Schizophrenia Flashcards by Jessica Weaver

schizophrenia patho

dec brain size and asymmetry, inc ventricle size, dec grey matter
DA deficit

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dx of schizo

delusions
hallucinations
disorganized speech
grossly disorganized or catatonic behavior
negative sx

2 or more of these present for significant portion of time in 1 month period that affects work, relationships, school etc.

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what is considered tx resistant

pt trialed on 2+ APs for at least 8 weeks on optimized dose

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mixing FGA and SGA can mitigate bennies of

SGA

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FGAs includes

haloperidol
chlorpromazine
periphenazine
fluphenazine
thioridazine
thiothixene

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FGAs AE and BBW

EPS (tardive dyskinesias, akesthesias,
QTc p
inc prolactin level
derm
photosnes
blue-grey skin
orthostatic hypotension
altered thermoregulation

BBW: dementia related psychosis;inc mortality in elderly patients w dementia-related psychosis

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SGAs includes

aripiprazole
quetiapine
clozapine
olanzapine
ziprasidone
risperidone
lurasidone
blexiprazole
paliperidone
cariprazine
Iloperidone

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SGAs AE and BBW

QTc p
anticholinergic
inc prolactin (palperidone, risperidone)
dec seizure threshold
blood dyscarias
sedation
ophthalmic (quetiapine)

BBW: dementia related psychosis; inc mortality in elderly patients w dementia-related psychosis

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tx options if pt is AP naive

risperidone, aripiprazole, ziprasidone (any AP except clozapine)

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high potency FGA and AE trend

hapoperidol
fluphenazine
thiothixine
trifluoperazine
perphenazine

higher EPS, less anticholinergic risk

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APs that have the most inc prolactin

FGA:
thioridazine
thiothixene
chlorpromazine
fluphenazine
haloperidol

SGA:
risperidone
paliperidone (P!)

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FGAs w anticholinergic AE

thioridazine
chlorpromazine
loxapine
molindone

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Aripiprazole
weight gain?
sedation?
key AE?
dosage forms

less weight gain
less sedation
can cause IMPULSIVITY, insomnia, akathisia, restlessness,
LAI (maintena, aristada)
new products: mycite and aristada initio

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asenapine
bennies
AE
pearl

new topical patch available!
change patch daily on upper arm, back, abdomen, hip

little weight gain, least sedating and anticholinergic AE
CI in severe heaptic disease
high risk of QTc prolongation
topical patch may cause skin irritation
anaphylaxis at a single dose

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impulsivity AE

aripiprazole
brexipiprazole

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brexipiprazole
AE
pearls

IMPULSIVITY
akasthisia (DOSE RELATED)
t1/2 = 91 hours
less metabolic changes than others
po only!

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caripiprazole (vraylar)
pearls

akasthisia (dose related)
long t1/2 2-4d

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clozapine

blood dyscrasia
QTc prolongation
constipation–> NEED bowel regimen
seizure
myocarditis
METABOLIC CONDITIONS
monitoring? see notes

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Iloperidone

ORTHOSTATIC HYPOTENSION–> titrate slowly
less sedating and no prolactin increase
po only!
if on CYP-is –> dec dose 50%

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which APs are PO only

brexipiprazole
Iloperidone
lurasidone
lumateperone
pimavanserin

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Lumateperone

no metabolic, EPS, ECG changes
po only!
well-tolerated

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Olanzapine
forms
AE
REMS?
uses

REMS for post-injection delirium and sedation syndrome
metabolic, ANC, QTc, sedation issues
DRESS!!!
sedation, metabolic issues, QTc, ANC
used in sz w acute BPD monotherapy

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which APs have REMS and what is the REMS for?

Clozapine - blood acrasias
Olanzapine - post-injection delirium and sedation syndrome

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Quetiapine

misused, do not use as sleep aid
QTc, sedation, metabolic issues
metab by 3A4

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risperidone

LAI (IM and SQ), po, ODT, po suspension INC PROLACTIN\ SQ uncomfy; cant touch area

ziprasidone

po cap TAKE W FOOD, SAI IM DRESS! CI in patients at high risk QTc p

pregnancy may need higher/lower doses and of what medications

higher; clozapine, olanzapine

APs FDA approved in pediatrics

aripiprazole lurasidone olanzapine quetiapine palperidone risperidone

short acting injectables

chlorpromazine haloperidol fluphenazine olanzapine ziprasidone

LAI

fluphenazine heloperidol aripiprazole olanzapine risperidone paliperidone

injectables with no po overlap recommended/required

risperidone (LAI) olanzapine

newer injectables (SGAs) are better bc...

water based, less discomfort and better tolerated

APs with the most sedation

chlorpromazine thioridazine clozapine quetiapine

APs with the most EPS

chlorpromazine haloperidol fluphenazine perphenazine thioridazine thiothixene risperidone palperidone

APs with most anticholinergic AE

chlorpromazine thioridazine clozapine - bowel regimen

APs w most orthostasis AE

chlorpromazine thioridazine clozapine Iloperidone

APs with most weight gain

Chlorpromazine clozapine olanzapine

Aps with most CV AE

haloperidol chlorpromazine clozapine Iloperidone Ziprasidone

acute dystonias tx

anticholinergics or benzos IM

pseudoparkinsonism tx

anticholinergics

tardive dyskinesias tx

prevention is key, switch AP, use Ingrenna caution: anticholinergics MASK sx

anticholinergic AE tx

bowel preps

akathisia AE tx

dec dose, BBs (propranolol, nadolol, metoprolol)

new tx Lybalvi is ___ + ___

olanzapine +samidorphan need 7d opiate free period or 14d LA-opiate free period

positive sz sx

hallucinations delusions ideas of influence disorganized speech discontinued thoughts

negative sx sz

AAAA flat Affect Alogia - not speaking Anhedonia Avolition

A patient starts an AP for sz and calls saying they see a capsule in their stool and is concerned. Which AP is this

Paliperidone

pt has parkinsons psychosis and has associated delusions and hallucinations what is the best tx option

Pimvanserin

APs metabolized by CYP3A4

Aripiprazole Brexipiprazole Cariprazine Clozapine Iloperidone Lurasidone Lumateperone Paliperidone Pimaavanserin Quetiapine Ziprasidone (All except risperidone, olanzapine, asenapine)

patient is experiencing significant impulsivity on their new AP which APs cause this

aripiprazole brexipiprazole

pt receiving a LAI SQ and is instructed not to touch the area or let clothing touch the area. patient also later develops significant gynecomastia. which LAI is this

Risperidone LAI

which APs are ODT

risperidone clozapine olanzapine

patient is informed that a new AP was released that is a patch. which AP is this

asenapine

which APs have dose-related akasthinia

brexipiprazole cariprazine

patients should avoid smoking in which APs and why

clozapine and olanzapine induced 1A2 which decreased Cp of AP if smoking, need increased dose. if quits smoking, decrease dose

which APs have long t1/2s and what are the half-lifes

brexipiprazole 91h cariprazine 2-4d

REMS program for clozapine - how frequently do draws need to be done

qwk x6mo then BIW x6mo then qmo

pt takes AP po for the first time and is experiencing significant orthostatic hypotension. which AP is this and how could it be prevented

Iloperidone slow titration needed!

avoid ______ if taking strong CYP3A4 inhibitors or inducers

Lurasidone

which AP now approved for 10-17 yo w BPD type I in addition to MDD w BPD I

Lurasidone

patients need bowel regimen when on

clozapine

paliperidone pt wants to switch from LAI Invega Sustena to LAI Trinza. how long does pt need to be on Sustena before they can try Trinza

4 months of qmo injections

which APs have BBW for use in patients with dementia-related psychosis

all APs

Ziprasidone CI with

high risk QTc p

Schizophrenia Flashcards

(64 cards)