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NAPLEX Review > Schizophrenia/Psychosis > Flashcards

Schizophrenia/Psychosis Flashcards

1
Q

Which two neurotransmitters are most implicated in schizophrenia?

A

dopamine and glutamate

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2
Q

What are 4 other predisposing factors to schizophrenia development?

A

drugs, environment, genetics, stressors

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3
Q

What are some examples of negative and positive symptoms of schizophrenia?

A

negative: anhedonia, apathy, social withdrawal, alogia (lack of speech), avolition
positive: hallucinations, delusions, disorganized thinking/behavior

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4
Q

Which OTC medication has preliminary but promising data in treating psychosis and other psychiatric disorders?

A

fish oil

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5
Q

Which drug classes can cause psychotic symptoms?

A 
interferons
anticholinergics (centrally acting, high doses)
illicit substances (PCP, bath salts, crack, meth)
dextromethorphan
stimulants
systemic steroids
cannabis
dopamine agonists
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6
Q

Which antipsychotics come as a long acting injection?

A 
haldol decanoate (monthly)
risperdal consta (biweekly)
invega sustenna (monthly)
invega trinza (every 3 months)
abilify maintena (monthly)
fluphenazine decanoate (biweekly)
zyprexa relprevv (2-4 weeks)
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7
Q

Which antipsychotics have a dosage form suitable for patients who are “cheeking” their pills?

A

ODT formulations: asenapine, olanzapine, risperidone, aripiprazole, clozapine

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8
Q

Though IM antipsychotics are often given with other acutely sedative medications like benzos or benadryl, which antipsychotic should not be given IM with benzodiazepines due to risk of significant orthostasis?

A

olanzapine

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9
Q

What is one form of pyschosis for which antipsychotics are not indicated?

A

dementia related psychosis in elderly patients (not saying they are never used for this indication, but there is increased risk of mortality if they are)

this is a boxed warning

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10
Q

First-generation antipsychotics are grouped based on potency. What are examples of low, medium and high potency FGAs?

A

low - chlorpromazine, thioridazine
mid - loxapine, perphenazine
high - haloperidol, fluphenazine

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11
Q

FGAs have many side effects, including EPS, sedation, anticholinergic, and CV (orthostasis, tachycardia). How does potency correlate with each of these side effects (do they go up or down with increasing potency)?

A

Lower potency FGAs have more cardiovascular, sedative, and anticholinergic side effects and less EPS risk. High potency FGAs have the highest EPS risk and lower risk of everything else (except moderate sedation).

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12
Q

Thioridazine has a boxed warning for _______.

A

QT prolongation

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13
Q

Second generation antipsychotics block ________ and ________ receptors.

A

dopamine (D2) and serotonin (2A)

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14
Q

What are the metabolic side effects of SGAs?

A

weight gain, dyslipidemia, hyperglycemia

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15
Q

What are the general class side effects of SGAs?

A 
CV (QT prolongation)
metabolic
hyperprolactinemia
EPS (dose-related, less than FGAs)
sexual dysfunction
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16
Q

Which SGA has the higher QT risk?

A

ziprasidone

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17
Q

Which SGA has great efficacy but multiple boxed warnings? What are the boxed warnings?

A

clozapine - agranulocytosis, seizures, myocarditis, metabolic risk

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18
Q

Though a few of the SGAs are associated with cerebrovascular events, which one has the highest risk?

A

risperidone

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19
Q

What period of time is considered an adequate trial of an antipsychotic, provided adherence is acceptable during this timeframe?

A

4-6 weeks

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20
Q

Which antipsychotics have the highest/lowest risk of EPS?

A

highest - high-potency FGAs, risperidone, paliperidone

lowest - quetiapine

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21
Q

Which antipsychotics have the highest/lowest risk of metabolic side effects?

A

highest - olanzapine, clozapine, quetiapine

lowest - FGAs, abilify, ziprasidone, lurasidone, asenapine

22
Q

Which antipsychotics have the highest risk of hematologic AEs?

A

clozapine

23
Q

Which antipsychotics have the highest risk of hyperprolactinemia?

A

risperidone, paliperidone

24
Q

What are the main side effects of aripiprazole?

A

akathisia, anxiety, insomnia

25
Q

How many other antipsychotics should be tried and failed before clozapine is used due to its dangerous side effects?

A

two (it’s usually used no sooner than 3rd line)

26
Q

For clozapine therapy, ANC should be above ______ at baseline, and therapy should be stopped if it falls below ______.

A

1500, 1000

27
Q

Zyprexa Relprevv has a boxed warning for ______ and ______, warranting a REMS program that requires patients be observed for ___ hours after injection.

A

sedation (including coma) and delirium (including agitation, anxiety, confusion), 3 hours

28
Q

main side effects of clozapine

A

increased BG, increased lipids, weight gain, sialorrhea (hypersalivation), orthostasis, somnolence, dizziness, GI upset

29
Q

Which SGAs can have reduced levels in smokers? Which CYP enzyme mediates this?

A

olanzapine and clozapine - 1A2 induction by smoking reduces levels

30
Q

main side effect of lurasidone

A

EPS

this drug has almost no effect on weight, lipids, and BG

31
Q

Which antipsychotic is the active metabolite of risperidone?

A

paliperidone

32
Q

What are the side effects of paliperidone?

A

basically all the side effects of SGAs but at a relatively higher rate than other SGAS

very similar to risperidone considering their metabolic relationship

33
Q

Which two SGAs have to be taken with a full meal to increase absorption?

A

lurasidone and ziprasidone

34
Q

If a patient on clozapine stops taking it for more than ____ hours, the dose titration must be restarted. If they stop taking it for more than ____ weeks, the monitoring schedule (ANC, etc.) must be restarted.

A

72, a few

35
Q

When using asenapine SL tabs, patients should be counseled to not consume food or drink for at least _________ before or after the dose.

A

10 minutes

36
Q

Quetiapine has a higher incidence of which side effects compared to other SGAs?

A

metabolic, somnolence, and orthostasis

37
Q

The XR form of quetiapine should be taken at what time of day? Should it be taken with or without food?

A

Take it at night without food or with a light meal (<300 cals).

38
Q

Risperidone has a higher risk of EPS, particularly with doses of _____ or higher.

A

6 mg

hyperprolactinemia also more prevalent at or above this dose

39
Q

Invega Sustenna should be used for at least ___ months before switching to Invega Trinza.

A

4

40
Q

Match the following antipsychotics with their major CYP enzyme(s): aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone.

A. 1A2
B. 2D6
C. 3A4

A 
aripiprazole - B/C
asenapine - A (however, smoking does not affect)
brexpiprazole - B/C
cariprazine - C
clozapine - A
iloperidone - B/C
lurasidone - C
olanzapine - A
paliperidone - none (mostly renal elimination and adj.)
quetiapine - C
risperidone - B (produces paliperidone)
ziprasidone - none (minor A and C)
41
Q

Which commonly used medication for N/V can cause increased risk of EPS?

A

metoclopramide

42
Q

Which antipsychotic can leave ghost tablets in the stool?

A

paliperidone

43
Q

Olanzapine should be taken at what time of day?

A

night time - highly sedating

44
Q

What medication is used to treat tardive dyskinesia?

A

valbenzine (Ingrezza)

45
Q

MOA of valbenazine

A

vesicular monoamine transporter 2 (VMAT2) reversible inhibition

46
Q

This agent used to treat TD is also approved for chorea associated with Huntington’s disease.

A

deutetrabenazine (austedo)

47
Q

Both medications used for TD have this side effect.

A

somnolence

48
Q

What are the signs of neuroleptic malignant syndrome?

A

hyperthermia, extreme muscle rigidity, AMS, tachycardia, tachypnea

49
Q

What lab values are altered in NMS?

A

CPK (increases), WBC (increases)

50
Q

Which antipsychotics are preferred in patients who have experienced NMS on another one?

A

quetiapine or clozapine

NAPLEX Review (9 decks)

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