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Flashcards in Schizophrenia Deck (67):
1

Paliperidone (Invega), Risperidone (Risperdal)

Dose, metabilism how to take blah blah blah

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2

What atypicals are highest for weight gain? What are the lowest?

Clozapine, Olanzapine

 

Aripiprazole, Lurasidone, Ziprasidone 

3

How can Akathisia be treated?

 

  • Reducing the dose of the AP 
  • You can switch to a low dose AP or SGA
  • Beta blockers like propranolol can help
  • Benzos

4

FGA, and SGAs both have effects on other receptors besides Dopamine and 5-HT2a what are the other receptors?

  • Muscarinic (cholinergic) receptors
  • A1 receptors
  • Histamine

 

5

What are the positive symptoms of schizophrenia?

  • Delusion
  • Hallucination
  • Disorganized speech
  • Unusual behavior
  • Hostility, agitation, combativeness

6

Talk about Asenapine, Iloperidone, Lurasidone?

Dose, metabilism how to take blah blah blah

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7

Comparison of Typical APs

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8

Drugs can induce psychosis what are the illicit ones?

Cocaine, PCP, Amphetamines, Mary Jane, LSD, Ketamine

 

9

Residual signs and symptoms 

 

  • Anxiety 
  • Suspicousness
  • Lack of motivation
  • poor insight and judgement 

 

10

What is the nonpharmacologic treatment for schizophrenia?

  • Psychsocial rehab programs
  • case management
  • support groups 
  • psychotherapy

11

What are some SEs of histamine and what is its therapeutic effects?

  • Sedation and weight gain 
  • Sedation is its therapeutic effects

 

12

Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon)

Dose, metabilism how to take blah blah blah

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13

For SGAs when do you monitor 

Weight

Waist

Glucose

Hyperlipidemia

  • monthly for first 3 months then quarterly 
  • ANual
  • 3 months then anually if normal
  • 3 months then anually if normal 

SKIPPED other ones 

14

What differientates between a good a bad prognosis?

  • Good mainly positive symptoms dominate
  • older than the average person to get diagnosed

 

  • Poor
    • Patient is younger than average when diagnosed
    • (+) FH
    • Negative symptoms are big 

15

Symptoms for Neuroleptic Malignant Syndrome?

FEVER

Fever

Encephalopathy

Vital unstable

Elevated Enzymes (CK)

Rigidity

16

Aripiprazole (Abilify), Brexipiprazole (Rexulti), Cariprazine (Vraylar)

Dose, metabilism how to take blah blah blah

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17

Negative symptoms?

  • Blunted/flat affect
  • Avolition (no motivation)
  • Anhedonia (lack of pleasure)
  • Poverty of Speech (Alogia)
  • Psychotomotor retardation

 

18

What atypicals are indicated for Irritability in Autism?

  • Apripirazole
  • Risperidone

19

The onset of schixophrenia in females occurs?

in their late 20s

20

Thiordazine cause?

This makes it a unlikely choice when chosing an antipsychotic

QTC Prlongation it can cause sudden death!

21

What are the social and occupational symptoms of schizophrenia?

  • Isolation 
  • Decrease self-care
  • poor hygiene
  • Dirty unkept
  • Difficulty with family and social relationships 
  • Employment difficulties 

 

22

Comparison of Atypical APs

EPS?

Akathisia?

Wt gain?

Hyperprolactin?

QTC

Ortho

Sedation 

 

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23

Excluding aripiprazole, brexipiprazole, cariprazine

What are the other atypical antipsychotic mechanism of action?

5-HT2a/ Dopamine D2 antagonist

 

24

tardive dyskinesia?

  • Facial movements
  • tongue
  • lip
  • neck and trunk
  • limb

 

25

What is the prodromal stage of schizophrenia?

No obvious symptoms are present but daily function begins to decline

  • Pts begin to become withdrawn, suspicious, and have an odd behavior?

26

The mesocortical system is responsible for the ____ symptoms of schizophrenia?

negative

27

The onset of schizophrenia in males usually occurs?

In their early 20s

28

Treatment for NMS?

Discontinue the AP, dopamine agonist, dantrolene IV or PO

29

What side effects are greater in SGAs compared to FGAs?

 

 

  • Weight gain
  • DM
  • Hyperlipidemia

All of these are related

30

The only treatment for TD is?

Prevention so you have to constantly be checking on the person every 3-6 months if they are on a FGA. 

It can be irreversible but if caught early enough you may be able to stop the progression 

31

What are Extrapyramidal side effects?

What other drugs can cause these?

  • Dystonia
  • Akathasia
  • Pseudoparkinsonism
  • Tardive

 

Prochloperazine, Promethazine, Metoclopramide

32

What atypicals are approved for the treatment of bipolar disorder?

  • Apriprazole
  • Olanzapine
  • Ziprasidone
  • Lurasidone
  • Quentiapine

33

Typical antipsychotics are dopamine antagonists, what are their common side effects?

  • Hyperprolactinemia is very common
  • EPS
  • Akathisia (agitation, distress, restlessness)

34

What SE is specific for Olanzapine Long acting injection?

Sedation delirium syndrome

35

Muscarinic receptor SEs and therapeutic effect?

 

  • Dry mouth
  • Constipation
  • Blurred vision
  • Urinary rentention

Relief of EPS SEs

36

Black Box warning for all APs

 

Increased mortality in all elderly patients with dementia related psychosis

Increased suicidal ideation in adolescents and young adults <25

- APs with bipolar depression or adjunt depression indications

37

Neuroleptic Malignant Syndrome?

  • Very rare can occur all throughout FGA treatment 

38

In the active stage of schizophrenia?

Patients have full blown schizophrenia

39

What SE is specific for Asenapine?

severe allergic rx (anaphylaxis, angioedema, rash, etc.)

40

SGA side effects include?

put these drugs in order of causing side effects 

Asenapine, Quetiapine, Iloperidone, Ziprasidone, Olanzapine, Clozapine, Resperidone, Lurasidone, Paliperidone, Aripiprazole

Clozapine=Olanzapine>quetiapine=risperidone= paliperidone>iloperidone>asenapine> ziprasidone=aripiprazole=lurasidone

 

Weight gain, glucose intolerance, DM, lipid abnormalities

41

What SE is specific for Clozapine?

– agranulocytosis, myocarditis

42

Positive symptoms of schizophrenia like delusion, hallucination, Disorganized speech, unusual behavior, agitation, hostility, combativeness. Occur in what system and too much of what is released?

Positive symptoms in the mesolimbic system. Occurs when too much dopamine is release in the synapse.

43

Ziprasidone, Olanzapine?

Severe skin reaction with Eosinophilia and Systemic Symptoms DRESS

44

What side effects are greater in FGAs compared to SGAs?

  • EPS
  • Neuroleptic malignant syndrome

45

What are the short term goals schizophrenia treatment?

  • Prevent harm to self and others
  • Improve social functioning 
  • Reduce acute symptoms

 

46

What a typical drugs are approved for the treatment of bipolar mania?

  • Apiprozole
  • Asenapine
  • Cariprazine
  • Olanzapine
  • Quetiapine
  • Risperidone
  • Ziprasidone

47

What SE is specific for Aripiprazole?

impulse control behaviors

48

Alpha 1? SE and Therapeutic effect?

  • Orthostatic hypotension
  • Reflex tachycardia

No therapeutic benefit!

49

What are the two high potency typical?

  • Fluphenazine (Prolixin)
  • Haloperidol (Haldol) 

 

50

How is dystonia treated?

  • IM or IV anticholinergics or benzodiazepines
    • Benztropine (cogentin) 2 mg IM
    • Diphenhydramine 50 mg IM

51

Lurasidone is metabolized by?

What do you have to take it with?

CYP3A4

Take with food 350 cals

52

Long term goals for the treatment of schizophrenia?

  • Prevent relapse 
  • Compliance (big thing)
  • Optimize medications and prevent side effects 
  • Monitor for Tardive Dyskinesia
  • Improve quality of life always 

53

Risk factors for TD?

Age, Female, duration of AP, and FGA

54

_____ is the most effective antipsychotic

Clozapine

55

Drugs can induce psychosis what are the non illicit ones?

  • Dopamine agonists (levo/carbodopa)
  • Anticholinergics
  • Steroids

56

What are the stages of schizophrenia?

  • Prodromal 
  • Active 
  • Residual

 

57

What atypicals are approved for Adjunct Depression?

 

  • Apriprazole
  • Brexipiprazole
  • Quetiapine ER

58

What are the overall SEs of Antipsychotics?

  • Cardiovascular SEs- QTc prolongation, Consider baseline EKG in all patients > 40
  • Thioerdazine most, Ziprasidone for 

 

  • increase prolactin
  • Drowsiness

59

In the residual stage of schizophrenia patients symptoms begin to?

Subside 

60

What atypicals are most likely to cause QTC prolongation?

Ziprazidone, Iloperidone

 

61

What are some ways to treat pseudopaekinsonism?

Anticholinergics 

  • Benztropine  1-2 mg BID MAX 8 mg/d
  • Diphenhydramine 25-50 mg po TID (increase sedation)
  • Trihexyphenidyl 2-5 mg PO TID
  • 3-4 days to work

Dopamine agonists as well

  • Amantidine, Bromocrtiptine
  • Can cause anxiety, agitation, and restlessness

 

62

What are the two low potency typical antipsychotics?

  • Chlorpromazine (Thorazine)
  • Thioridazine (Mellaril)

63

What atypicals are most likely to cause EPS, and Hyperprolactinemia?

Paliperidone, Respiridone

 

64

When performing an assessment to see if someone has schizophrenia what tests and various other things should be done?

  • Mental Status Exam
  • Physical Exam
  • Lab workup
    • Electrolytes, BUN, Cr
    • UDS 
    • Syphilis test
  • Medication assessment 

 

65

Akathisia?

  • Restless and unable to sit still

66

Explain the dopamine hypothesis?

Pathophysiology of schizophrenia that involves hyperactivity of the limbic system

67

What is needed to accurately diagnose schizophrenia?

  • Duration: Must have continuos signs for at least 6 months
  • 2 or more of the following symptoms for a significant portion of 1 month 
    • Delusions
    • Hallucinations
    • Disorganized speech
    • Catatonic behavior or unusual behavior
    • Negative symptoms 
  • None of these symptoms can be due to a medical disorder or substance abuse 
  • Mood disorders must be excluded