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Therapeutics III > Exam 4 - Ott Schizophrenia > Flashcards

Exam 4 - Ott Schizophrenia Flashcards

1
Q

Key features of Schizophrenia (5)

A

positiveSx:
-delusions
-hallucinations
-disorganized thoughts and speech
-disorganized or abnormal motor behavior
negative Sx

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2
Q

Typical disease course in schizophrenia (3)

A

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

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3
Q

Marijuana, cocaine, and amphetamine use can _____ the onset of schizophrenia, exacerbate symptoms, and ______ time to relapse

A

hasten, reduce

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4
Q

considerations with antipsychotic drug therapy (6)
-no step therapy

A

doses per day
SE
previous drug therapy
cost
concomitant disease drug therapy
need for monitoring: labs? weight? ECG?

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5
Q

most common antipsychotic agent used

A

haloperidol (ruotine and prn use)
-typical antipsychotic

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6
Q

Which agents, atypical or typical, cause more EPS?

A

more EPS seen in higher potency typicals

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7
Q

which is more effective for treating positive Sx, typical or atypical?

A

typical, however, they are more likely to worsen negative and cognitive Sx

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8
Q

partial agonists (aripiprazole, brexpiprazole, cariprazine) have ______ for akathisia (increased/decreased)

A

increased

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9
Q

partial agonists (aripiprazole, brexpiprazole, cariprazine) are approved for adjunct tx in _____ and come with a boxed warning for ________

A

depression, suicidal thinking

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10
Q

aripiprazole considerations (3)

A

2D6 and 3A4 substrate
moderate akathisia
low weight gain

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11
Q

brexpiprazole considerations (3)

A

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

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12
Q

cariprazine considerations (3)

A

3A4 substrate
moderate akathisia
low-moderate weight gain

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13
Q

the “pine’s” considerations (asenapine, clozapine, olanzapine, quetiapine) (4)

A

more 5HT2A antagonism, less D2 antagonism
less EPS
more weight gains
smoking is not a CI but still warn pts to be cautious

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14
Q

asenapine considerations (3)

A

patch (q24h, rotate sites) and SL tab
1A2 substrate
QTc prolongation

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15
Q

clozapine substrate

A

1A2 substrate

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16
Q

clozapine boxed warnings

A

bradycardia, syncope, seizures, myocarditis, cardiomyopathy

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17
Q

clozapine SE

A

sedation, weight gain (most of all of pines), constipation, hypersalivation, dry mouth, QTc prolongation

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18
Q

olanzapine

A

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

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19
Q

quetiapine

A

3A4 substrate
QTc prolongation
weight gain and sedation
boxed warning for suicidal ideation

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20
Q

clozapine monitoring timelines for ANC (absolute neutrophil count) due to risk of infection

A

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

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21
Q

normal ANC level on clozapine

A

1500 per microliter

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22
Q

Samidorphan (olanzapine/samidorphan combo product) acts on ______ receptors and can cause _______

A

opioid, opioid withdrawal

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23
Q

the “done’s” (iloperidone, lurasidone, ziprasidone, risperidone, paliperidone)

A

D2 and 5HT2A antagonists
variable EPS and metabolic effects

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24
Q

iloperidone considerations

A

high risk for orthostasis and syncope
QTc prolongation
2D6 substrate

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25
Q

lurasidone considerations

A

3A4 substrate
higher risk for akathisia
warning for suicidal thoughts - adjunct for bipolar depression
take with FOOD (to increase bioavailability)

26
Q

ziprasidone considerations

A

QTc prolongation (CI)
DRESS warning
take with FOOD (to increase absorption and bioavailability)
3A4 substrate (less worry for interactions)

27
Q

risperidone considerations

A

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

28
Q

paliperidone considerations (3)

A

renally eliminated - dose adjustments in renal impairment
SE: EPS, hyperprolactinemia, weight gain, sedation, orthostasis
QTc prolongation

29
Q

lumateperone considerations (3)

A

low risk for weight gain or metabolic SE
low risk for EPS or akathisia
3A4 substrate

30
Q

Pimavanserin considerations (3)

A

FDA approved for tx of hallucinations or delusions in a pt with PD
MOA: inverse agonist and antagonist at the 5HT2A receptor
3A4 substrate

31
Q

warnings for all antipsychotics (5)

A

boxed warning: increased risk of death in elderly patients treated with antipsychotics for dementia
metabolic AE
EPS
increased risk of falls

32
Q

Risperdal Consta (risperidone) considerations (1)

A

MUST supplment with oral risperidone for first few weeks of treatment (until 3rd injection)

33
Q

Perseris (risperidone) considerations (2)

A

abdominal injection every 4 weeks
with 3A4 inducers use 120mg or oral supplmentation

34
Q

Rykindo (risperidone) considerations (2)

A

every 2 weeks IM injection
oral overlap is 1 week (compared to 3 with Risperdal Consta)

35
Q

Uzedy (risperidone) considerations (2)

A

ab or upper arm SQ injection
once a month or once every 2 months

36
Q

Invega Sustenna (paliperidone) considerations (4)

A

loading dose, then booster, then every 4 weeks
initial loading and booster doses must be given in deltoid to improve absorption
no oral overlap
caution in renal impairment

37
Q

Invega Trinza (paliperidone) considerations (3)

A

may only be initiated for a pt who has been on stable monthly IM injection of Invega Sustenna for 4 injections (this one given q3months)
deltoid administration recommended
DO NOT USE in CrCl <50

38
Q

Invega Hafyera (paliperidone) considerations (2)

A

glute injection only
may be initiated after stable Invega Sustenna for 4 months or Invega Trinza for 1 month

39
Q

Zyprexa Relprevv (olanzapine) considerations (1)

A

PDSS - post dose delirium sedation syndrome

40
Q

Abilify Maintena (aripiprazole) considerations (2)

A

MUST overlap with oral for 14 days
deltoid or glute injection

41
Q

Abilify Asimtufii (aripiprazole) considerations (3)

A

q2months dosing
glute injection
oral aripiprazole overlap for 2 weeks

42
Q

Aristada (aripiprazole leuroxil) considertions (1)

A

overlap with oral for 3 weeks

43
Q

Aristada Initio considerations (2)

A

developed to avoid need for 21 day oral overlap
avoid in pts who are 2D6 poor metabolizers or strong 3A4 or 2D6 inhibitors

44
Q

IR antipsychotic injections for emergencies (3 drugs)

A

haloperidol - most common
chlorpromazine
fluphenazine

45
Q

olanzapine IM immediate release cannot be given with ________ due to boxed warning for respiratory depression

A

benzodiazapine immediate release injections

46
Q

EPS seen in schizophrenia (4)

A

acute dystonia
Drug-induced PD
akathisia
tardive dyskinesia

47
Q

acute dystonia tx strategy

A

IM anticholinergic NOW (benztropine 2mg, diphenhydramine 50mg)

48
Q

drug induced PD tx strategy

A

oral anticholinergic (benztropine, trihexyphenidyl, diphenhydramine)

49
Q

akathisia tx strategy

A

propranolol is 1st line
lorazepam 2nd line

50
Q

tardive dyskinesia tx strategy

A

VMAT inhibitors

51
Q

VMAT inhibitors

A

tetrabenazine (Xenazine)
valbenazine (Ingrezza)
deutetrabenazine (Austedo)

52
Q

valbenazine (Ingrezza)

A

2D6/3A4 substrate
QTc prolongation

53
Q

deutetrabenazine (Austedo)

A

2D6 substrate
QTc prolongation

54
Q

Neuroleptic Malignant Syndrome

A

life threatening medical emergency caused by dopamine blockade from antipsychotics
hyperpyrexia, tachycardia, labile BP
muscle rigidity
may use antipsychotics again in the future (not CI)

55
Q

Metabolic AE

A

hyperglycemia, hyperlipidemia, hypertension
weight gain

56
Q

rank the atypical antipsychotics from most metabolic AE to least

A

clozapine = olanzapine >

quetiapine = risperidone = paliperidone = asenapine = iloperidone = cariprazine = brexpiprazole >

ziprazidone = lurasidone = aripiprazole

57
Q

Metabolic Monitoring - personal or fam Hx

A

assess at baseline, then yearly

58
Q

Metabolic Monitoring - weight (BMI)

A

at baseline, 4 weeks, 8 weeks, 12 weeks, every 3 months

59
Q

Metabolic Monitoring - waist circumference

A

at baseline, then yearly

60
Q

Metabolic Monitoring - BP

A

at baseline, 12 weeks, then yearly

61
Q

Metabolic Monitoring - FPG/A1c

A

at baseline, 12 weeks, then yearly

62
Q

Metabolic Monitoring - fasting lipids

A

at baseline, 12 weeks, then every 5 years

Therapeutics III (22 decks)

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