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Schizophrenia Flashcards

(136 cards)

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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
what kind of psychotic are aripiprazole, brexpiprazole, and cariprazine
atypical antipsychotics, partial agonists
26
Name the 13 atypical antipsychotics
aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lumaterperone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone
27
what do aripiprazole, brexpiprazole, and cariprazine do
they stabilize dopamine transmission- not too much, not too little
28
what side effect is associated more with aripiprazole, brexpiprazole, and cariprazine
akathisia
29
what are the boxed warnings for the partial agonist atypical antipsychotics
suicidal thoughts and behaviors
30
partial agonist atypical antipsychotics (aripiprazole, brexpiprazole, and cariprazine) are approved for schizophrenia and adjunct treatment of what
depression
31
what part of the CNS is targeted by D2 antagonists for primary therapeutic effects
mesolimbic pathway
32
what part of the CNS is responsible for EPS and motor effects
basal ganglia and nigrostriatal pathway
33
what is the therapeutic conundrum of antipsychotic drugs
there's a narrow therapeutic window before EPS happen
34
when are EPS symptoms more likely
when the drug dose is too high
35
How common are EPS
30-50%
36
are EPS reversible or irriversible
reversible
37
how long does it take for EPS to occur
occur early, days/weeks
38
what is dystonia
increased muscle tone
39
what is pseudoparkinsonism
muscle rigidity
40
what is akathisia
restlessness
41
what are the four symptoms of EPS
akathisia, pseudoparkinsonism, dystonia, tremor
42
what classes of drugs can be used for EPS
anticholinergic, antihistamines, dopamine releasing agents
43
what drug can be used for akathisia
propanolol
44
what drugs specifically can be used for EPS (6)
benztropine, trihexyphenidyl, akineton, diphenhydramine, amantadine, propranolol
45
how often is tardive diskinesia
20-40%
46
how quick does tardive dyskinesia occur
occur late, months to a year
47
is tardive dyskinesia reversible or irriversible
irriversible
48
what are the symptoms of tardive dyskinesia (4)
rhythmic involuntary movements of mouth, choreiform, athetoid, axial hyperkinesias
49
what is choreiform
irregular purposelessness
50
what is athetoid
worm-like
51
what is axial hyperkinesias
to-and-fro movements
52
how do we monitor tardive dyskinesia
AIMS (abnormal involuntary movement scale)
53
how often should we monitor for tardive dyskinesia
q6months
54
how do we treat tardive dyskinesia
only through prevention, use the least risky agent at the lowest dose possible
55
what are tetrabenazine, valbenazine, and deutetrabenazine used for
tardive dyskinesia
56
what kinds of drugs are tetrabenazine, valbenazine, and deutetrabenazine
VMAT2 inhibitors
57
what is NMS
neuroleptic malignant syndrome
58
what is the prognosis of NMS
serious and rapid, 10% fatality
59
what are the symptoms of NMS (3)
EPS with fever, impaired cognition, muscle rigidity
60
how do you treat NMS
discontinue drug, use DA agonist
61
how long does it take for antipsychotics to work
2-3 weeks
62
when can you expect max efficacy of antipsychotics
6 months
63
what can be used for mania
lithium
64
what can pimozide (orap) be used to treat
tourette's syndrome-tics, vocalizations
65
what two drugs are used for huntington's chorea
tetrabenazine, deutetrabenazine
66
what drug is used for intractable hiccups
chlorpromazine
67
what drug is used for alcohol withdrawal
haloperidol
68
what drugs are used (2) for nausea vomiting
metoclopramide and promethazine
69
potentiation of opiates and sedatives drug
droperidol
70
how do normal subjects respond to antipsychotics
unpleasant
71
what is neuroleptic syndrome
suppression of emotions, reduce initiative and interest
72
is neuroleptic syndrome more similar to positive or negative symptoms
negative
73
what is the mechanism of action of weight gain
due to combined H1 and 5HT2c blockade
74
what is the mechanism of action of amenorrhea, infertility, and impotence from antipsychotics
dopamine receptor blockade which results in hyperprolactinemia
75
what is the mechanism of action of sedation from antipsychotics
histamine receptor blockade
76
what is the mechanism of action of toxic-confusional state
muscarinic blockade
77
what is the mechanism of action of tardive dyskinesia
super sensitivity of dopamine receptors
78
what is the mechanism of parkinson's syndrome, akathasia, and dystonias with antipsychotics
dopamine receptor blockade
79
what is the mechanism of orthostatic hypotension, impotence, and failure to ejaculate with antipsychotics
alpha adrenoceptor blockade
80
what is the mechanism of loss of accommodation, dry mouth, difficulty urinating, and constipation with antipsychotics
muscarinic anticholinergic receptor blockade
81
what are precautions and contraindications of antipsychotics
cardiovascular disease, parkinson's epilepsy, and diabetes
82
newer antipsychotics should not be used if patients have what co-morbid condition
diabetes
83
what antipsychotic lowers seizure threshold
clozapine
84
what problem is associated with typical first gen antipsychotics
movement problems, EPS, and tardive dyskinesia due to strong D2 block
85
what was the first antipsychotic
chlorpromazine
86
what specific drug is a phenothiazine
chlorpromazine
87
what twp drugs are aliphatic phenothiazines
chlorpromazine and promethazine
88
what aliphatic phenothiazine is used for H1 antagonistic properties
promethazine
89
promethazine or phenergan is also used for what
N/V
90
piperidine phenothiazine drug
thioridazine
91
what are the 3 side effects of thioridazine
sedation, hypotension, anticholinergic
92
what three drugs are piperazine phenothiazines
fluphenazine, prochlorperazine, and perphenazine
93
what is associated with fluphenazine
EPS
94
what is associated with prochlorperazine
antiemetic
95
what is associated with thiothixene
modest EPS
96
what drug is a butyrophenone
haloperidol
97
what is associated with haloperiodol
EPS
98
what is the generic name for moban
molindone
99
what is associated with molindone
moderate EPS
100
what is the brand name of pimozide
orap
101
what is pimozide also used to treat beside psychosis
tourette's disease-tics, vocalizations
102
what is the generic for thorazine
chlorpromazine
103
what antipsychotic was the first
chlorpromazine
104
what are the side effects of chlorpromazine
antihistamine
105
what drug is an antihistamine and antiemetic
promethazine
106
what is the generic of phenergan
promethazine
107
what is the generic of mellaril
thioridzaine
108
what are the side effects of thioridazine
anticholinergic, sedation, sexual dysfunction, and cardiovascular effects
109
what is the generic of permitil and proxilin
fluephenazine
110
what antipsychotic is an antiemetic
prochlorperazine
111
what drug is associated with CATIE studies
perphenazine
112
are the following drugs typical or atypical: chlorpromazine, promethazine, thioridazine, fluephenazine, prochlorperazine, perphenazine, thiothixene, haloperidol, molindone, pimozide
typical
113
are typical drugs first gen or second gen
first gen
114
what class of drugs is second gen
atypical
115
what is a key feature of atypical second gen drugs
less EPS
116
what receptor is antagonized more by second gen drugs
5HT2a
117
what is an increased risk of atypical drugs
more metabolic problems, linked more to diabetes
118
are typical or atypical drugs linked to diabetes
atypical
119
what is the generic of clozaril
clozapine
120
what was the first atypical antipsychotic
clozapine
121
how common is agranulocytosis
1-2%
122
how quickly does agranulocytosis occur
within 6 months
123
how often should we monitor for agranulocytosis
weekly blood monitoring
124
what are the two classes of side effects of clozapine
anticholinergic and antihistamine
125
what is a risk of taking clozapine compared to other antipsychotics
diabetes
126
what is the generic of zyprexa
olanzapine
127
what is the risk of taking olanzapine
diabetes
128
what is a side effect of olanzapine
weight gain
129
what are two benefits of olanzapine
less likely to cause N/V and less likely to cause movement problems
130
what is the generic of loxitane
loxapine
131
what is another use of loxapine besides psychosis
antidepressant
132
what is the generic of seroquel
quetiapine
133
what 4 drugs have a risk of diabetes
olanzapine, clozapine, quetiapine, and risperidone
134
can quetiapine be used as an atidepressant
yup
135
what is the generic name of risperidol
risperidone
136

exam 4 (7 decks)

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