MDD? what else?

A

refractory MDD
OCD

78
Q

AEs of paroxetine

A

very sedating, anticholinergic, bone fracture

79
Q

avoid paroxetine in

A

pregnancy

80
Q

aside from MDD paroxetine is also used for

A

GAD, OCD, panic, PTSD, PMDD, SAD

81
Q

aside from MDD, sertraline can also be used for?
what about the capsule?

A

OCD, panic, PTSD, PMDD, SAD
capsule- MDD, OCD

82
Q

which drugs are SNRIs (4)

A

venlafaxine, desvenlafaxine, duloxetine, levomilnacipran

83
Q

class AEs of SNRIs

A

abnormal bleeding, elevated BP, serotonin syndrome, d/c syndrome, more boosting (similar to SSRIs)

84
Q

how should venlafaxine be administered?
any dose adjustments?

A

with food
adjust for renal/hepatic impairment

85
Q

aside from MDD venlafaxine is also used for

A

GAD, panic, social phobia

86
Q

AE of duloxetine

A

urinary retention, less insomnia

87
Q

avoid use of duloxetine in

A

ESRD or hep dysfunction

88
Q

aside from MDD duloxetine is also used for

A

GAD, pain

89
Q

which drugs are tricyclic antidepressants (8)

A

amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine nortriptyline, maprotiline

90
Q

which 2 TCAs have an indication other than MDD? what is the indications?

A

clomipramine- OCD
doxepin- insomnia

91
Q

typical off label use for TCAs is

A

neuropathic pain among others

92
Q

class AEs of TCAs

A

anticholinergic & CV effects
withdrawal syndrome

93
Q

what potentially lethal effect can TCAs have

A

CV ventricular tachycardia & heart block

94
Q

avoid use of TCAs in patients with

A

cardiac conditions

95
Q

3 MAOIs used for MDD

A

phenelzine, tranylcypromine, selegiline

96
Q

when are MAOI used for MDD?

A

last line

97
Q

how long do you need to wait to use a MAOI after d/c an interacting drug? whats the exceptions?

A

4-5 t1/2 of the drug
except fluoxetine 5 weeks & vortioxetine 3 weeks

98
Q

AEs of MAOIs

A

postural hypotension, anticholinergic, serotonin syndrome

99
Q

DDI with MAOIs? can cause what?

A

tyramine foods & sympathomimetics — hypertensive crisis

100
Q

serotonin modulators used for MDD (5)

A

gepirone, nefazodone, trazodone, vilazodone, vortioxetine

101
Q

gepirone dosing may need alteration for?
what affects absorption?

A

high fat meal inc absorption
dose adjust older adults, hep or renal impairment

102
Q

gepirone has DDI potential for

A

CYP3A4

103
Q

AE of gepirone

A

QTc prolong, serotonin syndrome, MAO washout needed

104
Q

which 2 AEs occur less in gepirone

A

sexual AEs and weight gain

105
Q

nefazodone has a BBW for

A

life threatening hepatic failure

106
Q

bupropion has what major AE that leads to a CI?

A

risk of seizures- CI in seizure disorders

107
Q

caution using bupropion in patients with

A

eating disorders or AUD

108
Q

AE of mirtazapine

A

inc cholesterol, weight gain

109
Q

NMDA receptor antagonist used for TREATMENT RESISTANT DEPRESSION IN COMBO WITH AN ANTIDEPRESSANT

A

esketamine

110
Q

in order to use esketamine you must

A

fail 2 other drugs

111
Q

AEs of esketamine

A

impaired driving ability, sedation, dissociation, cog impairment, elevated BP

112
Q

esketamine is CI in

A

history of aneurysmal vascular disease and intracerebral hemorrhage

113
Q

esketamine has a BBW for

A

sedation, dissociation, abuse/misuse, suicidal thoughts

114
Q

oral agent used alone or in adjunct for PPD

A

zuranolone

115
Q

how long is zuranolone used for PPD

A

14 days

116
Q

BBW for zuranolone

A

impaired ability to drive or engage in other hazardous activity for at least 12 hours after admin

117
Q

continuous IV infusion over 60 hours used for PPD

A

brexanolone

118
Q

AEs of brexanolone

A

hypoxia, excessive sedation

119
Q

brexanolone BBW

A

excessive sedation
sudden loss of consciousness

Therapeutics (27 decks)

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