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PR3153 > IC10 > Flashcards

IC10 Flashcards

1
Q

symptoms of Schizophrenia

A

See DSM-4 criteria (pg10)

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2
Q

1st-line antipsychotics for psychosis treatment

A

Suitable non-clozapine antipsychotic (FGA or SGA)

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3
Q

When to use clozapine

A

failed ≥ 2 adequate trials of different antipsychotics (at least 1 should be a SGA)

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4
Q

methods to overcome poor treatment
adherence

A
  • IM long-acting injections
  • Community Psychiatric Nurse – home visit and administer LAI regularly
  • Patient and Family (Caregiver) Education
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5
Q

affective disorder means

A

mood disorders (e.g. psychotic depression)

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6
Q

Schizophrenia: Primary pathophysiological abnormality may occur in one of various neurotransmitters: ______

A

dysregulation of dopaminergic (DA), serotonergic (5HT) and glutamatergic functions

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7
Q

Drugs/ substances that could induce psychosis

A

alcohol, benzodiazepines, barbiturates, antidepressants, corticosteroids, CNS stimulants, Hallucinogens, BB, dopamine agonists

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8
Q

How often should MSE be performed?

A

Every visit / every time u see the patient

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9
Q

What non-pharm therapy can reduce auditory hallucinations?

A

Repetitive Transcranial Magnetic Stimulation

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10
Q

What is Electroconvulsive Therapy (ECT) reserved for?

A

treatment-resistant Schizophrenia

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11
Q

Is LT treatment necessary aft 1st episode of psychosis?

A

Yes

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12
Q

How long does relapse occur after cessation of treatment?

A

often delayed for several weeks, as Adipose tissues act as depot reservoir after chronic regular usage of antipsychotics

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13
Q

How do antipsychotics help with schizophrenia?

A

They relieve symptoms of psychosis such as thought disorder, hallucinations and delusions, and prevent relapse

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14
Q

Dopamine blockade in___ of the anterior pituitary leads to hyperprolactinemia

A

Tuberoinfundibular (TI) Tract

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15
Q

Overactivity in ____ is responsible for positive symptoms of Schizophrenia.

A

mesolimbic tract

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16
Q

MOA of antipsychotics

A

Blocks dopamine receptors in mesolimbic tract

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17
Q

Which tract is responsible for higher-order thinking and executive functions?

A

Mesocortical tract

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18
Q

Dopamine blockade/ hypofunction in mesocortical tract results in _____

A

negative symptoms

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19
Q

Which tract modulates body movement?

A

Nigrostriatal tract

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20
Q

Dopamine blockade in nigrostriatal tract results in ____

A

extrapyramidal side effects

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21
Q

Antagonism of M1 receptor results in ____

A

Anticholinergic effects

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22
Q

Antagonism of alpha 1 receptor results in ____

A

Orthostasis

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23
Q

Antagonism of H1 receptor results in _____

A

Sedation

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24
Q

Antagonism of 5-HT2c receptor results in ____

A

Weight gain

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25
Q

How long is the trial for non-clozapine antipsychotic?

A

At least 2-6 weeks at optimal therapeutic dose

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26
Q

How long is the trial for clozapine?

A

Up to 3 months

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27
Q

How long is the trial for antipsychotic added to clozapine?

A

Up to 8-10 weeks

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28
Q

What to consider when selecting an antipsychotic for the patient?

A
  • past response/ failure
  • efficacy
  • side effect
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29
Q

What to monitor patients for those on clozapine?

A

Mandatory routine hematological monitoring

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30
Q

When to check ECG for schizo patients?

A
  1. Has CV risk factors
  2. Hx of CVD
  3. Admitted as inpatient as naiive to antipsychotics
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31
Q

Contraindication for antipsychotic

A

QTc prolongation

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32
Q

Precaution to use of antipsychotic

A

– Parkinson’s (incr ESPE)
– Prostatic hypertrophy
– Angle-closure glaucoma
– Severe respiratory disease
– Elderly w dementia (incr risk of mortality & stroke)

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33
Q

Dose for lorazepam in acute agitation tx

A

1-2mg

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34
Q

Possible tx for acute agitation (if pt cooperative)

A
  1. Oral lorazepam
  2. Oral antipsychotics (haloperidol, risperidone, quetiapine, olanzapine)
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35
Q

Possible tx for acute agitation (if pt un-cooperative)

A
  1. IM lorazepam
  2. IM Olanzapine (space 1h from IM lorazepam)
  3. IM haloperidol (consider use of anticholinergic)
  4. IM promethazine (cause sedation)
36
Q

Tx for catatonia (frozen in thoughts)

A

Benzodiazepines: IM/PO lorazepam

37
Q

tmax of antipsychotics

A

mostly 1-3h (except Brexpiprazole, Olanzapine, Aripiprazole)

38
Q

t1/2 of antipsychotics

A

long t1/2 (can give once daily dosing), except some

39
Q

Risk when consolidating doses

A

Hypotension & seizures

40
Q

Initiation dose for haloperidol

A

0.5 – 3 mg BD or TDS
or 3 – 5 mg BD or TDS (severe symptoms)

41
Q

Usual adult dose for haloperidol

A

5-15mg

42
Q

Max dose for haloperidol

A

20 mg (oral)

43
Q

Max dose for CLOZAPINE

A

900mg

44
Q

Starting dose for CLOZAPINE

A

12.5 mg ON/BD (day 1), 25-50 mg ON (day 2), increase gradually if well tolerated in steps of 25-50 mg/day

45
Q

Starting dose for OLANZAPINE

A

10mg/day

46
Q

Usual dose for OLANZAPINE

A

5-20mg

47
Q

Max dose for QUETIAPINE

A

800 mg

48
Q

Starting dose for RISPERIDONE

A

2mg/day in 1 -2 divided doses

49
Q

Usual dose for RISPERIDONE

A

2-6mg

50
Q

Max dose for RISPERIDONE

A

16mg/day

51
Q

Major metaboliser of risperidone

A

CYP2D6

52
Q

Active metabolite of risperidone

A

Paliperidone (9-hydroxy)

53
Q

Examples of long-acting IM antipsychotics inj

A

Haloperidol decanoate, risperidone long-acting, paliperidone prolonged-release

54
Q

Dystonia clinical presentation

A

Muscle spasm e.g. oculogyric crisis, torticollis

55
Q

Which antipsychotic has a high potency?

A

Haloperidol

56
Q

Management for dystonia

A

IM anticholinergic e.g. benztropine, diphenhydramine

57
Q

Who has higher risk of developing Pseudo-parkinsonism?

A

Elderly females, those with previous neurological damage (e.g. head injury, stroke)

58
Q

Management of Pseudo-parkinsonism

A
  1. Reduce antipsychotic dose, or switch to SGA
  2. Anticholinergic PRN
59
Q

Akathisia clinical presentation

A

Restlessness

60
Q

Which ESPE have a late onset?

A

Tardive dyskinesia

61
Q

Tardive dyskinesia clinical presentation

A

Uncontrollable orofacial movements

62
Q

Anticholinergic drugs worsen which ESPE?

A

Tardive dyskinesia

63
Q

Management for hyperprolactinemia

A

-decr FGA dose
-Dopamine agonist (e.g. amantadine, bromocriptine)
-Switch to Aripiprazole

64
Q

Antipsychotics with high risk of metabolic SE

A

Olanzapine, clozapine

65
Q

Antipsychotics with lower risk of metabolic SE

A

Aripiprazole, Lurasidone, haloperidol, Ziprasidone

66
Q

Signs of Neuroleptic malignant syndrome (NMS)

A

Muscle rigidity, fever, autonomic dysfunction (incr PR, labile BP, diaphoresis), altered consciousness, incr CK

67
Q

Management for NMS

A

-IV Dantrolene 50mg TDS, oral dopamine agonist (e.g. amantadine, bromocriptine), supportive measures.
-Switch to SGA

68
Q

When to discontinue antipsychotic for haematological disturbances?

A

WBC<3x10^9/L or ANC<1.5x10^9/L

69
Q

Which drug req ECG monitoring

A

Ziprasidone

70
Q

Monitoring freq for WBC and ANC for clozapine

A

Weekly for first 18 weeks, then monthly

71
Q

Monitoring freq for EPSE exam

A

-Weekly for 1st 2 weeks after initiation new antipsychotic or until dose stabilized
-Low-risk patients: FGA q6 months;SGA q12 months -High-risk patients: FGA: q3 months; SGA q12 months

72
Q

Monitoring freq for BP

A

3 months after initiating SGA then annually

73
Q

Monitoring freq for lipid panel

A

-Low-risk patients: q2-5 years
-High-risk patients: (3 months after initiating SGA), q6 months

74
Q

Monitoring freq for BMI

A

-Weekly for 1st six weeks or every visit (at least monthly x 3 months for SGA) x 6 months
-q3 months when dose stabilized

75
Q

Monitoring freq for waist circumference

A
  • every visit x 6 months, then annually
76
Q

Monitoring freq for Fasting Blood Sugar

A

-Low-risk patients: annually
-High-risk patients: 4 months after initiating new
antipsychotic (or 3 months after initiating SGA), then annually

77
Q

Preferred antipsych for pregnancy & what to monitor

A

Olanzapine,Clozapine,to watch for gestational diabetes

78
Q

Preferred antipsych for breastfeeding

A

Olanzapine or Quetiapine

79
Q

Can clozapine be used for breastfeeding?

A

patients on Clozapine should continue on the drug and not breastfeed

80
Q

Preferred antipsych in renal impairment & what to avoid

A

Oral Aripiprazole preferred; Avoid sulpiride and Amisulpride

81
Q

Preferred antipsych in hepatic impairment

A

Sulpiride, Amisulpride preferred

82
Q

How to monitor effectiveness for therapy

A

MSE

83
Q

Time course of tx response

A

1st wk: decr agitation
2nd-4th wk: decr paranoia, hallucination
6-12 wk: decr delusion, -ve sx may improve
3-6 months: cognitive sx may improve with SGA

84
Q

Which type of SGA generally have more sedation/ weight gain SE?

A

-ines e.g. clozapine, olanzapine, quetiapine

85
Q

____ antagonism can help improve negative sx

A

5HT2A

PR3153 (17 decks)

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