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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
Tardive dyskinesias (TD)
abnormal facial movements can be irreversible stop immediately if it occurs
26
Tardive dyskinesia is more common in which population?
Older women
27
Conversion from PO Haldol to Haldol decanoate
10-20 x the oral dose
28
Max dose of Haldol
30 mg/day
29
MOA of 1st gen APs
block D2 receptors | Minimal blockade of 5HT2A
30
Abilify MOA
Blocks D2 and 5HT2a receptors | also act as D2 and 5HT1a partial agonist
31
Aripiprazole brands
Abilify abilify maintena Aristada (IM injection q4-8 weeks)
32
Abilify side effects
Akathisia anxiety insomnia Less weight gain than others
33
Saphris
Asenapine SL tablet | No food/drink 10 mins after dose
34
Rexulti
Brexpiprazole
35
Rexulti MOA
partial agonist of D2 and 5ht1a | 5HT2A antagonist
36
Vraylar
Cariprazine also approved for bipolar disorder MOA: partial agonist of D2 and 5HT1a
37
Clozaril
Clozapine less risk of EPS/TD reserved as a 3rd line agent
38
What are the reasons to reserve clozaril for 3rd line?
severe metabolic effects agranulocytosis seizures (slowly titrate)
39
Clozaril REMS program
``` 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
Fanapt
Iloperidone
41
Latuda
Lurasidone Cyp3a4 metabolism take w/ food
42
Olanzapine brands
Zyprexa Zydis ODT Relprevv (2-4 wk injection) [REMS}
43
Invega
paliperidone
44
Invage renal dosing
Crcl < 50: 3 mg daily | crcl < 10: do not use
45
Invega trinza
given q 3 months | must use Invega sustenna x 4 months before using trinza
46
Invega side effects
incr prolactin | EPS at higher doses
47
Main side effects of seroquel
somnolence, orthostasis | weight gain, incr lipids, incr glucose
48
when to take seroquel XR?
At bedtime
49
Risperidone main side effects
EPS (high doses) sexual dysfunction, gynecomastia weight gain, incr lipids, incr glucose
50
What doses of risperidone are you concerned with EPS and incr prolactin?
> 6 mg
51
Geodon
ziprasidone
52
Geodon clinical pearls
highest risk of QT prolongation | take w/ food
53
Nuplazid
Pimavanserin
54
Nuplazid MOA
inverse agonist and antagonist of 5HT2A receptors and 5HT2C inverse agonist = down regulate activity at receptor
55
Nuplazid use
Psychosis in Parkinson Disease does not affect dopamine so it doesnt affect motor symptoms
56
All APs cause Qt prolongation (t/f)
TRUE
57
Drug that could be increase the risk of EPS and TD when used with APs:
Metoclopramide (dopamine blocking agent)
58
Ingrezza
Valbenazine
59
Ingrezza use
tardive dyskinesia
60
Ingrezza MOA
reversible inhibition of monoamine transporter 2 (VMAT2) regulates monamine uptake from the cytoplasm can cause somnolence, qt prolongation
61
Ingrezza metabolism
CYP 3A4 amd 2D6

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