Exam 3 - Schizophrenia Flashcards by Robert Peterson

What are indications for clozapine as a schizophrenia treatment? (2)

treatment resistance or suicidal

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What antipsychotic is approved for sleep in non-psychiatric conditions?

NONE

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Explain effect of dopamine antagonism of the nigrostriatal pathway?

movement disorders

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Explain effect of dopamine antagonism of the mesolimbic pathway?

relief of psychosis

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Explain effect of dopamine antagonism of the mesocortical pathway? (2)

akathisia, relief of psychosis

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explain effect of dopamine antagonism of the tuberoinfundibular pathway?

increased prolactin

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What are first generation antipsychotics? (6)

chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), perphenazine (Trilafon), thioridazine (Mellaril), thiothixene (Navane)

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What are class related side effects of first generation antipsychotics? (5)

extrapyramidal symptoms (EPS), QTc prolongation, prolactin elevation, photosensitivity/tinged skin (blue-gray), orthostatic hypertension

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What is a boxed warning for first and second generation antipsychotics?

dementia-related psychosis

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What are second generation antipsychotics? (13)

aripiprazole (Abilify), asenapine (Saphris), brexiprazole (Rexulti), cariprazine (Vraylar), clozapine

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Which SGAs are partial dopamine agonists? (2)

aripiprazole (Abilify) and brexiprazole (Rexulti)

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What are AEs of aripiprazole (Abilify)? (3)

insomnia, akathisia, impulsivity

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What formulations are available for aripiprazole (Abilify)?

tablet, solution, Mycite (app), initio injection, LAI

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What are AEs of asenapine (Saphris)? (3)

QTc prolongation, anaphylaxis, skin reactions

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What formulations are available for asenaphine (Saphris)?

SL tab, patch

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Which SGAs have long half-lives (91hrs)? (2)

brexiprazole (Rexulti) and cariprazine (Vraylar)

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What are AEs of brexiprazole (Rexulti)? (2)

akathisia, impulsivity

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What formulations are available for brexiprazole (Rexulti)?

tablet

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What are AEs for cariprazine (Vraylar)? (2)

metabolite accumulation, akathisia

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What formulations are available for cariprazine (Vraylar)?

capsule

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What are AEs for clozapine (Clozaril, Fazaclo)? (4)

metabolic, blood dyscrasias (REMS), QTc prolongation, seizure

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What formulations are available for clozapine (Clozaril, Fazaclo)?

tablet, ODT, suspension

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What are AEs for iloperidone (Fanapt)? (4)

orthostatic HTN, priapism, QTc prolongation, CYP inhibitor interactions

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What formulations are available for iloperidone (Fanapt)?

tablet

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What are AEs for lurasidone (Latuda)? (1)

neurologic ADRs (sedation), NO METABOLIC PROBLEMS

What formulations are available for lurasidone (Latuda)?

capsule

What are AEs for olanzapine (Zyprexa)? (5)

metabolic, post injection delirium/sedation (PDSS; REMS) with LAI, DRESS, QTc prolongation, anticholinergic effects

What formulations are available for olanzapine (Zyprexa)?

tablet, ODT, short acting IM, LAI

What are AEs for olanzapine + samidorphan (Lybalvi)? (2)

same as olanzapine, risk of opioid withdrawal

What formulations are available for olanzapine + samidorphan (Lybalvi)?

tablet

What are AEs for paliperidone (Invega)? (6)

QTc prolongation, GI obstruction, priapism, thrombotic thrombocytopenic purpura (TTP), antiemetic effects, tablet shells in feces

What formulations are available for paliperidone (Invega)?

tablet, LAI

What is the indication for pimavanserin (Nuplazid)?

hallucinations/delusions in Parkinson's Disease

What are AEs for pimavanserin (Nuplazid)? (2)

renal function, QTc prolongation

What formulations are available for pimavanserin (Nuplazid)?

tablet

What are AEs for quetiapine (Seroquel)? (6)

metabolic, sedating (off-label use for insomnia INAPPROPRIATE), cataracts, hypothyroidism, QTc prolongation, anticholinergic effects

What formulations are available for quetiapine (Seroquel)?

tablet

What are AEs for risperidone (Risperidal)? (5)

prolactin elevation, EPS, priapism, thrombotic thrombocytopenic purpura (TTP), antiemetic effects

What formulations are available for risperidone (Risperidal)?

tablet, ODT, solution, LAI

What are AEs for ziprasidone (Geodon)? (4)

DRESS, SJS, QTc prolongation, priapism

What formulations are available for ziprasidone (Geodon)?

tablet, short acting injection

What is the treatment for individuals with first-break schizophrenia? (3)

aripiprazole (Abilify), risperidone (Risperidal), ziprasidone (Geodon)

What is the treatment for individuals restarting medications for schizophrenia?

any antipsychotic except clozapine or previously tried APS that worked poorly

What are indications for early use of clozapine? (3)

severely suicidal, EPS, history of violence/substance abuse

When may clozapine be considered for use as a monotherapy regularly?

Patients that fail other APS

Which FGAs have the lowest and highest EPS risk, respectively?

lowest = thioridazine (Mellaril) and chlorpromazine (Thorazine), highest = haloperidol (Haldol) and fluphenazine (Prolixin)

Which FGAs have the lowest and highest anticholinergic risk, respectively?

lowest = haloperidol (Haldol) and fluphenazine (Prolixin), highest = thioridazine (Mellaril) and chlorpromazine (Thorazine)

What is the indication for dexmedetomidine (Igalmi)?

acute agitation in adults with schizophrenia and bipolar disorders

What is the MOA for dexmedetomidine (Igalmi)?

alpha-2 adrenergic receptor agonist

What are the LAI FGAs? (2)

fluphenazine (Prolixin), haloperidol (Haldol)

What are the LAI SGAs? (4)

aripiprazole (Abilify), risperidone (Risperidal), paliperidone (Invega), olanzapine (Zyprexa)

Which SGAs are most likely to cause weight gain? (3)

olanzapine (Zyprexa), quetiapine (Seroquel), and clozapine (Clozaril, Fazaclo)

Explain acute dystonias?

painful prolonged muscle contractions, involuntary facial and oculogyric movements, may involve back or legs

Explain pseudo-parkinsonism?

bradykinesia, tremors, cogwheel rigidity and pill rolling, postural abnormalities

Explain akathisia?

restlessness, pacing/shuffling, complusitory motions, subjective feelings of distress

Explain tardive dyskinesia?

tongue thrusting, chewing, lip smacking, grimacing, limb twisting, rocking

What is the treatment for acute dystonia?

anticholinergics, IM benzodiazepines

What is the treatment for pseudo-parkinsonism?

anticholinergics

What is the treatment for akathisia?

beta blockers

What is the treatment for tardive dykinesia?

prevention

What is the treatment for neuroleptic malignant syndrome (NMS)?

discontinue offending APS and give dopamine agonists

What is the MOA of VMAT2s?

reversible reductions in dopamine release and availability to hypersensitive postsynaptic receptors

What are the VMAT2s? (2)

valbenazine (Ingrezza) and deutetrabenazine (Austedo)

Exam 3 - Schizophrenia Flashcards

(63 cards)