Schizophrenia/Psychosis Flashcards
List Extrapyramidal side effects
dystonias akathisia parkinsonism tardive dyskinesias dyskinesias
Define dystonias
prolonged contraction of muscles during initiation, including painful muscle spasms; life-threatening if airway is compromised. higher risk with younger males. Centrally-active anticholinergics (diphenhydramine, benztropine) can be used for prophylaxis or treatment
Define akathisia
restlessness with anxiety and an inability to remain still; treated with anticholinergics (diphenhydramine, benztropine), BZD, or propranolol
Define Parkinsonism
looks similar to parkinson disease with tremors, abnormal gait and bradykinesia; treated with anticholinergics, or propranolol if tremor is the main symptom
Define tardive dyskinesias
abnormal facial movements, primarily in the tongue or mouth; higher risk with elderly females. TD can be irreversible. must stop the drug and replace with an SGA with low EPS risk (quetiapine, clozapine)
Define dyskinesias
abnormal movements; more common with dopamine replacement for parkinson disease
dopamines role in schizophrenia
they have increased level of dopamine
DSM-5 for schizophrenia
delusion, hallucinations, or disorganzied speech must be present negative S/Sx -loss of interest -lack of emotion (apathy) -social withdrawal -loss of motivation -lack of speech postive S/Sx -hallucinations -delusions -disorganized thinking/behavior
First-generation antipsycotics MOA
mainly by blocking dopamine and minimal serotonin receptor blockade
FGA major SE
EPS
name a high potency FGA
haloperidol
Boxed warning for all FGA & SGA
elderly patients with dementia-related psychosis have an increased risk of death
Second-generation anti-psychotics MOA
blocking dopamine and serotonin receptors
which SGA has the highest risk of QT prolongation
ziprasidone
drug with lowest risk of EPS
quetiapine
drugs with highest risk of EPS
FGAs, risperidone, paliperidone
drugs with highest risk of metabolic SE
clozapine
olanzapine
quetiapine
drugs with moderate risk of metabolic SE
risperidone
paliperidone
drugs with lower risk of metabolic SE
FGAs aripiprazole ziprasidone lurasidone asenapine
drugs with highest QT prolongation
thioridazine
halperidol
ziprasidone
drugs with highest hematological effects
clozapine
drugs with highest cerebrovascular events
risperidone
drugs with highest risk to increase prolactin
risperidone
paliperidone
Drugs with highest seizure risk
clozapine
what happens with increased prolactin
gynecomastia
galactorrhea (breastmilk)
sexual dysfunction
List SGA (8)
aripiprazole clozapine lurasidone olanzapine papliperidone quetiapine risperidone ziprasidone
boxed warning for clozapine
agranulocytosis
S/Sx of NMS
hyperthermia
muscle rigidity
