Exam 3 - Schizophrenia (Watts/Ott) Flashcards
(115 cards)
1
Q
what are the positive symptoms
A
hallucinations
delusions
bizarre behavior
thought disorders
2
Q
what are the negative symptoms
A
blunted emotion
poor self care
social withdrawal
poverty in speech
3
Q
Cognitive symptoms involve ______ receptors and _____ receptors
A
D1 receptors; Glutamate Receptors
4
Q
what neurotransmitters are to be involved in schizophrenia
A
dopamine
serotonin
glutamate
5
Q
do positive or negative symptoms respond better to drug therapy
A
positive!
negative has like no response
6
Q
what 5HT receptor is known as the mediator for hallucinations
A
5HT 2A
7
Q
5HT2A receptors modulate _______ release in the cortex, limbic region, and striatum
A
dopamine
8
Q
5HT2A receptors modulate dopamine release in what area?
A
cortex, limbic region, and striatum
9
Q
5HT2A receptors modulate _______ release and ______ receptors
A
glutamate; NMDA
10
Q
what kind of agents can exacerbate symptoms of schizophrenia
A
dopaminergic
L-DOPA, Amphetamine, Bromocriptine
11
Q
what is the major receptor antagonized by antipsyhchotics
A
dopamine!
MAINLY D2
12
Q
newer antipsychotics also antagonize what receptor?
A
serotonin
13
Q
what are other (aka minor) receptors that antipsychotics antagonize?
A
NE, ACh, Histamine
14
Q
most antipsychotic drugs are (agonist, partial agonist, or antagonist?)
A
Antagonist!!
15
Q
D1 or D2 receptors have more correlation b/w binding potency and clinical effectiveness
A
D2!!
16
Q
when D2 antagonism occurs in the basal ganglia — what effects are seen?
A
EPS/motor effects
17
Q
what are symptoms of EPS
A
dystonia
pseudoparkinsonism
tremor
aktahisia
18
Q
what is akathisia
A
restlessness
19
Q
what is dystonia
A
increase muscle tone
20
Q
are EPS symptoms form antipsychotics reversible?
A
yes
21
Q
when do EPS symptoms occur when an antipsychotic is started
A
days to weeks
early on!
22
Q
what are symptoms of tardive dyskinesia?
A
rhythmic involuntary movements
irregular purposelessness
athetoid (worm like)
axial hyperkinesias (to and fro)
23
Q
are tardive dyskinesia symptoms form antipsychotics reversible?
A
no!
24
Q
when do tardive dyskinesia symptoms occur when an antipsychotic is started
A
later!
months to a year
25
what is NMS side effect from antipsychotic?
neuroleptic malignant syndrome
serious/rapid (fatality)
(EPS + Fever)
26
Antipsychotic drugs take about how long for effectiveness?
2- 3 weeks
27
Antipsychotic drugs take about how long for maximal effectiveness
6 weeks to 6 months...
28
ADE's of Antipsychotics: Autonomic
| when Muscarinic cholinoreceptors are blocked what are the manifestations?
dry mouth
difficulty urinating
constipation
loss of accommodation (eye)
29
ADE's of Antipsychotics: Autonomic
| when alpha adrenergic blockade occurs what are the manifestations?
orthostasis hypotension
impotence
failure to ejaculate
30
ADE's of Antipsychotics: CNS
| when dopamine receptor blockade occurs --- what are the manifestations?
parkinson's syndrome
aktahasia
dystonia
31
ADE's of Antipsychotics: CNS
| if supersensitvity of dopamine receptors occur --- what is the manifestation?
tardive dyskinesia
32
ADE's of Antipsychotics: CNS
| if muscarinic blockade happens - what is the manifestation? (CNS!!*)
toxic - confusional state
33
ADE's of Antipsychotics: CBS
| if histamine receptors are blocked - what is the clinical manifestation?
sedation
34
ADE's of Antipsychotics: Endocrine System
| what is the manifestation when dopamine receptors are blocked (causing hypoerprolactonemia)
ameorrhea
galactorhea
infertility
impotence
35
ADE's of Antipsychotics:
| when combined H1 and 5HT(2C) blockade occurs --- what is the manifestation
weight gain
36
which drug was the first typical antipsychotic?
chlorpromazine
37
Key Points for Chlorpromazine?
| Watts Table
1st antipsychotic
| antihistamine side effects
38
Key Points for Promethazine
| Watts Table
antihistamine
| antiemetic
39
Key Points for Thioridazine
| Watts Table
Anticholinergic
sedation
sexual dysfunction
cardiovascular
40
Key Points for Fluephenazine
| Watts Table
EPS
41
Key Points for Prochlorperazine
| Watts Table
Antiemetic
42
Key Points for Perphenazine
| Watts Table
CATIE Studies =
| Combo w/ anticholinergic vs newer agents
43
Key Points for Thiothixene
| Watts Table
modest EPS
44
Key points for haloperidol
| Watts Table
EPS
45
Key Points for Molindone
| Watts Table
moderate EPS
46
Key Points for Pimozide
| Watts Table
used for tourette's disease, suppress motor and vocal tics
47
what drug was the first atypical antipsychotic
clozapine
48
biggest side effect with clozapine
agranulocytosis
49
Clozapine & Agranulocytosis
| occurs when?
1 -2 % get it first 6 mos
50
why is aripiprazole's MOA so different?
partial agonist at 5HT(1A) (and D2?)
| aka a receptor involved in depression
51
what drugs are partial D2/D3 agonist
Brexpiprazole
| Cariprazine
52
key points for clozapine (watts table)
1st atypical antipsychotic
agranulocytosis
risk of diabetes
53
key points for Olanzapine (watts table)
weight gain
| risk of diabetes
54
key points for quetiapine (watts table)
metabolite w/ antidepressant activity
hypotension
sedation
55
key points for risperdone (watts table)
5HT2A/D2 receptor antagonist
56
key points for ziprasidone (watts table)
5HT2A/D2/alpha1 affinity
| prolongs QT interval
57
key points for Lurasidone (watts table)
5HT2A/D2
reduced metabolic effects
rapid titration
58
key points for Aripiprazole (watts table)
high 5HT2A/D2 affinity
| partial agonist activity
59
Key Features that define psychotic disorders
```
delusions
hallucinations
disorganized thinking
disorganized abnormal motor behavior
negative
```
60
what drugs can hasten the onset of schizophrenia/exacerbate symptoms, AND reduce time to relapse
marijuana
cocaine
amphetamines
61
oral antipsychotic therapy or IM depot drug treatment is first line?
oral is first line
62
Aripiprazole: long or short half life?
long
63
Aripiprazole - P450 interactions?
2D6 and 3A4 substrate
64
T or F: LAIs of Aripriprazole need dosing adjustment if given with 2D6/3A4 inhibitors or 3A4 inducers
truuuue
65
T or F: Aripiprazole does not need oral overlap with LAI?
FALSE!! need overlap the Ability Maintena and Aristada
66
Aripiprazole Oral/LAI Overlap:
Abilify Maintena needs ______ overlap
and
Aristada needs _____ overlap
(how long of overlap?)
Maintena: 2 - weeks
Aristada: 3 - weeks
67
Asenapine:
| what formulation only?
sublingual
68
Asenapine: P450 interaction?
1A2
69
Asenapine: Clinical Considerations?
QT prolonging
metallic tasta/unit dose packaging
smoking decrease concentration
caffeine can increase concentration
70
Brexpiprazole: once or twice daily dosing?
once
71
Brexpiprazole or Aripiprazole?
| which one has a higher incidence of akathisia
Aripiprazole
72
Brexpiprazole: P450 interactions?
2D6 and 3A4 substrate
| just like aripiprazole
73
Brexpiprazole Clinical Considerations?
P450 2D6 or 3A4 substrates
once daily dosing
Max Dose 4 mg (or 3mg if severe hepatic dysfunction or CrCl < 60 mL/min)
74
Cariprazine: P450?
3A4 substrate
75
Cariprazine: Max dose?
6 mg QD
76
Cariprazine: higher doses mean higher risk of _______ but not _______
akathisia risk increases
| higher doses does NOT lead to more efficacy
77
Cariprazine: dose adjustments?
not recommended in severe hepatic impairment or CrCl < 30 mL/min
78
Side Effects of Clozapine?
```
AGRANULOCYTOSIS
cardiomyopathy
hypersalivation
hypotension
metabolic syndrome
QT prolongation
constipation
sedation
```
79
which drugs has to have REMS program
Clozapine
80
what is the monitoring requirements for Clozapine
ANC weekly x 6 mos
ANC biweekly x 6 mos
then
every 4 weeks forever
81
Iloperidone ADEs?
boxed warning for QT prolongation
orthostatic hypotension!!
slow dose titration
82
Iloperidone: once or twice daily dosing?
TWICE Daily!!
83
Iloperidone P450 interactions?
2D6 and 3A4 substrate
84
Lurasidone: once or daily dosing?
once daily
85
usual max dose of Lurasidone
160 mg
86
for Lurasidone dosing: if moderate hepatic impairment or CrCl < 50 mL/min: max dose?
80 mg
87
for Lurasidone dosing: if severe hepatic impairment what is the max dose?
40 mg
88
Olanzapine: once or twice daily dosing?
both..
89
Olanzapine: best time to take the medication?
bedtime --- because sedation
90
ADEs of olanzapine?
sedation
hyperglycemia/hyperlipidemia
metabolic syndrome
anticholinergic ADEs at higher doses
91
P450 of Olanzapine?
1A2 substrate
92
what two meds MUST be taken with food (to improve bioavailability)
Lurasidone
| Ziprasidone
93
what drugs are 1A2 substrates
Olanzapine
Asenapine
Clozapine
94
which drugs have renal or hepatic dosing adjustments
brexpiprazole
cariprazine
lurasidone
(paliperidone - is renal only)
95
what drug will have a ghost capsule?
Paliperidone
96
Paliperidone --- what are the IM formulations available?
Invega Sustenna
| Invega Trinza
97
Paliperidone ----
Invega Sustenna given IM every _____ weeks
Invega Trinza given IM every _____ weeks
sustenna: q 4 weeks
trinza: q 12 weeks
98
Paliperidone ---
| can only do Invega Trinza if ???
patient has been stable Invega Sustenna 4 stable maintenance doses
99
Risperidone: has higher risks of what?
EPS and hyperprolactinemia
100
P450 interaction for risperdone?
2D6
101
which drug has 2D6 interactions only?
risperidone
102
Ziprasidone usually ______ dosing but can be ___
usually twice; can be once
103
Clinical Considerations of Ziprasidone?
twice daily
MUST TAKE WITH FOOD
QT prolongation
Dress warning
104
what is the drug Pimavanserin used for?
"antipsychotic" for parkinson patients having hallucinations
105
ADEs for pimavanserin
peripheral edema
confusional states
nausea
rare angioedema
106
Clozapine and REMS:
| patients can start the drug if their ANC level is greater than ________
1500 /uL
107
what IM drugs are oil based
Fluphenazine
| Haloperidol
108
what drug has to be refrigerated and reconstituted
Risperdal Consta
109
what drug can have PDSS from IM injection
Zyprexa Relprevv
110
what is PDSS
post dose delirium sedation syndrome
| monitor for 3 hours after dose
111
4 main types of EPS
Acute Dystonia
Drug Induced Parkinson's
Akathisia
Tardive Dyskinesia (
112
how to treat acute dystonia
IM anticholinergic now
can do 50 mg of benadryl
113
who is at highest risk for acute dystonia
young, black, male
114
how to treat akathisisa
```
beta blocker (propranolol)
BZD - prn dosing
Oral anticholinergic (not too effective)
try to lower dose of antipsychotic if possible
```
115
how to treat tardive dyskinesia
lower antipsychotic dose if possible,
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