SchizophreniaPsychFC Flashcards
Schizophrenia symptoms and pathophysiology
Debilitating brain disorder characterized by chronic, relapsing, and remitting episodes
Hallucinations, delusion, disordered thinking and behavior
There is increased dopamine in the mesolimbic pathway
Negative Signs and Symptoms of schizophrenia
Normal behaviors that are missing:
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 of speech (alogia)
Positive Signs and Symptoms of schizophrenia
Hallucinations: hearing voices
Delusions: beliefs the patient has, but are without basis in reality
Thought disorders, or difficulty speaking and organizing thoughts, such as stopping in mid-sentence or jumbling together meaningless words
difficulty paying attention
Medications that Can Cause Psychotic Symptoms
Methamphetamine, ice, crack
Cannabis (low risk)
Cocaine
Dextromethorphan
Phencyclidine (PCP), MDPV (bath salts)
Lysergic acid diethylamide (LSD)
Anticholinergics
dopamine agonist
Interferons
Steroids
Stimulants
Antipsychotics MOA
-MOA: primarily dopamine2 (D2) receptor blockers; all second generation antipsychotics (SGAs) block D2 and block 5HT2A recpetors, with aripiprazole also a 5HT1A partial agonist
Antipsychotics BBW
BBW: increase risk of mortality in elderly patients with dementia-related psychosis, primarily due to an increased risk of stroke
-Neuroleptic Malignant Syndrome (NMS):
Neuroleptic Malignant Syndrome (NMS): symptoms and treatment
signs: hyperthermia, extreme muscle rigidity, mental status changes, tachycardia, tachypnea, and BP changes
treatment: stop antipsychotic; provide supportive care; cool them down (cooling bed, antipyretics, cooled IV fluids); dantrolene
First Generation Antipsychotics (FGAs) names
-Drugs: chlorpromazine, thioridazine, loxapine (Loxatine), perphenazine, fluphenazine (2-wk Prolixin), haloperidol (Haldol, Haldol decanoate monthly), trifluoperazine, thiothixene (Navane)
first gen Aps Se
SE: sedating (less with haloperidol), cause EPS (less with chlorpromazine), tardive dyskinesias, dystonias, akathisia, sexual dysfunction, cardiovascular effects, orthostasis, tachycardia, QT prolongation
bbw of thioridazine
thioridazine has BBW for QT prolongation
Second Generation Antipsychotics
Clozapine (Clozaril, FazaClo ODT)
Olanzapine (Zyprexa, Zydis ODT, Relprevv inj)
-Risperidone (Risperdal, Risperdal M-Tabs ODT, Consta inj)
Quetiapine (Seroquel, Seroquel XR)
Ziprasidone (Geodon, Geodon inj)
Aripipazole (Abilify, Abilify Discmelt ODT, Abilify inj)
Paliperidone (Invega, Invega Sustenna inj)
Iloperidone (Fanapt)
Asenapine (Saphris)
Lurasidone (Latuda)
zyprexa or zydis
Olanzapine (Zyprexa, Zydis ODT, Relprevv inj)
risperidal
-Risperidone (Risperdal, Risperdal M-Tabs ODT, Consta inj)
seroquel generic
Quetiapine (Seroquel, Seroquel XR)
geodon generic
Ziprasidone (Geodon, Geodon inj)
abilify generic
Aripipazole (Abilify, Abilify Discmelt ODT, Abilify inj)
Invega generic
Paliperidone (Invega, Invega Sustenna inj)
Fanapt generic
Iloperidone (Fanapt)
Saphris generic
Asenapine (Saphris)
Latuda generic
Lurasidone (Latuda)
Clorazril generic
Clozaril, FazaClo ODT
clozapine when to use?
Use only if failed to respond to treatment with 2 standard AP treatment, or had significant ADRs
has decrease risk of EPS and TD
SE clozapine
-SE: risk of agranulocytosis and seizure; myocarditis, orthostasis (with or without syncope), weight gain, increase lipids, increase glucose, and QT prolongation
dose of cloazpine
-Dose: start with 25 mg and titrate to 300-900 mg/day divided (tirate off when discontinuing)
where must clozapine be registered?
REMS: must register with Clozaril Registry
mx clozapine
-Monitor: WBC must be >3500 and ANC >2000 (test weekly x6mo, then biweekly x6mo, then montly); also monitor metabolic effects
zyprexa generic
Olanzapine
olanzapine se
SE: sedation, weight gain, increase lipids, increase glucose, EPS, QT prolongation
olanzapine dose
-Dose: 10-20 mg QHS; Relprevv inj lasts 2-4 weeks
olanzapine mx
Monitor: metabolic effects
olanzapine must be registered as ?
-Relprevv restricted use REMS drug; can cause sedation and/or delirium after injection
Risperidone
Risperdal, Risperdal M-Tabs ODT, Consta inj
Three indications of risperidone ?
Also approved for autism and for psychosis and schizophrenia
se ripseridone
-SE: sedation, EPS, increase prolactin (sexual dysfunction, galactorrhea, irregular/missed periods), orthostasis, weight gain, increase lipids, increase glucose, QT prolongation
dose of risperidone
-Dose: 4-16 mg/day divided; Consta (2 week inj) 25-50 mg
mx risperidone
Monitor: metabolic effects
Quetiapine
Seroquel, Seroquel XR
quetiapine SE
SE: sedation, orthostasis, weight gain, increase lipids, increase glucose, little risk EPS, some QT prolongation
quetiapine dose
-Dose: 400-800 mg/day BID, or QHS for XR
quetiapine XR how to take
XR is taken at night without food, or with light meal
mx quetiapine
Monitor: metabolic effects
Ziprasidone
Geodon, Geodon inj
ziprasidone CI
-CI: prolongs QT interval; contraindicated with QT risk
ziprasidone Se
SE: sedation, respiratory tract infection
ziprasidone Dose
-Dose: 40-160 mg/day BID; 10-20 mg acute injection
Aripiprazole brand
Abilify, Abilify Discmelt ODT, Abilify inj
aripiprazole Se
-SE: anxiety, insomnia, constipation, some QT prolongation; no weight gain
aripiprazole dose
-Dose: 10-15 mg QAM
Paliperidone
Invega, Invega Sustenna inj
MOA of paliperidone
Active metabolite of Risperidone
paliperidone SE
SE: increase prolactin, EPS, tachycardia, HA, sedation, anxiety, QT prolongation (avoid Use with QT risk), weight gain, increase lipids, increase glucose
paliparidone dose
-Dose: 3-12 mg/day (3 mg if CrCl <50)
paliperidone long acting inj brand name
Sustenna is long-acting monthly inj
mx paliperidone
Monitor: metabolic effects
Lurasidone
Latuda
SE of latuda
-SE: sedation, EPS, dystonias, nausea, agitation, akathisia; nearly weight, lipid, and glucose neutral
latuda dose
-Dose: 40-80 mg/day
Choosing a SGA Based on the Side Effect Profile
Overweight, little physical activity, metabolic issues: avoid agents that cause metabolic risk (Olanzapine, Quetiapine)
Increasing prolactin levels: avoid Risperidone and Paliperidone
-History of TD: avoid risperidone and paliperidone; quetiapine and clozapine has low risk
Cost: cheapest agents are Olanzapine, Risperidone, Quetiapine, Ziprasidone, and Clozapine
