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NAPLEX - OUR cards > Schizophrenia/Psychosis > Flashcards

Schizophrenia/Psychosis Flashcards

1
Q

symptoms of schizophrenia

A

hallucinations
delusions (false beliefs)
disorganized thinking and behavior

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2
Q

Neurotransmitters primarily involved in schizophrenia

A

dopamine (too much) and glutamine

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3
Q

Negative s/sxs of schizophrenia

A 
Loss of interest in everyday activities
lack of emotion (apathy)
inability to plan or carry out activities
poor hygiene 
social withdrawal
loss of motivation
lack of speech (alogia)
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4
Q

positive s/sxs of schizophrenia

A 
Hallucinations (audio, visual, somatic)
Delusions
Disorganized thinking/behavior 
Incoherent speech 
Difficulty paying attention
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5
Q

Antipsychotics target which symptoms?

A

Positive symptoms

Also affect dopamine that is used to focus and pay attention

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6
Q

General side effects of high-potency 1st gen APs

A

high risk of EPS
moderate risk of sedation
Lower risk of orthostatic hypotension, tachycardia, and anticholinergic effects

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7
Q

General side effects of low-potency 1st gen APs

A

Lower risk of EPS
high sedation
high risk of orthostatic hypo, tachycardia, anticholinergic effects

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8
Q

1st gen APs metabolic effects

A

moderate risk of weight gain

low risk of metabolic effects

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9
Q

Major side effects of 2nd gen APs

A

metabolic side effects:
weight gain
incr in lipids
hyperglycemia –> could lead to diabetes

QT prolongation
Gynecomastia
sexual dysfunction

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10
Q

2nd gen AP with highest risk of QT prolongation

A

ziprasidone

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11
Q

2nd gen APs more associated with EPS

A

risperidone
paliperidone
lurasidone

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12
Q

adequate trial of an AP med

A

4-6 weeks of an adequate dose

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13
Q

Lowest risk for EPS

A

quetiapine

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14
Q

Highest risk of incr prolactin (gynecomastia, sexual dysfunction, etc.)

A

risperidone

paliperidone

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15
Q

Available long-acting injections

A 
Haldol decanoate (q4 weeks)
Risperdal Consta (2 weeks)
Invega sustenna (4 weeks)
Invega trinza (3 months)
Abilify maintena (4 weeks)
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16
Q

APs incr risk of mortality in elderly pts with dementia related psychosis (t/f)

A

True

use CV or infectious nature

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17
Q

Rare but fatal adverse effect more commonly associated with 1st gen APs

A

Neuroleptic malignant syndrome (NMS)

Intense muscle contraction -> renal injury, rhabdo, suffocation, death

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18
Q

Signs of NMS

A

Hyperthermia
extreme muscle rigidity
mental status change

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19
Q

treatment of NMS

A

quickly taper off AP and consider another choice (quetiapine, clozapine)
supportive care
cooling bed, antipyretics, cooled IV fluids
Muscle relaxation –> BZDs, or dantrolene, or bromocriptine

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20
Q

Low potency 1st gen APs

A

Chlorpromazine

Thioridazine

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21
Q

Mid potency 1st gen APs

A

Loxapine (Loxitane, Adasuve)

Perphenazine

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22
Q

High potency 1st gen APs

A

Fluphenazine
Haloperidol (Haldol)
Thiothixene (Navane)
Trifluoperazine

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23
Q

Dystonias

A

prolonged contraction of muscles which can occur at initiation of an AP

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24
Q

Dystonias are more common in which population?

A

Young males

use diphenhydramine/benztropine for prophylaxis/treatment of dystonias

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25
Q

Tardive dyskinesias (TD)

A

abnormal facial movements
can be irreversible
stop immediately if it occurs

26
Q

Tardive dyskinesia is more common in which population?

A

Older women

27
Q

Conversion from PO Haldol to Haldol decanoate

A

10-20 x the oral dose

28
Q

Max dose of Haldol

A

30 mg/day

29
Q

MOA of 1st gen APs

A

block D2 receptors

Minimal blockade of 5HT2A

30
Q

Abilify MOA

A

Blocks D2 and 5HT2a receptors

also act as D2 and 5HT1a partial agonist

31
Q

Aripiprazole brands

A

Abilify
abilify maintena
Aristada (IM injection q4-8 weeks)

32
Q

Abilify side effects

A

Akathisia
anxiety
insomnia
Less weight gain than others

33
Q

Saphris

A

Asenapine SL tablet

No food/drink 10 mins after dose

34
Q

Rexulti

A

Brexpiprazole

35
Q

Rexulti MOA

A

partial agonist of D2 and 5ht1a

5HT2A antagonist

36
Q

Vraylar

A

Cariprazine
also approved for bipolar disorder
MOA: partial agonist of D2 and 5HT1a

37
Q

Clozaril

A

Clozapine
less risk of EPS/TD
reserved as a 3rd line agent

38
Q

What are the reasons to reserve clozaril for 3rd line?

A

severe metabolic effects
agranulocytosis
seizures (slowly titrate)

39
Q

Clozaril REMS program

A 
Monitor ANC 
Must be > 1500 to start therapy
check q weekly x 6months
q 2 weeks x 6 months
then monthly
stop if ANC < 1000
40
Q

Fanapt

A

Iloperidone

41
Q

Latuda

A

Lurasidone
Cyp3a4 metabolism
take w/ food

42
Q

Olanzapine brands

A

Zyprexa
Zydis ODT
Relprevv (2-4 wk injection) [REMS}

43
Q

Invega

A

paliperidone

44
Q

Invage renal dosing

A

Crcl < 50: 3 mg daily

crcl < 10: do not use

45
Q

Invega trinza

A

given q 3 months

must use Invega sustenna x 4 months before using trinza

46
Q

Invega side effects

A

incr prolactin

EPS at higher doses

47
Q

Main side effects of seroquel

A

somnolence, orthostasis

weight gain, incr lipids, incr glucose

48
Q

when to take seroquel XR?

A

At bedtime

49
Q

Risperidone main side effects

A

EPS (high doses)
sexual dysfunction, gynecomastia
weight gain, incr lipids, incr glucose

50
Q

What doses of risperidone are you concerned with EPS and incr prolactin?

A

> 6 mg

51
Q

Geodon

A

ziprasidone

52
Q

Geodon clinical pearls

A

highest risk of QT prolongation

take w/ food

53
Q

Nuplazid

A

Pimavanserin

54
Q

Nuplazid MOA

A

inverse agonist and antagonist of 5HT2A receptors and 5HT2C

inverse agonist = down regulate activity at receptor

55
Q

Nuplazid use

A

Psychosis in Parkinson Disease

does not affect dopamine so it doesnt affect motor symptoms

56
Q

All APs cause Qt prolongation (t/f)

A

TRUE

57
Q

Drug that could be increase the risk of EPS and TD when used with APs:

A

Metoclopramide (dopamine blocking agent)

58
Q

Ingrezza

A

Valbenazine

59
Q

Ingrezza use

A

tardive dyskinesia

60
Q

Ingrezza MOA

A

reversible inhibition of monoamine transporter 2 (VMAT2)
regulates monamine uptake from the cytoplasm

can cause somnolence, qt prolongation

61
Q

Ingrezza metabolism

A

CYP 3A4 amd 2D6

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