Schizo

Question 1

Criteria to diagnose Schizophrenia….

Answer 1

A. 2+ of these symptoms, one must be 1,2,or 3:
Delusions, Hallucinations, Diorganized speech
Unorganized or catatonic behavior, Negative symptoms

B. FUNCTIONALITY DECREASED IN SOME ASPECT OF THEIR LIFE

C. 6 MONTHS OF SYMPTOMS W/1 MONTH OF SYMPTOMS

D. RULE OUT SHIZOEFFECTIVE DX, DEPRESSIVE/BIPOLAR DX, AND SUBSTANCE!!!

Question 2

Brain part demonstrated differnent in Schizo…

Answer 2

Large Lateral Ventricles

Question 3

Mainstay of NONDRUG Tx for Schizo….

Answer 3

Psychosocial Rehab Programs

Question 4

1st Line Pharm Treatment…

Answer 4

Second Gen Antipsychotics (ATYPICALS)

• Aripriprazole (Abilify)
• Ziprasidone (geodon)
• Risperidone (Risperidal)

Question 5

Aripiprazole

Answer 5

Abilify

Question 6

Ziprasidone

Answer 6

Geodon

Question 7

Risperidone

Answer 7

Risperdal

Question 8

What 3rd line agent is good if pt is suicidal…

Answer 8

Clozapine

Question 9

Second Gen Antipsychotics

Answer 9

• APINES
• IDONE
• PIPRAZOLE

Question 10

Clozapine brand name and important adverse effect….

Answer 10

CLozaril

Neutropenia (agranulocytosis)

Question 11

Clozapine WORST SE….

Answer 11

Seizures
Anticholinergic
Orthostatis
Metabolic (wt, glucose, lipids)

Question 12

Clozapine is least for giving this side effect….

Answer 12

EPS…may be used to treat TD

Question 13

Least SGA for Wt gain and QT prolongation

Answer 13

Aripripazole (Abilify)

Lurasidone (Latuda)

Question 14

WORST SGA for EPS and Hyperprolactinemia

Answer 14

Paliperidone (Invega)

Risperidone (Risperdal)

Question 15

Worst SGA for Metabolic (wt,lipids,glucose)….

Answer 15

Olanzapine

Clonazapine

Question 16

Ziprasidone is worst SGA for…

Answer 16

QT prolongation

Question 17

Asenapine comes in unique dosage forms…

Answer 17

Sublingual-SAPHRIS

Transdermal Patch-SECUADO approved 10/2019

Question 18

Clozapine comes in unique dosage forms…

Answer 18

Sublingual-FAZACLO ODT

Oral suspension-VERSACLOZ

Question 19

Loxitane is a FGA with unique dosing forms….

Answer 19

Inhaled-ADASUVE

Question 20

Antipsychotics LONG ACTING INJECTABLES

Answer 20

Olanzapine
Risperidone
Paliperidone

Question 21

Abilify is associated with what kind of problems?

Answer 21

Impulse control disorders like gambling, sexual urges, and uncontrolled spending or eating

Question 22

Possible Mood Stabilizers to add on…

Answer 22

Carbamazepine
Valproate
Lithium helps with agitation
Lamotrigine

Question 23

Antidepressants may help improve….

Answer 23

Negative Sysmptoms

Use Mirtazapine

Question 24

Olanzapine Brand and Injection info

Answer 24

Zyprexa
REMS Program
Post-injection delirium/sedation syndrome, monitor for this, symptoms are similar to a PO overdose and include delirium, ataxis, confusion, heavy sedation, or altered level of consciousness

Question 25

Paliperidone Palmitate Brand and Injection information

Answer 25

IVEGA TRINZA/3MPP LONGEST DOSING INTERVAL Treat w/IVEGA SUSTENNA 4 months prior to starting TRINZA

Question 26

Risperidone Brand and injection info

Answer 26

PERSERIS | SQ Abdomen

Question 27

Acute Dystonia | Definition, TOC

Answer 27

Abnormal tonicity-Sever muscle spasms, usually head + neck, 1-4 days of initiation IM or IV Anticholinergics, BENZOS 2nd line Benadryl 15-50mg IM Benztropine (Cogentin) 1-2mg IM

Question 28

Pseudoparkisonism | Info, TOC

Answer 28

Resembles Parkinson's: Gait disturbences, Cogwheel rigidity, 1-3 months of initiation ``` Decrease Dose + Anticholinergic Benztropine 4-10mg Diphenhydramine 50-200mg Trihexphenidyl (Artane) 4-20mg Amantadine 100-400mg ```

Question 29

Deutetrabenezine

Answer 29

AUSTEDO New med to treat Tardive Dyskinisia BBW: DEPRESSION AND SUICIDAL IDEATION

Question 30

Tardive Dyskinesia | Info and TOC

Answer 30

Insidious onset (late) oral and orofacial movements smacking or tongue thrusting CAN BE IRREVERSIBLE Prevention is key: Minimum effective dose, Atypical meds TOC: Deutrabenezine (AUSTEDO) Velbenazine (INGREZZA)

Question 31

Valbenazine

Answer 31

INGREZZA New med to treat TD Also has warnings for suicidality, depression, QT prolongation

Question 32

Akathisia | Info and TOC

Answer 32

Inner Restlessness-JITTERS, subjectively reported but can be observed Can lead to TD if not treated* COMMONLY CAUSED BY TOO FAST OF A TITRATION OF MEDICATION Decrease dose or change agent Propranolol (INDERAL) 30-120mg qd Lorazepam (Ativan) 0.5-10mg

Question 33

Seizure are associated with these meds because...

Answer 33

They decreased the seizure threshold, increasing risk of drug induced seizures Closely associated with High plasma conc, Rapid titration, Initiation of tx

Question 34

Highest Antipsychotics with Seizure possibility...

Answer 34

Clozapine | Chlorpromazine

Question 35

Lowest Seizure possibility...

Answer 35

``` Aripiprazole Risperidone Haloperidol Thioridazine Trifluoperazine Fluphenazine ```

Question 36

QT Prolongation...

Answer 36

Caution with other Qt prolonging agents, QTc near 500 Get a baseline ECG

Question 37

Most at risk for QT prolongation...

Answer 37

Ziprasidone Thioridazine Iloperidone

Question 38

LEAST at risk for QT prolongation...

Answer 38

Aripiprazole | Lurasidone

Question 39

Pregnancy...

Answer 39

Concerned with movement disorders and withdrawal following birth Maybe switch to med with less risk... CLOZAPINE AND LURASIDONE BOTH CLASS B NO BREAST FEEDING