Schizophrenia/Psychosis Flashcards
Three primary neurotransmitters involved in schizophrenia
dopamine
serotonin
glutamine
One of the biggest treatment barriers in schizophrenic patients
adherence
List of negative signs/symptoms
lack of emotion social withdrawal loss of motivation (avolition) lack of speech (alogia) poor hygiene
list of positive signs/symptoms
hallucinations
delusions
disorganized thinking/behavior
What are some drugs that can cause psychotic symptoms?
anticholinergics (high doses) dextromethorphan dopamine agonists (common in parkinson's patients) stimulants systemic steriods illicit substances
Main mechanism of antipsychotics
block dopamine receptors
newer drugs also block serotonin receptors
what type of symptoms do the drugs aim to treat
positive
What is first-line treatment and why?
second gen antipsychotics
less extrapyramidal symptoms (EPS)
What are some common EPS
dystonia (muscle contractions)
dyskinesias (abnormal movement)
tardive dyskinesia (repetitive movement)
akathisia (restlessness)
What should occur if a patient experiences tardive dyskinesia
d/c drug
this can be irreversible
What is a common “cocktail” to schizophrenic patients to add sedative effects and reduce dystonias
IM antipsychotic + BZD + anticholinergic
Which antipyschotic should absolutely not be given with BZDs due to excessive sedation
Olanzapine
What’s important to know about antipyschotics and elderly patients
Should NOT be used in dementia-related psychosis due to increased risk of mortality/stroke
All antipsychotics carry a warning for _____
falls
MOA FGA (first gens)
block D2 reception with little to no serotonin receptor blockade
List of low potency FGAs
chlopromazine
thioridazine
List of mild potency FGAs
loxapine
perphenazine
list of high potency FGAs
haloperidol
what drug can be used for Tourette syndrome
haloperidol
How often is haldol deconate injected?
monthly
how often is fluphenazine deconate injected
q 2 weeks
Which FGAs are especially known for QT prolongation
thioridazine
haloperidol
chlorpromazine
Warnings with FGAs
NMS (neuroleptic malignant syndrome) hyperprolacinemia EPS CNS depression anticholinergic effects Tachycardia
What side effect profile are the lower potency FGAs known for
higher sedation, lower EPS
What side effect profile are the high potency FGAs known for
less sedation, more EPS
Which drugs can be given with FGAs to limit dystonic reactions
benztropine
diphenhydramine
Which SGAs are partial agonists for DA and serotinin
aripiprazole
brexpiprazole
cariprazine
Side effects of aripiprazole
akathisia QT prolongation EPS in children sedation/activation constipation
which drug can be used in irritability with Tourette’s or autistic patients?
aripiprazole
When can clozapine be used and why?
3rd line agent
severe side effect potential (metabolic effects and neutropenia)
Which SGA has a REMS program
clozapine
Boxed warnings clozapine
neutropenia/agranulocytosis
cardiomyopathy
seizures
Highest starting dose for clozapine and why?
12.5mg qd or bid due to seizure risk
What is the lab parameter that must be considered before starting clozapine
baseline ANC must be >/= 1500mm^3
At what ANC value must clozapine be stopped?
<1000
Luradisone side effect profile
somnolence, EPS, nausea
almost weight, lipid, and glucose neutral
olanzapine boxed warning/side effect profile
after injection, must be monitored for 3 hours for delirium/sedation
somnolence, metabolic syndrome
Paliperidone side effects
increased prolactin (sexual dysfunction)
EPS
metabolic syndrom
Invega Trinza frequency
q 3 months (must have received Sustenna prior to use)
Quetiapine side effect profile
somnolence, metabolic syndrome
low EPS risk
take without food
which SGA can be used in Parkinson’s pyschosis due to low EPS risk?
quetiapine
risperidone side effect
metabolic disorder
EPS
increased prolactin
ziprasidone CI
QT prolongation
Which drugs would we avoid in a cardiac/QT risk patient?
ziprasidone, haloperidol, thioridazine, chlorpromazine
Which drugs would we avoid in a patient with hx of movement disorder or parkinsons?
FGAs
risperidone
paliperiodone
Which drug is preferred in parkinsons or patient with hx of movement disorder?
quetiapine
Which drugs should we avoid in overweight patients
olanzapine
quetiapine
Which drugs are good options in overweight patients
aripiprazole
ziprasiodne
lurasidone
asenapine
Which drugs would be good option in homeless patients
long acting injections!
What drug is used during acute psychosis in a patient refusing meds?
haloperidol IM
What is pimavanserin?
Indicated for parkinson’s pyschosis due to not affecting dopamine receptors
Medications approved for TD treatment
valbenazine
deutetrabenazine (hepatic impairment)
NMS signs/symptoms
hyperthermia
muscle rigidity
mental status change
increased creatine phosphokinase and WBC
How to treat NMS
taper off antipsychotic quickly
supportive care
cool patient down
bzd or dantrolene for muscle relaxation
