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PHRM 845 exam 4 > Schizophrenia Dr.OTT > Flashcards

Schizophrenia Dr.OTT Flashcards

1
Q

Key features that define psychotic disorders

A

delusion, hallucination, disorganized thinking, disoragnized or abnormal motor behavior
negative symptoms - withdrawal from social life, anxiety, depression, not taking care of self

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2
Q

Disease course in schizophrenia

A

onset late adolescence to early adulthood
men - late teens, early 20s
women - late 20s, early 30s

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3
Q

Link to substance use

A

smoking is associated with induction of 1A2 due to the hydrocabons in inhalants which decrease serum concentration of 1a2 substrate antipsychotics

Marijuiana, cocaine, and amphetamine use can hasten the onset of schizophrenia, exacerbate symptoms, and reduce time to relapse

Substance use treatment can be succussfully achieved along with mental health treatment in patients with schizophrenia, should be undertaken at the same time

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4
Q

MUST CONSIDER for antipsychotic drug therapy

A

dose per day
side effects
previous drug therapy
cost of drug therapy
concomitant drug therapy
need for monitoring

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5
Q

Antipsychotic drug selection

A

Oral antipsychotic drug therapy is generally considered first line, unless the patient presents with reasons to consider IM depot drug therapy first

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6
Q

Older agents

A

Primarily D2 receptor antagonists
Haloperidol - most commonly used - routine and PRN
fluphenazine
chlorpromazine
perphenazine
loxapine
thioridazine
these agents are very effective in treating the positive symptoms but are likely to worsen negative and cognitive symptoms

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7
Q

Atypical antipsychotics

A

D2 antagonists + 5HT antagonists
less EPS than typicals; more metabolic side effects
aripiprazole
clozapine
olanzapine
ziprasidone
asenapine
iloperidone
paliperidone
brexpiprazole
lumateperone
quetiapine
cariprazine
lurasidone
risperidone

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8
Q

Asenapine transdermal patch

A

apply 1 patch every 24 hours rotate pate site to minimize application site reaction
Reduce dose of patch if given with 1A2 inhibitor (fluvoxamine)
warning for QTC prolongation

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9
Q

Clozapine REMS

A

Monitoring timelines weekly x 6 months, biweekly x 6 months, then every 4 weeks

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10
Q

Olanzapine/ samidorphan (lybalvi)

A

samidorphan is an opioid antagonist with preferential activity at the mu opioid receptor

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11
Q

Lumateperone (Caplyta)

A

-low risk for weight gain or metabolic side effects
low risk for EPS or akathisia
- 3A4 substrate

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12
Q

Pimavanserin (nuplazid) side effects and use

A

Treatment of hallucination or delusions in patients with parkinsons disease
inverse agonist and antagonist at the serotonin 2A
3A4 substrate
SE: peripheral edema, confusional states, nausea, rare angioedema

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13
Q

Warning for all antipsychotics

A

Black box warning: increased risk of death in elderly patients treated with antipsychotics for dementia with related behaviors
metabolic adverse effects

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14
Q

Haloperidol injection

A

given every 4 weeks
load: 20 times oral dose
maintenance: 10 times oral dose
oil based Z-track method (pull needle out in Z shape to increase surface area)

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15
Q

Risperdal Consta (risperidone) injection

A

Has to be refridgerated, and reconstituted
Must supplement with oral risperidone for the first few weeks of treatment - I tell providers until 3 injections

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16
Q

Perseris (resperidone) Injection

A

Every 4 weeks
Abdominal subcutaneous injection (avoid belt line) - 90mg and 120mg
3A4 inducers - use 120mg dose or may need oral supplementation
easy conversion from injection to oral

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17
Q

Rykindo (risperidone)

A

Every 2 weeks IM injection
oral dose overlap is shorter than risperidal consta (7 days vs 21)

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18
Q

Uzedy (risperidone)

A

Abdominal or upper arm subcutaneous injection (ADVANTAGE - can be given upper arm)
Given once monthly or every 2 months

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19
Q

Invega Sustenna (paliperidone)

A

Loading dose, then booster, then every 4 weeks (starting 5 weeks after loading injection)
initial loading dose and booster dose must be given in deltoid to improve absorption consistency
if loading strategy followed no need for oral overlap
may require dose adjustment in moderate to severe renal impairment

20
Q

Invega Trinza (paliperidone q3mo)

A

May be initiated for patients who has been on stable monthly IM injections of Invega sustenna at least 4 stable invega sustenna doses
recommended to be given in deltoid; gluteal administration results in a lower Cmax
not recommended if CrCl < 50ml/min

21
Q

Invega Hafyera (paliperidone q6mo)

A

may be initiated after stable invega sustenna for 4 months or stable invega trinza after one 3 month dose
Gluteal injection ONLY

22
Q

Abilify Maintena (aripiprazole)

A

Must overlap with oral aripiprazole for at least 14 days after first injection
deltoid or gluteal injection
IF patient is taking 2D6 inhibitor or 3A4 inducers for more than 14 days as concomitant therapy a dose adjustment is needed

23
Q

Abilify asimtufii (aripiprazole)

A

every 2 months dosing - 720mg, 960mg
gluteal injection
continue oral aripiprazole for 2 weeks after first injection

24
Q

Ariistada (aripiprazole lauroxil)

A

PRODRUG
overlap with oral aripiprazole for 3 weeks after first injection

25
Q

Aristada initio

A

developed to avoid for 21 day oral overlap of antipsychotic
avoid in patients who are 2D6 poor metabolizers or with strong 3A4 or 2d6 inhibitors

26
Q

Immediate release antipsychotiv injections/ psychiatric emergencies

A

Haloperidol, chlorpromazine, fluphenazine are used, haloperidol most commonly
olanzapine immediate release IM - CANNOT be given at the same time as a benzodiazepine immediae release injection - box warning for respiratory depression
loxapine for inhalation (Adasuve)

27
Q

Clinical treatment strategies for EPS

A

Acute dystonia - IM anticholinergic NOW dose (benztropine 2mg, diphenhydramine 50mg)

Drug induced parkinsons - oral anticholinergic (benztropine, diphenydramine, trihexyphenidyl)

Akathisia - beta blockers - propranolol preffered, benzodiasepine - usually lorazepam

Tardive dyskinesia - VMAT inhibitors

28
Q

VMAT inhibitors

A

Used to treat tardive dyskinesia in these patients
Tetrabenazine (xenazine)
Valbenazine (ingrezza) - 2D6/3A4 substrate, Qtc prolongation
Deutetrabenazine (austedo) - 2D6 substrate, QTC prolongation

29
Q

Neuroleptic malignant syndrome

A

Life threatening is a medical emergency
hyperpyrexia, tachycardia, labile blood pressure, msucle rigidty - elevated CK
treatment is supportive
future antipsychotic use is not contraindicated

30
Q

Metabolic adverse effects

A

Hyperglycemia, hyperlipidemia, hypertension
Clozapine = olanzapine (the worst for atypical antipsychotic risk)
quetiapine = risperidone = paliperidone = asenapine = iloperidone = cariprazine = brexpiprazole (first in the middle)
ziprasidone = lurasidone = aripiprazole (least likely for atypical antipsychotic risk)

31
Q

Baseline monitoring

A

Personal and family hx
weight
waist cirvumference
blood pressure
FPG
fating lipids

32
Q

4 weeks and 8 weeks post therapy monitoring

A

weight

33
Q

12 weeks post monitoring

A

weight, blood pressure, FPG, fasting lipid

34
Q

yearly monitoring

A

personal family hx
waist circumference
blood pressure
FPG

35
Q

Aripirazole

A

Partial agonist
Stabilize dopamine transmission

associated with more akathisia than other antipsychotics
approved for adjunct treatment in depression so all have box warning for suicidal thoughts/behavior

2D6 and 3A4 substrate, moderate akathisia, low weight gain

36
Q

brexpiprazole

A

Partial agonist
Stabilize dopamine transmission

associated with more akathisia than other antipsychotics
approved for adjunct treatment in depression so all have box warning for suicidal thoughts/behavior

2D6 and 3A4 substrate, moderate akathisia, low-moderate weight gain

37
Q

cariprazine

A

Partial agonist
Stabilize dopamine transmission

associated with more akathisia than other antipsychotics
approved for adjunct treatment in depression so all have box warning for suicidal thoughts/behavior

3A4 substrate, moderate akathisia, Low-moderate weight gain

38
Q

Asenapine

A

sublingual and patch formulation, 1A2 substrate, QTC prolongation

39
Q

Clozapine

A

1A2 substrate, box warning - neutropenia, orthostasis, bradycardia, syncope, seizure, myocarditis, cardiomyopathy

40
Q

Olanzapine

A

1A2 substrate, significant weight gain and sedation, high metabolic syndrome, DRESS warning

41
Q

Quetiapine

A

3A4 substrate, QTC prolongation, weight gain and sedation, box warning for suicidal ideation

42
Q

iloperidone

A

high risk for orthostasis and syncope, QTC prolongation, 2D6 substrate

43
Q

Lurasidone

A

3A4 substrate, high risk for akathisia, warning for suicidal thoughts, adjunct for bipolar depression, take with food

44
Q

Ziprasidone

A

QTC prolongation, Dress warning, take with food to increase absorption, 3A4 substrate and aldehyde oxidase

45
Q

risperidone

A

Highest D2 blockade

2D6 substrate, EPS, hyperprolactinemia, weight gain, sedation, orthostasis

46
Q

paliperidone

A

renally eliminated - dose adjustments in renal impairment, similar side effects with resperidone, QTC prolongation

Highest D2 blockade

PHRM 845 exam 4 (13 decks)

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