Schizophrenia/ Psychosis Flashcards
Main xteristic of Schizophrenia?
Hallucinations
Delusions (false beliefs)
Disorganized thinking and behavior
Main MOA of antipsychotics?
Block DA receptors
Newer agents also block serotonin receptor
List NEGATIVE s/sx of Schizophrenia
Loss of interest in everyday activities
Lack of emotion
Inability to plan or carry out activities
Poor hygiene
Social withdrawal
Loss of motivation (Avolition)
Poverty (lack of) speech (alogia)
List POSITIVE s/sx of Schizophrenia
Hallucinations: hearing voices (auditory hallucinations) visual hallucinations
Delusions: beliefs the pt has, but are w/o a basis in reality
Disorganized thinking/behavior, incoherent speech, purposeless behavior or difficulty speaking
Difficulty paying attention
What sx MUST be present for a pt to be diagnosed schizophrenic?
Delusions
Hallucinations
Disorganized speech
+ 2 or more other sx
Medications that can cause Psychotic sx?
Amphetamines, Methamphetamines, Ice, Crack
Cannabis, Cocaine
Dextromethropan
Phencyclidine (PCP), MDPV (bath salts)
Lyse thick acid diethylamide (LSD) and other hallucinogens
Anticholinergics (centrally-acting, high doses)
Dopamine or dopamine agonist used for PD (Requip, Mirapex, Sinemet etc)
Interferons
Steroids (+ lack of sleep - ICU psychosis)
Stimulants (esp, is already at risk) including ADHD drugs, modafinil etc
What must be evaluated b4 changes is made to initial tx?
Adequate trial time (at least 4-6 wks)
Adequate dose
Adherence/compliance
Previous tve or negative hx with antipsychotics should be a guide therapy
Main SE of Clozapine? Role of Clozapine in therapy?
BBW of Agranulocytosis
Others: seizures, myocarditis, high metabolic risk
Used only when pt has had no or poor response to 2 trials of antipsychotic med (at least 1 should be a SGA)
Common SEs of FGAs such as Haloperidol?
Associated with high risk of eps effects
Moderate risk of sedation
In which antipsychotic is QT prolongation risk significant?
Thioridazine
Ziprasidone
SEs of SGAs? (esp, Clozapine, Olanzapine & Quetiapine)
Weight gain
Lipid & glucose abnormalities (metabolic SE)
Common SE of Risperidone and Palioperidone?
Moderate risk of metabolic SE
According to American Diabetes Association (ADA), what should be screened for and routinely monitored when initiating antipsychotics?
Overweight and obesity
Dyslipidemia
Hyperglycemia
HTN
Personal or FH of risk
Which SGAs should be avoided if pt has cardiovascular risk?
Ziprasidone -greatest risk
High risk
Phenothiazines in general, Thioridazine in particular
Which SGAs should be avoided if pt is overweight, has little physical activity or has metabolic issues?
Most notably Olanzapine and Quetiapine
Which SGAs should be considered if pt is overweight, has little physical activity or has metabolic issues?
LAAZ
Lurasidone
Aripiprazole
Asenapine
Ziprasidone
All these have the least risk of metabolic SE and wipeight gains
Whats a concern with Risperidone and Paliperidone, esp with higher doses?
High prolactin levels =>
Galactorrhea (milk production w/o pregnancy)
Sexual dysfxn
Gynecomastia (painful, swollen breast tissue)
Irregular or missed periods
Osteoporosis (after several yrs)
Which SGAs should be avoided if pt has hx of Tardive dyskinesia (TD), or any movement disorder?
Risperidone
Paliperidone
Lurasidone
Which SGAs should be recommended if pt has hx of Tardive dyskinesia (TD), or any movement disorder?
Quetiapine (low risk and recommended agent for psychosis in pt with PD)
BBW of Antipsychotics (APs)?
Risk of mortality in elderly pts with dementia-related psychosis, primarily due to an increased risk of stroke and infection
Signs of Neuroleptic Malignant Syndrome (NMS) - rare, but fatal?
Hyperthermia (high fever, with profuse sweating)
Extreme muscle rigidity (called “lead pipe” rigidity)
Mental status changes
Other signs can include Tachycardia and tachypnea and BP changes
Tx of NMS?
Stop APs
Provide supportive care
Cool them down: cooling bed, antipyretics, cooled IV fluids
Muscle relaxants
Airway support
MOA of FGAs?
Block D2 and 5HT2A receptors
List low potency FGAs? (Higher sedation and lower EPS)
Chlorpromazine
Thioridazine (BBW - QT prolongation)
List mid-potency FGAs?
Loxapine (Adasuve inhalation powder for acute agitation)
Perphenazine
List high potency FGAs? (Lower sedation and Higher EPS)
Fluphenazine (available in 2-wk Decanoate)
Haloperidol (Haldol)
Trifluoperazine
Thiothixene (Navane)
Brand name of Haloperidol? Class of meds? Howz haloperidol Decanoate doses?
Haldol
Butyrophenones
Monthly
SEs of FGAs?
All are sedating and all cause EPS
Dystonias (higher risk in younger males)
Akathisia (restlessness + anxiety + inability to remain still)
Parkinsonism
Tardive Dyskinesias (TD) - abnormal facial movements, esp, in tongue or mouth
Dyskinesias - abnormal movements
What can be used as prophylaxis for dystonias?
Centrally-acting anticholinergic (diphenhydramine, benztropine)
Akathisia (restlessness + anxiety + inability to remain still) tx?
Anticholinergics
BZD
Propranolol
In what population is the highest risk of Tardive Dyskinesias (TD)? TX of TD?
Elderly females
Stop drugs ASAP (TD can be irreversible)
Cardiovascular effects caused by FGAs, esp, IV Haloperidol?
Orthostasis
Tachycardia
QT prolongation
MOA of SGAs? Exception?
Block D2 and 5HT2A
Aripiprazole is unique - acts as D2 and 5HT1A partial agonist and 5HT2A
List SGAs
Clozapine (Clozaril)
Olanzapine (Zyprexa)
Risperidone (Risperdal; M-Tabs ODT)
Quetiapine (Seroquel; XR)
Ziprasidone (Geodon)
Aripiprazole (Abilify, Abilify Discmelt ODT)
Paliperidone (Invega)
Iloperidone (Fanapt)
Asenapine (Saphris)
Lurasidone (Latuda)
Brand name of Clozapine (SGAs)?
Clozaril
Brand name of Olanzapine (SGAs)?
Zyprexa
Brand name of Risperidone (SGAs)?
Risperdal
Risperdal M-Tabs ODT (also approved for autism)
Risperdal Consta, 2 wk injection
Brand name of Quetiapine (SGAs)?
Seroquel
Seroquel XR
Brand name of Ziprasidone (SGAs)?
Geodon
Brand name of Aripiprazole (SGAs)?
Abilify
Abilify Discmelt ODT
Brand name of Paliperidone (SGAs)?
Invega
Ses of Clozapine (Clozaril)? REMS drug
Agranulocytosis
Seizures
Myocarditis
SEs of Olanzapine (Zyprexa) - SGAs?
Sedation
Wt gain, increased lipids and glucose
SEs of Risperidone (Risperdal) & Paleperidone (Invega) - SGAs?
EPS, esp at higher doses
Increased Prolactin => sexual dysfxn, galactorrhea, irregular/missed
periods
Weight gain, increased lipids and glucose
SEs of Quetiapine (Seroquel) - SGAs?
Sedation, Orthostasis
Weight gain, increased lipids and glucose
SEs of Ziprasidone (Geodon) - SGAs?
Prolongs QT interval; CI with QT risk
SEs of Aripiprazole (Abilify) - SGAs?
Anxiety
Insomnia
Which SGA is to be used without food/drink for 10 mins after dose?
Asenapine (Saphris) SL
SEs of Asenapine (Saphris) SL - SGA?
Tongue/mouth numbness
Smoking and APs?
Smoking may reduce plasma levels of Olanzapine and Clozapine
Pts who smoke may req higher doses
Formulations of Haloperidol
Oral tabs
IM inj
Long-acting monthly Decanoate
Oral soln
SEs from Haloperidol?
Painful dystonic rxns
TD
QT prolongation + possible arrhythmia risk
EPS is still a risk with Risperdal Consta? (2-wkly dose of Risperidone)
T
Value of WBC and ANC needed to start Clozapine (Clozaril)?
WBC >= 3,500/mm^3
ANC >= 2,000/mm^3
Whats schizophrenia?
Debilitating thot disorder xterized by chronic, relapsing and remitting episodes that are a result of EXCESS DOPAMINE and other changes in brain
