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NAPLEX 25 > Chapter 63: Schizophrenia/Psychosis > Flashcards

Chapter 63: Schizophrenia/Psychosis Flashcards

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1
Q

What is Schizophrenia?

A

It is a chronic, severe, diabling thought disorder.

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2
Q

What are common symptoms of schizophrenia?

A

Common symptoms of schizophrenia include hallucinations, delusions, and disorganized thinking/behavior.

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3
Q

What are the primary neurotransmitters involved in schizophrenia?

A

Dopamine, serotonin, and glutamine.

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4
Q

Negative Signs and Symptoms of schizophrenia according to the DSM-5 include

A
  • Loss of interest in everyday activities
  • Lack of emotion (apathy)
  • Inability to plan or carry out activities
  • Poor hygiene
  • Social withdrawal
  • Loss of motivation (avolition)
  • Lack of speech (alogia)
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5
Q

Positive Signs and Symptoms of schizophrenia according to the DSM-5 include

A
  • Hallucinations: can be auditory (hearing voices), visual or somatic
  • Delusions: beliefs held by the patient that are without a basis in reality
  • Disorganized thinking/behavior
  • Difficulty paying attention
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6
Q

Medications/illicit drugs that can cause psychotic symptoms

A
  • Anticholinergics (centrally-acting, high doses)
  • Dextromethorphan
  • DA or DA agonists (e.g., Requip, Mirapex, Sinemet)
  • Interferons
  • Stimulants
  • Systemic steroids
  • Illicit drugs include bath salts, cannabis, cocaine, LSD, methylphenidate/ice/crystal, PCP
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7
Q

Antipsychotics primarily block which receptors?

A

DA and serotonin

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8
Q

What drug class is used first line in schizophrenia & why?

A

Second-generation antipsychotics; they have a lower risk of extrapyramidal symptoms

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9
Q

What are the common extrapyramidal symptoms (EPS) associated with FGAs?

A
  • Painful dystonias (muscle contractions),
  • Dyskinesias (abnormal movements),
  • Tardive dyskinesias (repetitive, involuntary movements such as grimacing and eye blinking),
  • Akathisia (restlessness, inability to remain still)
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10
Q

What is tardive dyskinesias (TD)?

A

TD can be irreversible; the drug causing the TD should be discontinued.

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11
Q

Which two drugs should not be given together due to risk of excessive sedation and breathing difficulty?

A

Olanzapine and benzodiazepines

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12
Q

What is the increased risk of mortality when antipsychotics are used for what purpose in elderly with dementia-related psychosis?

A

agitation control

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13
Q

What warning do several antipsychotics carry for patients with dementia?

A

increased risk of stroke

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14
Q

What is the mechanism of action (MOA) of first-generation antipsychotics?

A

They work mainly by blocking dopamine-2 (D2) receptors, with minimal serotonin receptor blockade.

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15
Q

What is the boxed warning for Thioridazine?

A

QT prolongation.

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16
Q

Which first-generation antipsychotics (FGAs) have a warning for QT prolongation?

A

Thioridazine, haloperidol, chlorpromazine.

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17
Q

What are other warnings for FGAs besides QT prolongation?

A

Orthostasis/falls, anticholinergic effects, CNS depression, EPS, hyperprolactinemia, neuroleptic malignant syndrome (NMS).

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18
Q

What are the side effects of FGAs?

A

Sedation, dizziness, anticholinergic effects, increased prolactin, EPS.

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19
Q

What medication class can you give with FGAs to limit/avoid painful dystonic reactions?

A

Anticholinergics (e.g., benztropine, diphenhydramine).

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20
Q

Do higher or lower potency drugs have increased sedation and decreased EPS?

A

Lower potency drugs.

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21
Q

Do higher or lower potency drugs have decreased sedation and increased EPS?

A

Higher potency drugs.

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22
Q

What is the brand name of Haloperidol?

A

Haldol, Haldol Decanoate.

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23
Q

What is the mechanism of action (MOA) of second generation antipsychotics?

A

They work mainly by blocking dopamine-2 (D2) receptors & serotonin (5-HT2A) receptors.

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24
Q

What is the brand name of Aripiprazole?

A

Abilify

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25
What are the brand names for Clozapine?
Clozaril
26
At what line is Clozapine used due to severe side effect potential?
Clozapine is used no sooner than 3rd line.
27
What is the boxed warning for Clozapine?
Significant risk of potentially life-threatening **neutropenia/agranulocytosis** (REMS program); **myocarditis** and cardiomyopathy: d/c if suspected; **seizures**.
28
What are the side effects of Clozapine?
Agranulocytosis, seizures, constipation, metabolic syndrome (↑ weight, ↑ BG, ↑ lipids), hypersalvation
29
What is a notable side effect of Abilify?
Akathisia and activating
30
Which SGA requires a REMS program?
Clozapine.
31
What must the baseline ANC be to start Clozapine treatment?
It must be > /= 1500/mm3.
32
When must Clozapine therapy be stopped?
If ANC falls below 1000/mm3.
33
Lurasidone brand name
Latuda
34
Lurasidone side effects
Somnolence, EPS (dystonias), nausea
35
Olanzapine brand name
Zyprexa
36
Zyprexa Relprevv injection can cause sedation and delirium following injection & must be administered in a registered healthcare facility. Patients must be monitored for _____ post-injection (REMS program requirements)
3 hours
37
Olanzapine side effects
Somnolence, metabolic syndrome (↑ weight, ↑ BG, ↑ lipids)
38
Paliperidone brand name
Invega, Invega Sustenna, Invega Trinza
39
How often is Invega Sustenna IM injection given?
monthly
40
How often is Invega **Tri**nza IM injection given?
every 3 months
41
How often is Invega **Hafyer**a IM injection given?
every 6 months
42
Paliperidone side effects
↑ prolactin – sexual dysfunction, galactorrhea, irregular/missed periods EPS, especially at higher doses Metabolic syndrome (↑ weight, ↑ BG, ↑ lipids)
43
Quetiapine brand name
Seroquel
44
Quetiapine side effects
Somnolence, metabolic syndrome (↑ weight, ↑ BG, ↑ lipids) ## Footnote Low EPS risk - often used for psychosis in PD
45
When should Seroquel XR be taken and how
At night, without food or with a light meal
46
Risperidone brand name
Risperdal, Risperdal Consta
47
How often is Risperdal Consta IM injection given
every 2 weeks
48
Risperidone side effects
↑ prolactin – sexual dysfunction, galactorrhea, irregular/missed periods EPS, especially at higher doses Metabolic syndrome (↑ weight, ↑ BG, ↑ lipids)
49
Ziprasidone brand name
Geodon
50
Should ziprasidone be taken with or without food
with food
51
Ziprasidone contraindication
QT prolongation: do not use with QT risk
52
What SGA comes as a sublingual tablet
Asenapine (Saphris)
53
Counseling for Asenapine (Saphris)
No food/drink for 10 min after dose
54
Asenapine (Saphris) side effect with SL tab
Tongue numbness
55
Which antipsychotics can cause increased prolactin, leading to painful gynecomastia?
Risperidone, paliperidone
56
Which SGA can cause painful dystonia and tardive dyskinesia?
Haloperidol
57
Which SGAs have cardiac risk/QT prolongation?
Ziprasidone, haloperidol, thioridazine, chlorpromazine
58
Besides FGAs, which SGAs have high risk of EPS?
Risperidone, paliperidone (at high doses)
59
Which SGA should you give someone if they have a history of movement disorder (e.g., Parkinson’s Disease)?
Quetiapine
60
Which SGAs worsen metabolic issues?
Olanzapine, quetiapine
61
Which SGAs are preferred in overweight/metabolic risk (e.g., increased TG)?
Aripiprazole, Ziprasidone, lurasidone, and asenapine
62
Which antipsychotics should be given in someone who has acute psychosis and refusing PO meds?
Haloperidol IV or IM ## Footnote Alternatives: Ziprasidone IM, Olanzapine IM
63
Which SGAs come as ODT?
Aripiprazole, olanzapine, risperidone
64
Which SGAs come as oral liquids?
Aripiprazole, fluphenazine, haloperidol, risperidone
65
Which SGA comes as a patch?
Asenapine
66
Which SGAs can cause hyperglycemia and weight gain?
Olanzapine, quetiapine, risperidone, and paliperidone
67
What should risperidone oral solution not be mixed with?
Cola or tea
68
What is the first drug that has been approved for tardive dyskinesia?
Valbenazine (Ingrezza)
69
What are the warnings associated with Valbenazine?
Somnolence
70
What is a contraindication for Deutetrabenzine, another drug approved for tardive dyskinesia?
Hepatic impairment
71
What is neuroleptic malignant syndrome (NMS)?
NMS is a rare but highly lethal condition that commonly occurs with FGAs due to D2 blockade.
72
What are the signs of NMS?
Signs of NMS include: - Hyperthermia - Extreme muscle rigidity (called 'lead pipe' rigidity), which can lead to respiratory failure - Mental status changes - Other signs can include tachycardia, tachypnea, and BP changes.
73
How do you treat NMS?
Treatment includes: - **Stop the antipsychotic** quickly and considering another choice (quetiapine or clozapine) - Providing supportive care - Cooling the patient down - Muscle relaxation with BZDs or **dantrolene** is sometimes used, as some cases may require a DA agonist such as bromocriptine.

NAPLEX 25 (63 decks)

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