Two or more of the following must be present for a significant portion of time during a 1 mo. period - Delusions - Hallucinations - Disorganzied speech - Grossly disorganzied - Negative symptoms - diminished emotional expression or avolition

Exam 3: Schizo Flashcards by Shiqi Zhang

Schizophrenia vs. Schizoaffective

Affective has a mood component

How well did you know this?

Not at all

Perfectly

Schizophrenia dx

Two or more of the following must be present for a significant portion of time during a 1 mo. period

Delusions
Hallucinations
Disorganzied speech
Grossly disorganzied
Negative symptoms - diminished emotional expression or avolition

How well did you know this?

Not at all

Perfectly

Which antipsychotics have a strong sedating effect?

First gen
- chlorpromazine
- thioridazine

Second gen
- clozapine
- quetiapine

How well did you know this?

Not at all

Perfectly

Which antipsychotics are most likely to cause EPS?

First gen: all of them
- chlorpromazine
- fluphenazine
- haloperidol
- perphenazine
- thioridazine
- thiothixene

Second gen
- paliperidone
- risperidone

How well did you know this?

Not at all

Perfectly

Which antipsychotics are the most anticholinergic?

First gen:
- chlorpromazine
- thioridazine

Second gen
- clozapine

How well did you know this?

Not at all

Perfectly

Which antipsychotics are the most likely to cause orthostasis?

First gen:
- chlorpromazine
- thioridazine

Second gen
- clozapine
- iloperidone - avoid in old people

How well did you know this?

Not at all

Perfectly

Which antipsychotics are the most likely to cause weight gain?

First gen:
- chlorpromazine

Second gen
- clozapine
- olanzapine
- quetiapine

How well did you know this?

Not at all

Perfectly

Which antipsychotics are the most likely to cause an elevation in prolactin?

First gen: (all of them)
- chlorpromazine
- fluphenazine
- haloperidol
- perphenazine
- thioridazine
- thiothixene

Second gen
- paliperidone
- risperidone

How well did you know this?

Not at all

Perfectly

Which antipsychotics are the most likely to cause CV AE?

First gen:
- chlorpromazine
- haloperidol

Second gen
- clozapine
- iloperidone
- ziprasidone

How well did you know this?

Not at all

Perfectly

What is included in metabolic syndrome and which antipsychotics are most likely to cause metabolic syndrome

hypertriglyceridemia
hyperglycemia
weight gain (waist circumfernce)
___
clozapine
olanzapine
quetiapine (kinda)

How well did you know this?

Not at all

Perfectly

Which antipsychotics are available as LAI

First gen
- fluphenazine
- haloperidol

Second gen:
- aripiprazole
- olanzapine - only admin if there is life support near by d/t post injection delirum/sedation syndrome (PDSS); monitor for 3 hrs
- paliperidone
- risperidone

How well did you know this?

Not at all

Perfectly

Which antipsychotics are available as short acting injections?

Second gen:
- olanzapine
- ziprasidone

How well did you know this?

Not at all

Perfectly

Which antipsychotic is a NIOSH drug (much hazardous, needs full garbing)

ziprasidone

How well did you know this?

Not at all

Perfectly

Which are the 2 highest potency antipsychotics?

fluphenazine
haloperidol

higher potency, higher risk for EPS

How well did you know this?

Not at all

Perfectly

Antipsychotics as antidepressants

MUST BE IN CONJUNCTION WITH AN ACTUAL ANTIDEPRESSANTS

aripiprazole
brexipiprazole
olanzapine (but must be with fluoxetine)
quetiapine

How well did you know this?

Not at all

Perfectly

Which antipsychotic has an APPROVED indication for agitation in Alzheimer’s patients?

Brexipiprazole

How well did you know this?

Not at all

Perfectly

Clozapine missed dose >48 hrs

Must start the titrating process all over again

How well did you know this?

Not at all

Perfectly

What is the benefit of olanzapine+samidorphan over olanzapine?

Samidorphan is an opioid system modulator (like naltrexone so don’t give in pts who need opioids) and is supposed to help reduce METABOLIC (weight, TGs, glucose, NOT EPS) effects of olanzapine

How well did you know this?

Not at all

Perfectly

Which antipsychotic is available through the OROS delivery system and what are the implications of this?

Paliperidone PO

osmotic pump delivery, you’ll see the shell in your poo (dw, the med is working)

How well did you know this?

Not at all

Perfectly

Which antipsychotic has NO DOPAMINE action, just serotonin?

Pimavavanserin

because it is just serotonin action, is only indicated for parkinson’s psychosis

How well did you know this?

Not at all

Perfectly

EPS s/s and how to treat

dystonias - muscle contractions
- anticholinergics IV/IM (benadryl and benztropine) and IM benzos can help - want fast acting
- decrase dose or dc med

pseudo-parkinsonisms
- anticholinergics can help
- decrase dose or dc med

akathisia - anx and restlessness
- PO propranolol can help

tardive dyskinesia - permanent and hard to mask/hide
- dc med
- may try -benazines (VMAT2)
- do NOT use anticholinergics - will mask s/s delaying dx

How well did you know this?

Not at all

Perfectly

Antipsychotics that can cause DRESS

olanzapine
ziprasidone

How well did you know this?

Not at all

Perfectly

BBW for ALL antipsychotics

Study These Flashcards

Dementia related psychosis, increased all cause mortality in pts with dementia

UNLESS the primary indication for usage is for an approved psychiatric use (e.g. schizophrenia), then ok to use
- would still avoid lurasidone though d/t increase ADR in pts with dementia/Lewy bodies/Parkinson’s

Which antipsychotic has opthalmic effects (cataracts AE)

Study These Flashcards

Quetiapine

Clozapine special AE and DDI

AE - salivation (despite it being very very very anticholinergic effects) - try scopolamine patches behind the ear to help reduce - fatal constipation (because it is very very very anticholinergic) DDI - benzos - respiratory depression - carbamazepine - will lower ANC (the lab value we monitor in REMS for clozapine)

Which antipsychotics have the greatest QTc prolonging properties and after what point do we consider someone's QTc prolonged?

450 mms - chlopromazine - thioridazine - iloperidone while these are the most prolonging, *ALL* antipsychotics are prolonging

General first gen antipsychotic AE

EPS QTc prolongation prolactin elevation deramtologic photosensitivity blue-gray skin orthostatic hypotension altered thermoregulation

T/F: Second gen antipsychotic injections are better tolerated than first gen

True the injectables for second gen are water based and hurt a lil less on injection

General second gen antipsychotic AE

metabolic syndrome - hypertriglyceridemia - hyperglycemia - weight gain (waist circumfernce) QTc prolongation blood dyscarsia/neutropenias → increased risk of infection (not dose related; clozapine is a big offender here) lowers seisure threshold (pt more likely to have sezure) anticholinergic effects sedation prolactin elevation (d/t dopamine blockade)

Aripiprazole formulations

1. PO tab 2. Soln 3. initio inj (loading dose for LAI) 4. LAI

Asenapine formulations

SL tab (do not eat/drink 10 min after taking) topical patch

Brexiprzole formulations

PO tab - t1/2 of 91 hrs

Ariprazine formulations

PO cap

Which antipsychotics are associated with impulsivity?

Aripiprazole Brexiprazole

Which antipsychotic is the gold standard for refractory illness (or soooner if suicidal risk)?

Clozapine in most cases, clozapine isn't ued untilafter 2 meds have already been trialed

Clozapine formulations

1. PO tab 2. ODT 3. PO susp

Iloperidone formulations

PO tab

Lurasidone formulations

PO cap

Olanzapine formulations

PO tab ODT Short acting IM LAI

Olanzapine+ samidorphan formulations

PO tab

Paliperidone formulations

PO tab (OROS delivery) LAI

Pimvanserin formulatios

PO tab

Quetiapine formulations

PO tab (IR and XL)

Risperidone formulatiosn

- PO tab - ODT - Soln - LAI

Ziprasidone formulations

1. PO tab 2. short acting inj

Approach to starting a pt on an LAI

start them on the PO and estbalish tolerability of PO efore staretig LAI - for paliperidone, since it is a metabolite of risperidone, can challenge with risperidone

Whcih antipsychotics are the more activating ones (least sedating)

Second gen: - aripiprazole - lurasidone

acute dystonias s/s

- painful prolonged muscle contractions - involuntary - buccal and facial muscles, may involve back, arms, and legs - oculogyric (eyes roll into back of head and don't unroll)

pseudo-parkinsonism s/s

- bradykinesia - tremmor - pill rolling - cogwheel rigidity - postural and oral abnormalities

akathisia s/s

- restlessness - pacing - shuffling - compulsion to stay in motion - subjectie feelings of distress

tardive dyskinesia s/s

much stigma because it's the face - tongue thrusting, chewing - lip smacking - grimacing - limb twisting - rockign

neuroleptic maligant syndrome and antipsychotics and s/s

possible with all antipsychotics but is really most common with the high potency ones s/s - hyperpyrexia (fever) - labile bp (autonomic dysfuntcion, change in hr, bp, rr) - conufusion - increased muscle tone pts are at higher riks if dehdyrated or orgnaic mental disorder

Smoking affects which antipsychotics?

- olanzapine - clozapine d/t CYP1A2 being induced from the smoke -> induces metabolism of olanzapine and clozapine -> higher dose of clozapine and olanzapine needed if pt smokes

Why do second gen antipsychotics have a greater chance of cardiometabolic AE?

has 5-HT2 effects (more so than dopamine) fist gen is mostly D2

Which antipsychotics ahve the least weight gain

lurasidone arirpiprazole ziprasoidone

Which meds are most liekly to cause NMS

haloperidoel and flupheanzine (high dose FGAs (tho all antipsychotics have a precaution for this)

Exam 3: Schizo Flashcards

(56 cards)