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NAPLEX Review > Schizophrenia/Psychosis > Flashcards

Schizophrenia/Psychosis Flashcards

1
Q

What are common symptoms of schizophrenia

A

Hallucinations
Delusions
Disorganized thinking/behavior

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2
Q

What are the DSM-5 criteria for schizophrenia diagnosis

A

Delusions, hallucinations, or disorganized speech MUST be present
Negative s/sx: loss of interest, emotion, motivation, and ability to plan or carry out activities, poor hygiene, social withdrawal, and lack of speech
Positive s/sx: Hallucinations, delusions, disorganized thinking/behavior

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3
Q

What medications and illicit drugs can cause psychotic symptoms

A 
Anticholinergics
Dextromethorphan 
Dopamine or dopamine agonists
Interferons
Stimulants
Systemic steroids
Bath salts
Cannabis
Cocaine
Lysergic acid diethylamide
Methamphetamine
Phencyclidine (PCP)
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4
Q

Which is preferred for schizophrenia – first or second generation antipsychotics? Why?

A

Second generation because first generation have a high incidence of EPS

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5
Q

What do extrapyramidal symptoms include?

A

Dystonias (muscle contractions)
Dyskinesias (abnormal movements)
Tardive dyskinesia (repetitive involuntary movements)
Akathisia (restlessness, inability to remain still)

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6
Q

Why should olanzapine and benzos not be given together?

A

Risk of excessive sedation and breathing difficulty

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7
Q

What medications are first-generation antipsychotics

A

Low potency: Chlorpromazine, thioridazine
Mid potency: Loxapine, perphenazine
High potency: haloperidol, fluphenazoine, thiothixene, trifluoperazine

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8
Q

First generation antipsychotics BBW, warnings, SE

A

BBW: do not use in elderly patients with dementia-related psychosis d/t increased risk of death from antipsychotics
Warnings: QT prolongation, anticholinergic effects, CNS depression, EPS, hyperprolactinemia, neuroleptic malignant syndrome
SE: Sedation, dizziness, anticholinergic effects, EPS

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9
Q

What can be given with first generation antipsychotics to limit/avoid dystonic reactions?

A

Anticholinergics (benztropine, diphenhydramine)

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10
Q

What medications are second-generation antipsychotics?

A

Aripiprazole (Abilify)
Clozapine (Clozaril)
Lurasidone (Latuda)
Olanzapine (Zyprexa)

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11
Q

Aripiprazole SE

A

Akathisia

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12
Q

Clozapine BBW, SE, monitoring

A

BBW: neutropenia/agranulocytosis (REMS), myocarditis and cardiomyopathy, seizures
SE: Agranulocytosis, seizures, constipation, metabolic syndrome
Monitoring ANC must be 1500 or higher to start and check ANC regularly – stop if <1000

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13
Q

Lurasidone SE

A

Somnolence, EPS (dystonias), nausea

Weight, lipid, and BG neutral

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14
Q

Olanzapine (Zyprexa) BBW and SE

A

BBW: monitor for 3 hours post injection
SE: Somnolence, metabolic syndrome

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15
Q

Paliperidone (Invega) SE

A

SE: increased prolactin, EPS, metabolic syndrome

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16
Q

Quetiapine (Seroquel) SE and notes

A

SE: somnolence, metabolic syndrome, low EPS risk
Notes: Take at night without food or with a light meal (300 cal or less)

17
Q

Risperidone (Risperdal) SE

A

Increased prolactin, EPS, Metabolic syndrome

18
Q

Ziprasidone (Geodon) CI

A

QT prolongation; do not use with QT risk

Take with food

19
Q

Asenapine (Saphris – SL tab) SE and notes

A

SE: Tongue numbness; metallic taste

No food/drink for 10 mins after dose

20
Q

What medications should not be chosen in someone with cardiac risk/QT risk?

A

QT prolonging meds (ziprasidone, haloperidol, thioridazone, chlorpromazine)

21
Q

What medications should not be used in patients with a history of movement disorders (e.g. Parkinson disease?

A

Do not choose meds with EPS risk (first gen antipsychotics, risperidone, paliperidone)
Quetiapine is preferred

22
Q

What medications should not be used in patients who are overweight or have metabolic risk?

A

Do not choose olanzapine or quetiapine

Lower risk with aripiprazole, ziprasidone, lurasidone, and asenapine – can choose these

23
Q

What to give if a patient is having an acute psychosis episode and they are refusing oral meds?

A

Haloperidol IV or IM

24
Q

Which second generation antipsychotic has a black box warning for QT prolongation?

A

Thioridazine

25
Q

What medications can be used to treat tardive dyskinesia?

A

Valbenazine (Ingrezza)

Deutetrabenazine (Austedo)

26
Q

Valbenazine (Ingrezza) warning

A

Somnolence

27
Q

Deutetrabenazine CI and warnings

A

CI: hepatic impairment
Warnings: somnolence

28
Q

What did antipsychotics use to be called?

A

Neuroleptics

29
Q

What is neuroleptic malignant syndrome (NMS)?

A

Rare but lethal
Caused by D2 blockade
Intense muscle contractions can lead to acute renal injury (d/t rhabdo), suffocation, and death, hyperthermia, mental status change

30
Q

Treatment for neuroleptic malignant syndrome (NMS)

A

Taper off antipsychotic – can switch to quetiapine or clozapine
Supportive care
Cool patient down
Muscle relaxation with benzos or dantrolene

NAPLEX Review (79 decks)

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