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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
aside from schizophrenia, brexiprazole is also used for
MDD augment, alzheimers dementia agitation
26
almost all 2nd gen APS can be used for BPD EXCEPT (4)
brexiprazole, clozapine, paliperidone, pimavanserin
27
aside from schizophrenia, risperidone is also used for
BPD & autism sx
28
pimavanserin is a 2nd gen APS indicated for
parkinsons psychosis
29
AE of aripiprazole
activating, akathisia, restlessness, impulsivity
30
for SL asenapine, do not
eat or drink for 10 mins
31
AE of asenapine
high QTc risk, skin rxn from patch
32
what needs to be monitored for after 1st dose of asenapine
anaphylaxis risk
33
which 2 2nd gen APS have very long half lives
brexiprazole cariprazine
34
AEs of clozapine
HIGH METABOLIC RISK, QTc prolong, severe constipation/GI hypomotility, hypersalivation, ANTICHOLINERGIC
35
avoid using clozapine with what due to severe sedation
IM benzo
36
BBW for clozapine
blood dyscrasia, bradycardia, myocarditis, seizure risk at high conc
37
what reduces serum clozapine & olanzapine due to 1A2
smoking
38
AEs of iloperidone which AE is usually avoided?
orthostatic hypotension, priapism no prolactin elevation
39
AE of lurasidone? in those with dementia/PD/Lewy?
sedation neurologic
40
avoid using olanzapine with what due to high sedation risk
IM benzo
41
AE of olanzapine
HIGH METABOLIC RISK, DRESS, QTc, anticholinergic
42
BBW for olanzapine LAI
post injection delirium/sedation syndrome
43
olanzapine + samidorphan combo has what risk
opioid withdrawal
44
AE of paliperidone
QTc risk
45
avoid pimavanserin in those with
renal impairment, conflicting CYPs
46
AEs of quetiapine
metabolic risks, cataract development, anticholinergic, misuse potential
47
AEs of risperidone
prolactin elevation, EPS MORE LIKELY (akathisia)
48
AEs of ziprasidone
DRESS, QTc
49
is an oral challenge always done before starting a LAI APS?
yes- detect allergy & know best dose before transition
50
is oral overlap always used for LAI APS?
no- only used if coverage needed while LAI kicks in
51
selective alpha 2 adrenergic agonist used for schizophrenia that needs to be administered by a provider due to BP changes
dexmedetomidine
52
how can NMS be treated?
dopamine agonist
53
how to treat acute dystonia from APS
anticholinergics or IM benzo
54
how to treat pseudo-parkinsonism from APS
anticholinergics
55
how to treat akathisia from APS
B-blockers
56
how to treat tardive dyskinesia
d/c drug
57
how does NMS occur? what happens?
from DA antagonists onset 1-3 days muscle rigidity, hyporeflexia, normal pupils, decreased bowel sounds
58
what are the initial agents used for MDD
SSRI, SNRI, bupropion, mirtazapine, vortioxetine
59
how long (minimum) until seeing MDD symptom resolution with treatment
2-4 weeks
60
best MDD agents for elderly
SSRI best, then bupropion or venlafaxine
61
which 2 MDD agents are approved for younger ages in children
fluoxetine and escitalopram
62
what is most commonly used for MDD in pregnancy? which one cannot be used?
SSRIs but NOT PAROXETINE
63
aside from 2nd gen APS, what else can be used for MDD augmentation
lithium triiodothyronine
64
BBW for all antidepressants
increased risk of suicidality in those up to age 24, especially in early treatment stages
65
what may be a concern if a MDD agent is working very well in under 2 weeks
BPD and precipitation of mania/episodes
66
serious AE causes by serotonin agents with onset <12 hours that causes hyperreflexia, dilated pupils, hyperactive bowel sounds/GI sx, mental changes
serotonin syndrome
67
class AEs for SSRIs
abnormal bleeding, hyponatremia & SIADH, more energy boosting, sexual dysfunction, QTc prolong, serotonin syndrome
68
most MDD agents may have DDI with which 2 CYPs
2D6 and 3A4
69
when d/c SSRI or SNRI, taper to avoid what? which drug is an exception?
avoid discontinuation syndrome- electric shock sensations not fluoxetine- long t1/2
70
avoid SSRIs in?? modify dose for??
avoid- GI bleed, on anticoagulation dose mod- hepatic impairment
71
citalopram carries a higher risk of
QTc prolongation
72
citalopram has dose limitations for what? (3 things)
age 60 and older CYP2C19 interactions hepatic impairment
73
which drugs are SSRIs? (6)
citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
74
aside from MDD, escitalopram is also used for
GAD
75
fluoxetine is able to be dosed how often
once a week
76
aside from MDD, fluoxetine can also be used for
OCD, panic, PMDD, bulimia, BPI depress episode
77
fluvoxamine is primary used for what type of MDD? what else?
refractory MDD OCD
78
AEs of paroxetine
very sedating, anticholinergic, bone fracture
79
avoid paroxetine in
pregnancy
80
aside from MDD paroxetine is also used for
GAD, OCD, panic, PTSD, PMDD, SAD
81
aside from MDD, sertraline can also be used for? what about the capsule?
OCD, panic, PTSD, PMDD, SAD capsule- MDD, OCD
82
which drugs are SNRIs (4)
venlafaxine, desvenlafaxine, duloxetine, levomilnacipran
83
class AEs of SNRIs
abnormal bleeding, elevated BP, serotonin syndrome, d/c syndrome, more boosting (similar to SSRIs)
84
how should venlafaxine be administered? any dose adjustments?
with food adjust for renal/hepatic impairment
85
aside from MDD venlafaxine is also used for
GAD, panic, social phobia
86
AE of duloxetine
urinary retention, less insomnia
87
avoid use of duloxetine in
ESRD or hep dysfunction
88
aside from MDD duloxetine is also used for
GAD, pain
89
which drugs are tricyclic antidepressants (8)
amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine nortriptyline, maprotiline
90
which 2 TCAs have an indication other than MDD? what is the indications?
clomipramine- OCD doxepin- insomnia
91
typical off label use for TCAs is
neuropathic pain among others
92
class AEs of TCAs
anticholinergic & CV effects withdrawal syndrome
93
what potentially lethal effect can TCAs have
CV ventricular tachycardia & heart block
94
avoid use of TCAs in patients with
cardiac conditions
95
3 MAOIs used for MDD
phenelzine, tranylcypromine, selegiline
96
when are MAOI used for MDD?
last line
97
how long do you need to wait to use a MAOI after d/c an interacting drug? whats the exceptions?
4-5 t1/2 of the drug except fluoxetine 5 weeks & vortioxetine 3 weeks
98
AEs of MAOIs
postural hypotension, anticholinergic, serotonin syndrome
99
DDI with MAOIs? can cause what?
tyramine foods & sympathomimetics --- hypertensive crisis
100
serotonin modulators used for MDD (5)
gepirone, nefazodone, trazodone, vilazodone, vortioxetine
101
gepirone dosing may need alteration for? what affects absorption?
high fat meal inc absorption dose adjust older adults, hep or renal impairment
102
gepirone has DDI potential for
CYP3A4
103
AE of gepirone
QTc prolong, serotonin syndrome, MAO washout needed
104
which 2 AEs occur less in gepirone
sexual AEs and weight gain
105
nefazodone has a BBW for
life threatening hepatic failure
106
bupropion has what major AE that leads to a CI?
risk of seizures- CI in seizure disorders
107
caution using bupropion in patients with
eating disorders or AUD
108
AE of mirtazapine
inc cholesterol, weight gain
109
NMDA receptor antagonist used for TREATMENT RESISTANT DEPRESSION IN COMBO WITH AN ANTIDEPRESSANT
esketamine
110
in order to use esketamine you must
fail 2 other drugs
111
AEs of esketamine
impaired driving ability, sedation, dissociation, cog impairment, elevated BP
112
esketamine is CI in
history of aneurysmal vascular disease and intracerebral hemorrhage
113
esketamine has a BBW for
sedation, dissociation, abuse/misuse, suicidal thoughts
114
oral agent used alone or in adjunct for PPD
zuranolone
115
how long is zuranolone used for PPD
14 days
116
BBW for zuranolone
impaired ability to drive or engage in other hazardous activity for at least 12 hours after admin
117
continuous IV infusion over 60 hours used for PPD
brexanolone
118
AEs of brexanolone
hypoxia, excessive sedation
119
brexanolone BBW
excessive sedation sudden loss of consciousness

Therapeutics (34 decks)

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