Schizophrenia

Question 1

What is the sx of schizophrenia

Answer 1

Hallucinations
Delusions
Disorganized thinking/behaviors

Question 2

Neurotransmitters involved with schizophrenia

Answer 2

Dopamine, Serotonin, Glutamine

Question 3

What are the negative sx of schizophrenia?

Answer 3

Lack of emotion (apathy)
Social withdrawal
Loss of motivation (avolition)
Lack of speech (alogia)

Question 4

What are the positive sx of schizophrenia

Answer 4

Hallucination
Delusions
Disorganized thinking/behaviors

Question 5

Drugs that cause psychotic sx?

Answer 5

Illicit/recreational drugs

Question 6

First line for schizophrenia

Answer 6

2nd Antipsychotics > 1st gen → lower risk for EPS

Question 7

EPS sx

Answer 7

Dystonia (muscle contractions)
Dyskinesias (abnormal movements)
Tardive dyskinesia (repetitive, involuntary movements)
Akathisia (restlessness, inability to remain still)

Question 8

Due to adherence being low, what are formulations that a good for schizophrenics?

Answer 8

Long-acting injections
ODT
Oral solutions/suspensions
Acute IM injections

Question 9

What is the BBW of all antipsychotics

Answer 9

Not indicated for agitation control in elderly patients with dementia-related psychosis → ↑ mortality

Question 10

What is blocked by 1st gen antipsychotics

Answer 10

D2 receptors →with minimal serotonin receptor blockade

Question 11

1st gen that causes QTc prolongation

Answer 11

Thioridazine, haloperidol, chlorpromazine

Question 12

ADR of 1st gen antipsychotics

Answer 12

QTc prolongation, orthostasis/falls

CNS depression
EPS
Hyperprolactinemia → infertility, ED, galactorrhea
NMS

Sedation, Dz, anticholinergics

Question 13

How to mitigate EPS sx and dystonic reactions?

Answer 13

Give anticholinergic (benzotropine, benadryl)

Question 14

Difference between lower and higher potency 1st gen

Answer 14

Lower: ↓ EPS and ↑ sedation
Higher: ↓ sedation and ↑ EPS

Question 15

Low potency 1st gen

Answer 15

Chlorpromazine
Thioridazine

Question 16

Medium potency 1st gen

Answer 16

Loxapine
Perphenazine

Question 17

High potency 1st gen

Answer 17

Haloperidol
Fluphenazine
Thiothixine
Trifluoperazine

Question 18

Activity of 2nd gen

Answer 18

Blocks D2 and 5-HT2A receptors

Question 19

Aripiprazole

Answer 19

Abilify

Question 20

ADR of Abilify

Answer 20

Akathesia, activating

Question 21

Dosing form of Aripiprazole

Answer 21

IM, ODT, tablet

Question 22

BBW of clozapine

Answer 22

Neutropenia/agranulocytosis
Myocarditis, cardiomyopathy
Seizures

No longer in REMs

Question 23

ADR of clozapine

Answer 23

Agranulocytosis, seizures, constipation, weight gain, hyper salivation

Start at ANC ≥1500 → Check Q6W

Stop if ANC <1000

Question 24

Despite being effective why is clozapine last line

Answer 24

Severe ADR profile bu low EPS/TD

Question 25

Clozapine

Answer 25

Clozaril

Question 26

Lurasidone

Answer 26

Latuda

Question 27

ADR of Latuda

Answer 27

Somnolence, EPS, nausea, ↓ risk of metabolic syndrome compared to other SGAs

Question 28

Dosing of Latuda

Answer 28

Take with foos ≥350 kcal

Question 29

Olanzapine

Answer 29

Zyprexa

Question 30

Dosage form of Olanzapine

Answer 30

IM: Relprevv Zydis: ODT

Question 31

BBW of olanzapine

Answer 31

Zyprexa Relprcc → monitor 3 fr post-injection (REMS)A

Question 32

ADR of olanzapine

Answer 32

Somnolence, metabolic syndrome (Weight, BG, and lipids)

Question 33

Paliperidone

Answer 33

Invega

Question 34

Dosing of Paliperidone

Answer 34

IM: Invega Sustenna: QM Invega Trinza: Q3M Invega Hafyera: Q6M

Question 35

ADR of Paliperidone

Answer 35

↑ prolactin EPS Metabolic syndrome

Question 36

Quetiapine

Answer 36

Seroquel

Question 37

ADR of Seroquel? Counseling

Answer 37

Somnolence, metabolic syndrome, low EPS → psychosis in PD Take XR at night without food or light meal (≤300 kcal)

Question 38

Risperidone

Answer 38

Risperidal

Question 39

Formulation of Risperidal

Answer 39

I M, SC, ODT, tablet

Question 40

ADR of Risperidone

Answer 40

↑ prolactin EPS Metabolic syndrome

Question 41

Ziprasidone

Answer 41

Geodan

Question 42

ADR of Ziprasidone? Counseling?

Answer 42

QTc prolongation Take with food

Question 43

Asenapine counseling and ADR

Answer 43

No food/drink for 10 min after dose Tongue numbness

Question 44

Cariprazine

Answer 44

Vraylar

Question 45

Brexipiprazole

Answer 45

Rexulti

Question 46

Mechanism of EPS

Answer 46

Dopamine receptor antagonism

Question 47

Mechanism of metabolic syndrome

Answer 47

Serotonin receptor antagonism

Question 48

Length of antipsychotic trial

Answer 48

6 weeks

Question 49

Highest risk of EPS

Answer 49

FGA, risperidone, paliperidone Quetiapine is preferred

Question 50

Drugs that worsen weight

Answer 50

Olanzapine and quetiapine Lower risk: Aripirazole, ziprasidone, lurasidone, asenapine

Question 51

Formulation best for nonadherence

Answer 51

Long acting injection

Question 52

Formulation best of acute psychosis

Answer 52

Haloperidol (IV/IM) +/- diphenhydramine Alt: Ziprasidone IM, olazapine IM

Question 53

Chronic treat for daily adherence

Answer 53

FGA and SGA PO tabled

Question 54

Chronic treat for daily non-adherence

Answer 54

ODT: Olanzapine, Apripriprazole, Risperidone SL: Asenapine PO Liquid: Aripiprazole, Fluphenazine, Haloperidol, Risperidone Patch: Asenapine

Question 55

Schedule of Invega Hayfyera

Answer 55

Q6M

Question 56

Schedule of Invega Trinza

Answer 56

Q3M

Question 57

Schedule of Aripiprazole (Ability Asimtufi)

Answer 57

Q2M

Question 58

Schedule of Aripiprazole (Aristide) and Risperidone (Used)

Answer 58

1-2 months

Question 59

Monthy formulation

Answer 59

Aripiprazole: Abilify Maintenance Haloperidol: Haldol Deconoate Paliperidone: Invega Sustenna Risperidone: Perseris

Question 60

Duration of olanzapine (Relprevv)

Answer 60

2-4 weeks

Question 61

2 weeks duration formulation

Answer 61

Fluphenazine deconoate, Risperidone (Risperidal Consta, Rykingo)

Question 62

Formulation that is SC

Answer 62

Risperidone

Question 63

Drugs for psychosis in PD

Answer 63

Qutiapine Pimavanserin

Question 64

ADR of Pimavanserine

Answer 64

QTc prolongation

Question 65

Treatment for TD

Answer 65

Valbenazine Deutrabenazine

Question 66

MOA of TD drugs

Answer 66

Reversibly inhibit vesicular monoamine transporter 2 (VMAT2) → transporter that regulates monoamine uptake

Question 67

ADR of valbenazine

Answer 67

Somnolence

Question 68

ADR of deutetrabenazine

Answer 68

CI: hepatic impairment ADR: Somnolence

Question 69

DDI of VMAT2

Answer 69

MOAIs

Question 70

What causes NMS

Answer 70

D2 blockade

Question 71

Sx of NMS

Answer 71

Hyperthermia Muscle ridgitiy Mental status changes Tachycardia, tachypnea, blood pressure changes

Question 72

Tx of NMS

Answer 72

1. Stop antipsychotics 2. Control patient temp 3. Relax muscles: BZD, dantroline, dopamine agonist (bromocriptine) 4. Consider different antipsychotics (quetiapine, clozapine)