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exam 4 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

what are delusions

A

fixed, false beliefs that are not amenable to change even with conflicting evidence

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2
Q

what are hallucinations

A

perception-like experiences that occur without an external stimulus

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3
Q

what are the 5 key features of psychotic disorders

A

delusions
hallucinations
disorganized thinking and speech
disorganized or abnormal motor behavior
negative symptoms

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4
Q

demographics of schizophrenia

A

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

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5
Q

substance use and schizophrenia are proportionally linked, t/f

A

true

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6
Q

smoking induces what enzyme

A

cyp1a2

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7
Q

how does smoking effect antipsychotics

A

hydrocarbons from smoking induce cyp1a2, which decreases the serum concentration of 1a2 substrate antipsychotics

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8
Q

marijuana, cocaine, and amphetamines do what three things to schizophrenia

A

hasten onset, exacerbate symptoms, and reduce time to relapse

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9
Q

what should you do if a patient has substance use and schizophrenia at the same time

A

treat both at the same time

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10
Q

Rank the schizophrenic drugs in order of efficacy

A

all are equally effective, depends on individual patients for success

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11
Q

How do we choose the right antipsychotic for schizophrenia

A

doses per day, side effects, previous drug therapy, cost, dosage form, other drugs being taken, need for monitoring, co-morbid conditions

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12
Q

what dosage form of antipsychotics is first line

A

oral, unless pt prefers IM depot

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13
Q

6 typical antipsychotics

A

haloperidol, chlorpromazine, fluphenazine, perphenazine, loxapine, thioridazine

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14
Q

Are typical antipsychotics old or new

A

old drugs

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15
Q

what is the receptor target of typical antipsychotics

A

D2 receptor antagonist

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16
Q

is schizophrenia an issue of too much or too little dopamine

A

too much (opposite of PD)

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17
Q

what kinds of symptoms are typical antipsychotics the most effective for

A

positive symptoms (delusions, hallucinations)

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18
Q

what is the most commonly used typical antipsychotic

A

haloperidol, routine and prn

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19
Q

what is the black box warning for thioridazine

A

QTc prolongations

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20
Q

do typical antipsychotics have higher or lower risk for EPS than atypical

A

higher

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21
Q

what is used first typically, typical antipsychotics or atypical antipsychotics

A

atypical usually used first, when it fails use typical

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22
Q

what is the effect of typical antipsychotics on negative symptoms

A

usually make negative symptoms worse

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23
Q

what is the target of atypical antipsychotics

A

D2 antagonists and 5HT2A antagonists

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24
Q

what kinds of side effects are more common with atypical antipsychotics

A

more metabolic side effects

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25
Q

what kind of psychotic are aripiprazole, brexpiprazole, and cariprazine

A

atypical antipsychotics, partial agonists

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26
Q

Name the 13 atypical antipsychotics

A

aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lumaterperone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone

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27
Q

what do aripiprazole, brexpiprazole, and cariprazine do

A

they stabilize dopamine transmission- not too much, not too little

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28
Q

what side effect is associated more with aripiprazole, brexpiprazole, and cariprazine

A

akathisia

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29
Q

what are the boxed warnings for the partial agonist atypical antipsychotics

A

suicidal thoughts and behaviors

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30
Q

partial agonist atypical antipsychotics (aripiprazole, brexpiprazole, and cariprazine) are approved for schizophrenia and adjunct treatment of what

A

depression

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31
Q

what part of the CNS is targeted by D2 antagonists for primary therapeutic effects

A

mesolimbic pathway

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32
Q

what part of the CNS is responsible for EPS and motor effects

A

basal ganglia and nigrostriatal pathway

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33
Q

what is the therapeutic conundrum of antipsychotic drugs

A

there’s a narrow therapeutic window before EPS happen

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34
Q

when are EPS symptoms more likely

A

when the drug dose is too high

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35
Q

How common are EPS

A

30-50%

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36
Q

are EPS reversible or irriversible

A

reversible

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37
Q

how long does it take for EPS to occur

A

occur early, days/weeks

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38
Q

what is dystonia

A

increased muscle tone

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39
Q

what is pseudoparkinsonism

A

muscle rigidity

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40
Q

what is akathisia

A

restlessness

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41
Q

what are the four symptoms of EPS

A

akathisia, pseudoparkinsonism, dystonia, tremor

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42
Q

what classes of drugs can be used for EPS

A

anticholinergic, antihistamines, dopamine releasing agents

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43
Q

what drug can be used for akathisia

A

propanolol

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44
Q

what drugs specifically can be used for EPS (6)

A

benztropine, trihexyphenidyl, akineton, diphenhydramine, amantadine, propranolol

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45
Q

how often is tardive diskinesia

A

20-40%

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46
Q

how quick does tardive dyskinesia occur

A

occur late, months to a year

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47
Q

is tardive dyskinesia reversible or irriversible

A

irriversible

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48
Q

what are the symptoms of tardive dyskinesia (4)

A

rhythmic involuntary movements of mouth, choreiform, athetoid, axial hyperkinesias

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49
Q

what is choreiform

A

irregular purposelessness

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50
Q

what is athetoid

A

worm-like

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51
Q

what is axial hyperkinesias

A

to-and-fro movements

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52
Q

how do we monitor tardive dyskinesia

A

AIMS (abnormal involuntary movement scale)

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53
Q

how often should we monitor for tardive dyskinesia

A

q6months

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54
Q

how do we treat tardive dyskinesia

A

only through prevention, use the least risky agent at the lowest dose possible

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55
Q

what are tetrabenazine, valbenazine, and deutetrabenazine used for

A

tardive dyskinesia

56
Q

what kinds of drugs are tetrabenazine, valbenazine, and deutetrabenazine

A

VMAT2 inhibitors

57
Q

what is NMS

A

neuroleptic malignant syndrome

58
Q

what is the prognosis of NMS

A

serious and rapid, 10% fatality

59
Q

what are the symptoms of NMS (3)

A

EPS with fever, impaired cognition, muscle rigidity

60
Q

how do you treat NMS

A

discontinue drug, use DA agonist

61
Q

how long does it take for antipsychotics to work

A

2-3 weeks

62
Q

when can you expect max efficacy of antipsychotics

A

6 months

63
Q

what can be used for mania

A

lithium

64
Q

what can pimozide (orap) be used to treat

A

tourette’s syndrome-tics, vocalizations

65
Q

what two drugs are used for huntington’s chorea

A

tetrabenazine, deutetrabenazine

66
Q

what drug is used for intractable hiccups

A

chlorpromazine

67
Q

what drug is used for alcohol withdrawal

A

haloperidol

68
Q

what drugs are used (2) for nausea vomiting

A

metoclopramide and promethazine

69
Q

potentiation of opiates and sedatives drug

A

droperidol

70
Q

how do normal subjects respond to antipsychotics

A

unpleasant

71
Q

what is neuroleptic syndrome

A

suppression of emotions, reduce initiative and interest

72
Q

is neuroleptic syndrome more similar to positive or negative symptoms

A

negative

73
Q

what is the mechanism of action of weight gain

A

due to combined H1 and 5HT2c blockade

74
Q

what is the mechanism of action of amenorrhea, infertility, and impotence from antipsychotics

A

dopamine receptor blockade which results in hyperprolactinemia

75
Q

what is the mechanism of action of sedation from antipsychotics

A

histamine receptor blockade

76
Q

what is the mechanism of action of toxic-confusional state

A

muscarinic blockade

77
Q

what is the mechanism of action of tardive dyskinesia

A

super sensitivity of dopamine receptors

78
Q

what is the mechanism of parkinson’s syndrome, akathasia, and dystonias with antipsychotics

A

dopamine receptor blockade

79
Q

what is the mechanism of orthostatic hypotension, impotence, and failure to ejaculate with antipsychotics

A

alpha adrenoceptor blockade

80
Q

what is the mechanism of loss of accommodation, dry mouth, difficulty urinating, and constipation with antipsychotics

A

muscarinic anticholinergic receptor blockade

81
Q

what are precautions and contraindications of antipsychotics

A

cardiovascular disease, parkinson’s epilepsy, and diabetes

82
Q

newer antipsychotics should not be used if patients have what co-morbid condition

A

diabetes

83
Q

what antipsychotic lowers seizure threshold

A

clozapine

84
Q

what problem is associated with typical first gen antipsychotics

A

movement problems, EPS, and tardive dyskinesia due to strong D2 block

85
Q

what was the first antipsychotic

A

chlorpromazine

86
Q

what specific drug is a phenothiazine

A

chlorpromazine

87
Q

what twp drugs are aliphatic phenothiazines

A

chlorpromazine and promethazine

88
Q

what aliphatic phenothiazine is used for H1 antagonistic properties

A

promethazine

89
Q

promethazine or phenergan is also used for what

A

N/V

90
Q

piperidine phenothiazine drug

A

thioridazine

91
Q

what are the 3 side effects of thioridazine

A

sedation, hypotension, anticholinergic

92
Q

what three drugs are piperazine phenothiazines

A

fluphenazine, prochlorperazine, and perphenazine

93
Q

what is associated with fluphenazine

A

EPS

94
Q

what is associated with prochlorperazine

A

antiemetic

95
Q

what is associated with thiothixene

A

modest EPS

96
Q

what drug is a butyrophenone

A

haloperidol

97
Q

what is associated with haloperiodol

A

EPS

98
Q

what is the generic name for moban

A

molindone

99
Q

what is associated with molindone

A

moderate EPS

100
Q

what is the brand name of pimozide

A

orap

101
Q

what is pimozide also used to treat beside psychosis

A

tourette’s disease-tics, vocalizations

102
Q

what is the generic for thorazine

A

chlorpromazine

103
Q

what antipsychotic was the first

A

chlorpromazine

104
Q

what are the side effects of chlorpromazine

A

antihistamine

105
Q

what drug is an antihistamine and antiemetic

A

promethazine

106
Q

what is the generic of phenergan

A

promethazine

107
Q

what is the generic of mellaril

A

thioridzaine

108
Q

what are the side effects of thioridazine

A

anticholinergic, sedation, sexual dysfunction, and cardiovascular effects

109
Q

what is the generic of permitil and proxilin

A

fluephenazine

110
Q

what antipsychotic is an antiemetic

A

prochlorperazine

111
Q

what drug is associated with CATIE studies

A

perphenazine

112
Q

are the following drugs typical or atypical: chlorpromazine, promethazine, thioridazine, fluephenazine, prochlorperazine, perphenazine, thiothixene, haloperidol, molindone, pimozide

A

typical

113
Q

are typical drugs first gen or second gen

A

first gen

114
Q

what class of drugs is second gen

A

atypical

115
Q

what is a key feature of atypical second gen drugs

A

less EPS

116
Q

what receptor is antagonized more by second gen drugs

A

5HT2a

117
Q

what is an increased risk of atypical drugs

A

more metabolic problems, linked more to diabetes

118
Q

are typical or atypical drugs linked to diabetes

A

atypical

119
Q

what is the generic of clozaril

A

clozapine

120
Q

what was the first atypical antipsychotic

A

clozapine

121
Q

how common is agranulocytosis

A

1-2%

122
Q

how quickly does agranulocytosis occur

A

within 6 months

123
Q

how often should we monitor for agranulocytosis

A

weekly blood monitoring

124
Q

what are the two classes of side effects of clozapine

A

anticholinergic and antihistamine

125
Q

what is a risk of taking clozapine compared to other antipsychotics

A

diabetes

126
Q

what is the generic of zyprexa

A

olanzapine

127
Q

what is the risk of taking olanzapine

A

diabetes

128
Q

what is a side effect of olanzapine

A

weight gain

129
Q

what are two benefits of olanzapine

A

less likely to cause N/V and less likely to cause movement problems

130
Q

what is the generic of loxitane

A

loxapine

131
Q

what is another use of loxapine besides psychosis

A

antidepressant

132
Q

what is the generic of seroquel

A

quetiapine

133
Q

what 4 drugs have a risk of diabetes

A

olanzapine, clozapine, quetiapine, and risperidone

134
Q

can quetiapine be used as an atidepressant

A

yup

135
Q

what is the generic name of risperidol

A

risperidone

136
Q
A

exam 4 (7 decks)

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