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Pharm 845 Exam #3 > Psychotic Disorders- Dr. Campbell > Flashcards

Psychotic Disorders- Dr. Campbell Flashcards

1
Q

Schizophrenia definition

A
  • Two or more of the following symptoms
  • Delusion
  • Hallucination
  • Disorganized speech
  • Grossly disorganized
  • Negative symptoms
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2
Q

Schizoaffective disorder

A
  • Presence of major mood episode (Mania)
  • Presence of delusion or hallucination for 2 or more weeks
  • Basically Schizophrenia + mood disorder
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3
Q

Positive symptoms

A
  • Not generally seen in healthy pts
  • Hallucinations
  • Delusions
  • Thought disorders
  • Movement disorders
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4
Q

Negative symptoms

A
  • Absent features generally present in healthy pts
  • Blunted or flat affect
  • Anhedonia
  • Avolition
  • Poverty of speech
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5
Q

Cognitive Symptoms

A
  • Not required for diagnosis
  • Poor ability to process information to make a decision
  • Difficulty paying attention
  • Working memory impairment
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6
Q

Treatment goals

A
  • Reduce or eliminate symptoms
  • Maximize quality of life
  • Promote and maintain recovery
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7
Q

Acute treatment goals

A
  • Ensure safety
  • Reduce agitation
  • Relieve detrimental effects
  • Improve thought processes
  • Decrease social withdrawal
  • Evaluate secondary health conditions
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8
Q

Chronic treatment goals

A
  • Minimize symptoms
  • Improve social function
  • Maintain safe living environment
  • Manage chronic health conditions
  • Minimize drug side effects
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9
Q

Which FGAs come as long acting injectables

A
  • Haloperidol

- Fluphenazine

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10
Q

Which SGAs come as long acting injectables

A
  • Aripiprazole
  • Olanzapine
  • Paliperidone
  • Risperidone
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11
Q

Therapeutic effects and side effects of D2 antagonist

A
  • Reduce + Symptoms
  • EPS
  • Increased - symptoms
  • Hyperprolactinemia
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12
Q

Therapeutic effects and side effects of alpha 2 agonists

A
  • Reduce nightmares
  • Dizziness
  • Sedation
  • Hypotension
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13
Q

Therapeutic effects and side effects of M1

A
  • Reduces EPS
  • Constipation
  • Sedation
  • Dry mouth
  • Blurred vision
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14
Q

Therapeutic effects and side effects of M2

A
  • Reduces EPS
  • Cardiometabolic
  • Constipation
  • Sedation
  • Dry mouth
  • Blurred vision
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15
Q

Therapeutic effects and side effects of H1 antagonist

A
  • Hypnotic
  • Cardiometabolic
  • Sedation
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16
Q

Extrapyramidal Symptoms (EPS)

A
  • More prevalent with FGAs> SGAs
  • Akathisia: restlessness
  • Pseudoparkinsonism
  • Acute dystonia
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17
Q

Tardive Dyskinesia

A

-Involuntary, repetitive, potentially irreversible
-Cause: induced D2 receptor hypersensitivity
(Clozapine or quetiapine are preferred alternatives)

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18
Q

Which antipsychotics are least likely to cause QTc prolongation

A
  • Aripiprazole

- Lurasidone

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19
Q

Which antipsychotics are most likely to cause QTc prolongation

A
  • Thioridazine

- Ziprasidone

20
Q

Metabolic Complications

A
  • Increased weight
  • Increased fasting lipids
  • Increased fasting glucose
21
Q

Drugs with the Highest metabolic risk

A
  • Clozapine
  • Olanzapine
  • Quetiapine
22
Q

Drugs with the lowest metabolic risk

A
  • Aripiprazole
  • Cariprazine
  • Lurasidone
  • Brexpiprazole
23
Q

Treatment of Metabolic complications

A
  • Diet
  • Exercise
  • Prophylactic Metformin
  • Possible statin therapy
24
Q

Acute control of psychotic agitation

A
  • Provide environment with minimal stimulation
  • Avoid physical restraints
  • Attempt oral meds before IM
  • Place on direct observation
25
Q

Acute control of psychotic agitation 5-2-1 method

A
  • 5mg haloperidol
  • 2mg lorazepam
  • 1mg benztropine
26
Q

Acute control of psychotic agitation B52 method

A
  • 50mg Benadryl
  • 5mg Haloperidol
  • 2mg Lorazepam
27
Q

What can you use instead of haloperidol and anticholinergic for acute control of psychotic agitation?

A

-Olanzapine

28
Q

Olanzapine benzo interaction

A
  • IM olanzapine + IV benzos
  • Leads to excessive sedation
  • Avoid administration with in one hour of each other
29
Q

Texas Medication Algorithm Project

A
  • Stage 1: Single SGA
  • Stage 2: Different SGA or FGA
  • Stage 3: Clozapine
  • Stage 4: Add SGA/FGA/ETC to Clozapine
  • Stage 5: Try a single SGA/FGA that has not already been tried
  • Stage 6: Combine any/all of the above
30
Q

Special Considerations: First episode of psychosis

A
  • Consider a SGA

- Try using a lower dose

31
Q

Special Considerations: when using Clozapine

A
  • Indicated when:
  • Comorbid Parkinson’s
  • Development of TD
32
Q

Special Considerations: when using ETC

A
  • Indicated when:
  • Failure of Clozapine
  • Catatonia
  • Persistent suicidality
33
Q

Special Considerations: when using long acting ejectable

A

-Indicated with repeated medication non adherence

34
Q

Basics of Long acting injectables

A
  • Prolonged absorption over several weeks
  • Exhibit absorption dependent kinetics
  • Must verify effect and tolerability with oral agent first!
35
Q

Benefits of Long acting injectables

A
  • Increased medication adherence
  • Reduced relapse and readmission rates
  • Impossible to intentionally overdose
  • Facilitates routine follow up
36
Q

Draw backs of long acting injectables

A
  • Potentially painful
  • Requires frequent clinic visits
  • Negative stigma
  • Harder to titrate
  • Expensive
37
Q

Haloperidol Decanoate

A
  • FGA long acting injectable
  • 10x PO daily dose = IM dose
  • Titrate over 3 months
38
Q

Fluphenazine deconoate

A
  • FGA long acting Injectable
  • 1.25x PO dose = IM dose
  • Q3wks
  • Bridge with PO for 2 to 6 weeks
39
Q

Risperidone (Risperdal Consta)

A
  • SGA long acting injectable
  • Start at 25mg IM adjust PRN
  • Oral bridge = 3wk minimum
  • Renal and hepatic impairment = dose adjustment
40
Q

Risperidone (Perseris)

A
  • SGA long acting injectable
  • Just FDA approved
  • SubQ
  • Dose 90mg or 120mg Q4weeks
  • 3mg PO = 90mg SQ
  • 4mg PO = 120mg SQ
41
Q

Paliperidone (Invega Sustenna)

A
  • SGA long acting injectable
  • Dose 39 to 234mg IM Q4weeks
  • 12mg PO = 234mg IM Q4week
  • Requires loading dose
  • No PO overlap needed
  • Has dosing “windows” which helps with compliance
42
Q

Paliperidone (Invega Trinza)

A
  • SGA long acting injectable
  • Ever 3 MONTHS WOW
  • Must be on Invega sustenna for a minimum of 4 months prior to first Trinza dose
  • No loading strategy
  • No oral bridge
43
Q

Aripiprazole (Abilify Maintena)

A
  • SGA long acting injectable
  • Usually 400mg q4wk
  • Dose adjust dependent on pts other medications
  • Oral bridge therapy = 2weeks (10 to 20mg daily)
44
Q

Aripiprazole lauroxil (Aristada)

A
  • SGA long acting injectable
  • 441mg, 662mg q4weeks
  • 882mg q4 to 6 weeks
  • 1064mg q8weeks
  • Dose adjust for CYP3A4/2D6 inhibitors/inducers
45
Q

Olanzapine (Zyprexa Reprevv)

A
  • SGA long acting injectable
  • Black box warning: post injection delirium/sedation syndrome (PDSS)
  • Must be administered within a facility
  • Observation 3hrs post injection
  • Must have a ride home from the clinic
46
Q

Non-response

A

-6 weeks on therapy without improvement

Pharm 845 Exam #3 (7 decks)

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