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Neuro Quiz 4 > Treatment of Schizophrenia > Flashcards

Treatment of Schizophrenia Flashcards

1
Q

Clinical Presentation

A 
Difficult to live independently
Withdrawn socially
Poor self-care
Poor insight into illness
Substance abuse
Intermittent acute psychotic episodes
Social deterioration during first 5 years
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2
Q

Late life Schizo

A

Less acute psychotic episodes but residual negative symptoms presist

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3
Q

***DSM5 Criteria for Schizo

A
  • 2+ following persisting for at least 1 month (at least 1 must be 1/2/3)
    1. Delusions
    2. Hallucinations
    3. Disorganized speech
    4. Disorganized or catatonic behavior
    5. Negative symptoms
  • Level of social and/or occupational function has significantly declined
  • Continuous signs for at least 6 months (prodromal or residual symptoms)
  • Schizoaffective or mood disorder has been excluded
  • Disorder not due to medical disorder or substance abuse
  • If a development disorder is present, there must be symptoms of hallucination/delusions for at least 1 month
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4
Q

Treatment of Schizo

A

ECT
Assertive Community Treatment
Cognitive Behavioral Therapy
Pharmacological (antipsychotics)

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5
Q

Assertive Community Treatment (ACT)

A

Multidisciplinary team
Provides home vistis several times a week
Training for activities of daily living, grocery shopping, med management, public transportation
- Shown to reduce hospitalization and homelessness

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6
Q

Cognitive Behavioral Therapy (CBT)

A

Develop strategies for coping

- 4 to 9 months

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7
Q

Acute Stabilization Treatment

A

Initiate antipsychotic treatment and titrate dose every few days to a moderate dose
Severely agitated = fast acting antipsychotic by IM injection
- If cheeking, use oral disintegrating tablet or liquid
- Chemical not physical restraining

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8
Q

Define Cheeking

A

Appear to be taking medications but really just put in in cheek and spit it out later

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9
Q

First 7 days of acute treatment?

A

Decreased agitation, hostility, anxiety and aggression

Improved Sleep and appetite

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10
Q

What is typically used with IM anti-psychotics and wht?

A

Lorazepam and benztropine IM
L: aids in calming
B: prevents dystonia

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11
Q

Lorazepam shouldn’t be combined with:

A

Olanzapine due to hypotension, respiratory depression and CNS depression

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12
Q

2-3 weeks with treatment

A

Increased socialization
Improved self care and mood
Decreased hallucinations

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13
Q

6-8 weeks with treatment

A

Improvement in formal thought process

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14
Q

No improvement in 3-4 weeks or partial decrease in (+) symptoms within 12 weeks =

A

Next treatment algorithm stage

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15
Q

Increase dose?

A

Continuously and gradually for more symptom control

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16
Q

Treatment goal:

A

No or minimal (+) symptoms

(-) or cognitive symptoms are less likely to remit

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17
Q

Maintenance Treatment

A

Continued antipsychotic for at least 5 years or lifetime for chronically ill

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18
Q

Relapse rate

A

18-32% with maintenance

60-80% without

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19
Q

Dosing points to consider:

A

First episode = lower dose (start low and titrate)

Use 1/2 life to determine how fast to titration or taper

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20
Q

First Psychotic Episode Treatment

A

Antipsychotic not cloza/olnzapine

Not effective – switch to a different one (not clozapine)

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21
Q

More than 1 psychotic episode but successful treatment in past Treatment

A

Antipsychotic not clozapine

Not effective – switch to a different one (not clozapine)

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22
Q

For treatment resistant patients or violet behaviors or suicidalitytreatment

A

See definition

Clozapine

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23
Q

Common side effects in 1st Generation Antipsychotics

A

EPS and hyperprolactinemia (D2)
Anticholinergic (M1)
Sedation/weight gain (H1)
Orthostasis (alpha1)

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24
Q

Chlorpromazine and Thioridazine Side Effects

A 
Anticholinergic
Sedation/weight gain
Lower BP
M1, H1, alpha1
***Low EPS (D2)
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25
Q

Loxapine Side Effects

A

Some anticholinergic, sedation weight gain, EPS/hyperprolactin

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26
Q

Perphenazine Side Effects

A

Low anticholinergic, sedation weight gain, alpha 1

***HIGH EPS/hyperprolactin

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27
Q

Thiothixene Side Effects

A

Low anticholinergic, sedation weight gain, alpha 1

***HIGH EPS/hyperprolactin

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28
Q

Haloperidol and Fluphenazine Side effects

A

Low anticholinergic, sedation weight gain, alpha 1

**SUPER HIGH EPS/hyperprolactin

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29
Q

Most common AE with 2nd Generation

A

Weight gain
Dyslipidemia
Hyperglycemia
- Anticholinergic, H1, alpha 1, some EPS/hyperprolactin

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30
Q

“PINES”

A

Clozapine
Olanzapine
Quetiapin
Asenapine

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31
Q

Clozapine Side effects

A

High everything except EPS/hyperprolactin

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32
Q

Olanzapine Side effects

A

High everything except EPS/hyperprolactin and alpha 1

33
Q

Quetiapine Side Effects

A

High sedation, low BP and metabolic

- H1, alpha 1, 5HT

34
Q

Asenapine Side Effects

A

High sedation

Everything else is low

35
Q

“DONES”

A 
Risperidone
Paliperidone
Ziprasidone
Iloperidone
Lurasidone
36
Q

Risperidone Side effects

A

High EPS/Hyperprolactin

High alpha 1 (low BP)

37
Q

Paliperidone Side Effects

A

High EPS/Hyperprotlactin

Everything else is low

38
Q

Ziprasidone Side effects

A

Low across the board

39
Q

Iloperidone Side effects

A

High alpha 1 (low BP)

40
Q

Lurasidone Side Effects

A

High EPS/hyperprolactin

41
Q

“PIPS”

A

Partial D2 agonists
Aripiprazole
Brexipiprazole

42
Q

Aripiprazole & Brexipiprazole Side effects

A

Low across the board
A: has akathisia
B: less akathisia

43
Q

Define akathisia

A

State of agitation, restlessness, distress

44
Q

High risk of metabolic side effects:

A

Clozapine

Olanzapine

45
Q

Low risk of metabolic side effects

A

Ziprasidone
Aripiprazole
Lurasidone
Brexipiprazole

46
Q

Monitoring for 2nd gen antipsychotics

A 
BMI Q3 months
Waist annually
BP 12 weeks -- annually
FPG 12 weeks -- annually
FLP 12 weeks -- 1-5 years
47
Q

Agranulocytosis as a side effect in what drugs

A

Clozapine —- phenothiazines —- olanzapine

48
Q

Seizures as a side effect in what drugs

A

Clozapine — phenothiazine

49
Q

QT prolongation as a side effect in what drugs

A

Phenothizines, haloperidol IV, ziprasidone

50
Q

Sexual dysfunction as a side effect in what drugs

A

High potency first gen

51
Q

Neuroleptic Malignant Syndrome (NMS) as a side effect in what drugs

A

High potency first generation

52
Q

What is Neuroleptic Malignant Syndrome (NMS)

A 
Symptoms develop in 24-72 hours
Temp greater than 100.4
Alter consciousness
Vital fluctuations
Muscle rigidity
Leukocytosis
Elevated CPK
Rhabdo
Elevates AST/ALT
53
Q

Define Parkinsonism

A

Experience muscle rigidity, tremor, bradykinesia, postural instability
Develops over 1-2 weeks

54
Q

Treatment of parkinsonism

A

Anticholinergics (benztropine, diphenhydramine and trihexyphenidyl)

55
Q

Define Dystonia

A

Muscle contractions
Neck and shoulders usually
Develops 1-4 days

56
Q

Treatment of parkinsonism

A

Anticholinergics (benztropine, diphenhydramine and trihexyphenidyl)

57
Q

Define Akathsia

A

Inner restlessness: pace back and forth, shift, tapping feet

58
Q

Treatment of akathsia

A

Reduce antipsychotic dose or use a different agent

- Propranolol

59
Q

Define Tardive Dyskinesia

A

Involuntary movements of the muscles (sticking out tongue, puckering lips, lip smacking, grimacing)
IRREVERSIBLE

60
Q

Treatment of tardive dyskinesia

A

Decrease or d/c antipsychotic and switch to an agent with less DA antagonism

61
Q

Define AIMS

A

Abnormal Involuntary Movement Scale

- If you have a higher score, you will probably never be below that score again

62
Q

Long Acting Antipsychotics Given IM

A 
Haloperidol
Fluphenazine
Risperidone
Paliperidone
Olanzapine
Aripiprazole
63
Q

Haloperidol IM
Aripiprazole IM
Paliperidone IM

A

Once monthly

64
Q

Fluphenazine IM

A

Q3-6 weeks

65
Q

Risperidone IM

A

Q 2 wks

66
Q

Olanzapine IM

A

Once or twice monthly

67
Q

Oral therapy to IM, how long for overlap?

A

Stabilze on oral therapy first or at least 3-7 days of oral therapy to see if pt tolerates

68
Q

Risperidone Overlap

A

Reconsituted before given
Continue oral for 3 weeks before first depot shot
IN THE BUTT

69
Q

Fluphenazine (prolixin D)

A

1.2 X the oral dose
Weekly for first 4-6 weeks then Q3-6 wks
Deep Ztract IM method

70
Q

Fluphenazine (prolixin D) overlap

A

Oral overlapped by 1 week

71
Q

Haloperidol (Haldol D)

A

10-15 times the oral dose

Deep Ztract IM method

72
Q

Haloperidol (Haldol D) overlap

A

Oral overlap by 1 month

73
Q

Paliperidone (Invega Sustenna)

A

Deltoid or gluteal muscle
234 mg initially then 156 mg given 1 week later as loading doses
Then 39-234 mg

74
Q

Paliperidone (Invega Sustenna) overlap

A

Not necessary

75
Q

Aripiprazole (Abilify Maintena)

A

IN THE BUTT

400 mg loading dose

76
Q

Aripiprazole (Abilify Maintena) overlap

A

14 days overlap with oral

77
Q

Olanzapine (zyprexa relprevv)

A

LD: 210-300 mg Q 2 weeks X 4
MD: 150-300 Q2wks OR 300-405 Q 4 wks
IN THE BUTT

78
Q

Olanzapine (zyprexa relprevv) Black Box Warning

A

Sedation and delirium have been observed after use

79
Q

CATIE and CUtLASS showed

A

No difference between first and second generation antipsychotics when comparing clinical outcomes (time to d/c and QofL

Neuro Quiz 4 (4 decks)

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