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Pharm Exam 3 > Wk 9 Antipsychotic's > Flashcards

Wk 9 Antipsychotic's Flashcards

1
Q

schizophrenia

A

US lifetime prev is ~1%

lifetime prev of suicide is ~10%

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2
Q

risk if 2nd degree relative has schizophrenia

A

~3%

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3
Q

risk if 1st degree relative has schizophrenia

A

~10%

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4
Q

Risk if both parents have schizophrenia

A

~40%

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5
Q

monozygotic twin risk for schizophrenia

A

~48%

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6
Q

schizophrenia presentation

A

NOT “split personality”
chronic disorganization of thought and affect
pharmacotherapy is mainstay of treatment
psychosocial rehab is mainstay of non-drug tx

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7
Q

acute psychotic episodes of schizophrenia

A 
auditory hallucinations (esp voices) 
delusions (fixed false beliefs) 
ideas of influence (external forces control their actions)
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8
Q

symptom classification of schizophrenia

A

positive (most obvious/dramatic), negative (functional impairment) and cognitive

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9
Q

original “dopamine hypothesis”

A

acue psychotic episodes inc dopamine neurotransmission

results in hypersensitivity to stimuli

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10
Q

newer “dysregulation hypothesis”

A

since inhibitor neurons are modulated by dopamine, 5-HT, Act and NE, these become targets for new agents

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11
Q

first generation antipsychotics

A

dopamine antagonism was found to be the mode of action (esp D2)
MOA characterizes “typical” antipsychotics
dec presynaptic release of dopamine
not typically first line
used before SGA if chronically ill pt had previously satisfactory response

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12
Q

neuroleptic

A

AP drugs with prominent D2-dopamine rec antagonism

“typical” antipsychotics, first generation antipsychotics

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13
Q

traditional equivalent doses of Fluphenazine and Haloperidol

A

2 mg, but also have long-acting depot injection formulations available (highly potent)

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14
Q

FGA >60% D2 blockade

A

clinical response

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15
Q

FGA > 70% D2 blockade

A

hyperprolactinemia

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16
Q

FGA >80% D2 blockade

A

inc risk of extrapyramidal symptoms

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17
Q

incidence of death from FGA

A

~0.015%/yr

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18
Q

most likely FGA to cause QT prolongation

A

Thioridazine

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19
Q

least likely FGA to cause QT prolongation

A

Haloperidol

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20
Q

early neuro adverse effects of FGA

A 
acute dystonia (1-5 days = max risk)
akathisia (5-60 days, usual tx for agitation is to give more drug but not in this case)
Parkinsonism (5-30 days)
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21
Q

late neuro adverse effects of FGA

A 
neuroleptic malignant syndrome (weeks, 10% mortality, antiparkinson agents not effective) 
tardive dyskinesia (months-yrs of tx)
perioral tremor (rabbit syndrome, months-yrs)
22
Q

neuroleptic malignant syndrome

A

more common in pt’s on high potency or depot FGAs, dehydrated or exhausted pt’s

23
Q

neuroleptic malignant syndrome tx

A

discount antipsychotic

use only SGAs for re challenge post-NMS

24
Q

only SGA to fulfill all criteria

A

clozapine

25
Q

additional SGA therapeutic mechanisms

A

D1, D4 antagonism

NE, 5-HT antagonism

26
Q

early SGAs

A 
greatly reduced risk of tar dive dyskinesia 
esp good for - symptoms 
sig less relapse than with FGAs
25% relapse rate with Risperidone 
40% relapse rate with haloperidol
27
Q

3 phases of tx in schizo

A

acute, stabilization and maintenance phase

28
Q

tx of first (acute) psychotic episode

A

initial goal is to calm agitated pt
immediate tx improves long term outcome
most psychiatrist rx SGA (NOT CLOZAPINE) (dec anger and anxiety usually in 24-48 hrs)
near max improvement seen by 6-8 wks
suicide risk inc’s as other symptoms improve!!!!!

29
Q

pharm algorithm stage 1

A

only for pt’s with FIRST schizo episode

SGAs considered 1st line

30
Q

pharm algorithm stage 2

A

chronically ill pt recently started on AP or new onset pt with poor response to stage 1
mono therapy with FGA or SGA (not clozapine)
chose different AP than stage 1

31
Q

pharm algorithm stage 3

A

switch to clozapine
inc efficacy for suicidal behavior
consider earlier in suicidal pt

32
Q

pharm algorithm stage 4

A

cont clozapine

add an additional AP (combo AP therapy)

33
Q

pharm algorithm stage 5

A

trial of mono therapy AP

use FGA or SGA not previously used

34
Q

pharm algorithm stage 6

A

consider combo therapy

when switching to APs: overlap 2nd agent for 1-2 weeks then taper and DC 1st agent

35
Q

combination

A

involves using 2 AP simultaneously

36
Q

augmentation

A

addition of a non-AP drug to an AP

37
Q

augmentation agents

A

mood stabilizers, SSRIs, BB’s (anti aggressive effect)

38
Q

combo therapy steps 4-6

A

multiple MOAs
combo trials should be time-limited (12 wks)
if no improvement, taper 1 med then D/C
a series of mono therapies is preferred over AP combinations

39
Q

maintenance tx

A

1st presentations may respond sooner
meds may red symptoms, but are not curative
all symptoms may not abate
prevents relapse (18-32% on drug vs 60-80% on placebo)
cont at least 12 months past remission

40
Q

long-acting depot injectable APs

A

recommended in unreliable pt’s
not used as 1st line
look for SE as a cause of nonadherence

41
Q

haloperidol deconate

A

use 10-15 x PO dose
round dose up to nearest 50 mg
give dose via deep IM injection q month
overlap with PO haloperidol for 1st month

42
Q

risperidone

A

only SGA depot, needs reconstitution

43
Q

bipolar 1 vs 2

A

mania, usually requiring hospitalization (classic) vs hypomania (major depression + hypomania)
need to r/o amphetamine abuse and pheochromocytoma

44
Q

bipolar dx

A

previously called manic-depression
one of most distinctive syndromes in psychiatry
unique hallmark of illness is mania (different from pt’s usual behavior)
single manic episode sufficient for dx

45
Q

S/S’s of bipolar dx

A

elevated mood, overactivity, lack of need for sleep and inc optimism

46
Q

types of bipolar disorder

A

one mamic episode, alternating episodes and mania every few yrs

47
Q

rapid cyclers

A

patient with >4 manic or depressive cycles/yr

48
Q

genetic risk of bipolar dx

A

~50% of pt’s have family hx

~10% in siblings of affected pt’s

49
Q

tx of acute mania

A

medical ER!
non tx endangers: marriage, job, pt’s life
AP drugs effective
rapid drug onset may be lifesaving (think short acting injectables!!)
newer “atypical” Abs are effective in compliant pt’s

50
Q

bipolar depression

A

depressive episode responds to SSRIs, TCAs and MAOIs
Antidepressants may induce switch from depression to mania!!! (don’t use antidepressants in pt’s with hx of dangerous mania episodes)

51
Q

lithium

A

collect trough samples just prior to next dose

recently found this prophylactically is much more effective than valproate for suicide prevention

Pharm Exam 3 (3 decks)

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