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Therapeutics 3 > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

What are the positive symptoms of schizophrenia?

A

-hallucinations
-delusions
-disorganized speech/thought
-disorganized, bizarre behavior
-paranoia/suspiciousness

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2
Q

What are the negative symptoms of schizophrenia?

A

-alogia
-affective blunting
-avolition
-anhedonia
-poor grooming, hygiene
-social dysfunction/isolation

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3
Q

What major side effects are associated with first generation antipsychotics?

A

EPS/TD

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4
Q

What major side effects are associated with second generation antipsychotics?

A

metabolic effects

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5
Q

What is the correlation between potency and side effects of first generation antipsychotics?

A

-low potency agents= less D2 blockade= less EPS risk
-high potency agents= more D2 blockade= high EPS risk

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6
Q

What drugs are first generation antipsychotics?

A

chlorpromazine, fluphenazine, haloperidol, loxapine

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7
Q

Describe the Potency, EPS, Sedation, Anticholinergic, and Orthostatic Hypotension SE of Chlorpromazine:

A

potency: low
EPS: low risk
Sedation: high risk
Anticholinergic SE: high
Orthostatic hypotension: mod-high

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8
Q

Describe the Potency, EPS, Sedation, Anticholinergic, and Orthostatic Hypotension SE of Fluphenazine:

A

potency: high
EPS: very high risk
Sedation: low risk
Anticholinergic SE: low
Orthostatic hypotension: low

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9
Q

Describe the Potency, EPS, Sedation, Anticholinergic, and Orthostatic Hypotension SE of Haloperidol:

A

potency: high
EPS: very high risk
Sedation: very low risk
Anticholinergic SE: very low
Orthostatic hypotension: very low

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10
Q

Describe the Potency, EPS, Sedation, Anticholinergic, and Orthostatic Hypotension SE of Loxapine:

A

potency: moderate
EPS: mod risk
Sedation: mod risk
Anticholinergic SE: low
Orthostatic hypotension: low-mod

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11
Q

What formulation of first generation antipsychotics may be useful for acute agitation?

A

immediate acting IM injections (haloperidol lactate)

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12
Q

What are the overall adverse effects of first generation antipsychotics?

A

-CV= QTc prolongation -> risk of torsade’s de pointes
-seizures (lowered seizure threshold, dose-related, rapid titrations)
-prolactin/sexual= menstrual irregularities, gynecomastia, sexual dysfunction (erectile dysfunction, decrease libido)
-sedation
-anticholinergic (dry mouth, blurred vision, constipation, urinary retention, cognitive impairment)

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13
Q

What first generation antipsychotics have the lowest/highest risk of seizures?

A

-LOWEST= haloperidol
-HIGHEST= chlorpromazine

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14
Q

What first generation antipsychotics have the lowest/highest risk of sedation?

A

-LOWEST= haloperidol
-HIGHEST= chlorpromazine

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15
Q

What first generation antipsychotics have the lowest/highest risk of Anticholinergic symptoms?

A

-LOWEST= haloperidol
-HIGHEST= chlorpromazine

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16
Q

What first generation antipsychotic has a warning due to torsade’s de pointes risk?

A

chlorpromazine

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17
Q

What are the 3 main symptoms of Extrapyramidal Symptoms (EPS)?

A

-acute dystonia (severe muscle spasms of the face and throat)
-akathisia (feeling of “inner restlessness”)
-pseudo-parkinsonism (PD- cogwheel rigidity, shuffling gait, etc.)

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18
Q

What is the treatment of EPS, acute dystonia?

A

anticholinergic= benzotropine, diphenhydramine

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19
Q

What is the treatment of EPS, akathisia?

A

propranolol, lorazepam

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20
Q

What is the treatment of EPS, pseudo-parkinsonism?

A

benztropine, amantadine

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21
Q

What is Tardive Dyskinesia and how is it monitored and treated?

A

TD is a late onset movement disorder due to long-term D2 blockade which may be irreversible. can be monitored via AIMS which is important because there is no treatment but Vmat2 inhibitors may provide some relief.

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22
Q

What is Neuroleptic Malignant Disorder (NMS) and how is it treated?

A

a potential fatal syndrome associated with antipsychotic use that is categorized by symptoms, such as: muscle rigidity, hyperthermia, autonomic dysfunction, mental status changes. Treatment includes stopping offending agent and bromocriptine, sodium dantrolene. Treatment with antipsychotic is okay to continue but NEVER with same agent.

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23
Q

What are the uses of Clozapine?

A

-FDA APPROVED for treatment resistant schizophrenia, only used after failure of 2 antipsychotics
-superior for reduction of suicide attempts
-effective for the management of aggression and violent behavior, and potential anti-hostility effects

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24
Q

What is unique about Chozapine’s dosing?

A

must be titrated, but if the patient misses doses > 48 hours the titration must be started from the beginning

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25
What drugs are metabolized via CYP1A2 and smoking cigarettes may effect dosing?
-clozapine -olanzapine
26
What is the black box warning of Clozapine?
-seizures -AGRANULOCYTOSIS, REMS program= monitor absolute neutrophil count (ANC) -myocarditis/cardiomyopathy (promptly discontinue) -orthostatic hypotension -increased mortality in dementia patients
27
What are the adverse effects of Clozapine?
sialorrhea (drooling) and severe constipation (could progress to life threatening!)
28
What is the use of Risperidone?
schizophrenia (adults & adolescents) and bipolar disorder *second to clozapine*
29
What are the adverse effects of Risperidone?
somnolence, EPS, syncope, orthostasis, HYPERPROLACTEMIA/GYNECOMASTIA (may be 2nd line for males)
30
What is the use of Olanzapine?
schizophrenia, bipolar disorder, acute agitation associated with bipolar mania or schizophrenia
31
What are the adverse effects of Olanzapine?
-metabolic effects= weight gain, DM (avoid in children) -EPS -constipation -dizziness -postural hypotension
32
What is the use of Quetipine?
schizophrenia, bipolar disorder *behind clozapine and olanzapine due to metabolic effects*
33
What are the adverse effects of Quetiapine?
-somnolence -dry mouth -sedation -orthostatic hypotension
34
What are the uses of Ziprasidone?
schizophrenia, bipolar disorder, acute agitation in schizophrenia
35
What is unique dosing requirements for Ziprasidone?
must be taken with a 500 calorie meal
36
What is the warning associated with Ziprasidone?
QTc prolongation
37
What are the uses of Aripiprazole?
schizophrenia and bipolar disorder
38
What is the FDA warning on Aripiprazole?
increased compulsive behaviors
39
What drug mitigates hyperprolactinemia due to partial D2 agonism?
Aripiprazole
40
What are the uses of Paliperidone?
schizophrenia and schizoaffective disorder
41
What are the unique kinetics of Paliperidone?
-active metabolite of risperidone -does not undergo first pass metabolism= favorable option in patients with hepatic dysfunction
42
What are the clinical pearls of Paliperidone?
OROS formulation= tablet may be found in stool, avoid in GI dysfunction (GI narrowing, stricture)
43
What are the adverse effects of Paliperidone?
hyperprolactinemia, caution GI blockage
44
What are the uses of Iloperidone?
schizophrenia
45
What drug should be avoided in severe hepatic impairment?
-iloperidone -asenapine -lumateperone *caution with use of ziprasidone, olanzapine*
46
What are the adverse effects of Iloperidone?
orthostasis, QTc prolongation
47
What drugs can cause QTc prolongation?
-ziprasidone -iloperidone
48
What is unique about Iloperidones dosing?
titration need to minimize orthostasis, if patient missed >3 days of therapy titration must be restarted
49
What is unique about the formulations of asenapine?
only available as SL or transdermal patch
50
What is unique about the kinetics of Asenapine?
Tmax= 0.5-1.5h (SL), avoid smoking/eating/drinking for 10 mins after SL administration, high clearance drug (CONTRAINDICATED in severe hepatic impairment)
51
What are the adverse effects of Asenapine?
-sedation -somnolence -hypoesthesia and dysgeusia (SL formulation)
52
What drug is preferred in pregnancy?
Lurasidone
53
What is the unique dosing recommendations of Lurasidone?
take with at least 350 calories
54
What are the adverse effects of Lurasidone?
-akathisia -EPS -agitation *less risk of weight gain*
55
What drugs should be avoided in renal impairment?
-cariprazine
56
What are the unique kinetics of Cariprazine?
longest 1/2 life of all second generation antipsychotics
57
What are the adverse effects of Cariprazine?
-akathisia -EPS -activating > sedating= insomnia
58
What are the adverse effects of Brexpiprazole?
-headache -akathisia -tremor -diarrhea -dizziness *weight gain > aripiprazole, akathisia < aripiprazole*
59
What is unique about the dosing of Lumateperone?
no titration required
60
What are the adverse effects of Lumateperone?
-increased liver function tests (LFTs) -sedation -somnolence -weight loss
61
What second generation antipsychotic has the highest risk of cardiovascular SE?
-iloperidone, clozapine= hypotension -ziprasidone, iloperidone= QT prolongation
62
What second generation antipsychotic has the lowest risk of cardiovascular SE, hypotension?
aripiprazole, lurasidone, cariprazine, brexpiprazole
63
What second generation antipsychotic has the lowest risk of cardiovascular SE, QTc prolongation?
aripiprazole, lurasidone, lumateperone
64
What second generation antipsychotic has the highest risk of seizures?
clozapine, olanzapine, quetiapine
65
What second generation antipsychotic has the lowest risk of seizures?
aripiprazole, risperidone
66
What second generation antipsychotic has the highest risk of prolactin/sexual SE?
risperidone, paliperidone
67
What second generation antipsychotic has the lowest risk of prolactin/sexual SE?
clozapine, quetiapine, aripiprazole, brexpiprazole, cariprazine
68
What second generation antipsychotic has the highest risk of sedation?
clozapine, olanzapine (the 'pines)
69
What second generation antipsychotic has the lowest risk of sedation?
aripiprazole/brexpiprazole, iloperidone, risperidone/paiperidone
70
What second generation antipsychotic has the highest risk of anticholinergic SE?
clozapine, olanzapine, quetiapine
71
What second generation antipsychotic has the lowest risk of anticholinergic SE?
asenapine, lurasidone, lumateperone, cariprazine, brexpiprazole
72
What second generation antipsychotic has the highest risk of EPS?
paliperidone and risperidone
73
What second generation antipsychotic has the highest risk of EPS, acute dystonia?
risperidone/paliperidone > lurasidone, asenapine
74
What second generation antipsychotic has the highest risk of EPS, akathisia?
lurasidone> cariprazine> aripiprazole
75
What second generation antipsychotic has the highest risk of EPS, pseudo-parkinsonism?
risperidone/paliperidone, cariprazine, lurasidone
76
What second generation antipsychotic has the highest risk of dyslipidemia?
olanzapine
77
What second generation antipsychotic has the highest risk of diabetes?
clozapine, olanzapine
78
What second generation antipsychotic has the highest risk of weight gain?
clozapine, olanzapine
79
What is the black box warning of long-acting injection, olanzapine (RELPREVV)?
post-injection delirium/sedation syndrome (REMS program)

Therapeutics 3 (21 decks)

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