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Diagnosis_Management 1 > Schizophrenia and atypical antipsychotics > Flashcards

Schizophrenia and atypical antipsychotics Flashcards

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1
Q

circumstantiality

A

apparently unnecessary detail and irrelevant remarks make it take forever to get to the point

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2
Q

tangential thinking

A

moving from thought to thought without ever getting to the point. thoughts are somewhat connected to

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3
Q

perseverative thinking

A

continuous negative thinking about future or past events

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4
Q

neologisms

A

new word, expression, or usage

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5
Q

echolalia

A

repetition of another’s speech

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6
Q

verbigeration

A

compulsive repetition of meaningless words, phrases, or sentences

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7
Q

loss of ego boundaries

A

no sense of where they end and something else begins

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8
Q

types of ego boundary loss

A

ideas of reference
thought control
thought broadcasting
fused with an external object
disintegrated and fused with the universe

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9
Q

thought broadcasting

A

thinking others can read their mind or they can broadcast thoughts through TV or radio

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10
Q

cenesthetic hallucinations

A

sensation of an altered state of bodily organs like burning in the brain or pushing in the blood vessels

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11
Q

what is the leading cause of death among schizophrenics

A

suicide

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12
Q

risk factors for violent/impulsive behavior in schizophrenics

A

persecutory delusions
previous episodes of violence
neurologic deficits

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13
Q

what are the 3 subgroupings of symptoms for schizophrenia

A

positive sx
negative sx
cognitive sx

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13
Q

quick way to remember difference between positive and negative symptoms

A

positive sx are abnormal behavior
negative sx are the absence of normal behavior

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14
Q

which two antipsychotics cause the most weight gain and development of DM

A

olanzapine and clozapine

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15
Q

what are some labs you should check prior to prescribing antipsychotics

A

weight/height = BMI
waist circumference
BP
fasting plasma glucose
fasting lipids

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16
Q

main indications for antipsychotic use

A

schizophrenia and schizoaffective
mood disorders

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17
Q

other indications for antipsychotic usage

A

aggressive/violent behavior
AIDS dementia
Autism
Tourette’s
Huntington’s
Lesch-Nyhan syndrome

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18
Q

Indications for clozapine other than failed treatments

A

severe TD
low threshold for EPS

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19
Q

what increases the effectiveness of clozapine

A

risperidone

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20
Q

indications for risperidone

A

-acute and maintenance of schizophrenia
-acute manic/mixed episodes of bipolar 1
-irritability associated w/ autism

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21
Q

half life for risperidone

A

20 hours

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22
Q

when does risperidone reach peak plasma levels

A

1 hour for parent and 3 hours for metabolite

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23
Q

available formulations for risperidone

A

oral solution
disintegrating tablet
depot
PO

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24
how should you start depot of risperidone
give PO with depot for first few weeks
25
dosage for PO risperidone
1-2mg at hs which can be increased to 4mg
26
what can happen with risperidone SSRI combo
marked elevation in prolactin
27
what drugs inhibit CYP2D6 and should not be given with risperidone
paroxetine fluoxetine
28
other name for risperidone
risperidal
29
other name for paliperidone
invega
30
indications for paliperidone
acute/maintenance of schizophrenia acute schizoaffective disorder adjunct to mood stabilizers adjunct to antidepressants
31
peak plasma and steady state for paliperidone
24 hours and 4-5 days
32
recommended dosage for paliperidone
6mg daily with or w/o food
33
half life of IM paliperidone
24-49 days
34
how do you initiate IM paliperidone
first 2 in deltoid then you can alternate between deltoid and gluteal
35
indications for olanzapine
schizophrenia acute tx of manic/mixed episodes in bipolar 1 maintenance of bipolar 1
36
other name for olanzapine
zyprexa
37
how can zyprexa be used for bipolar 1
as monotherapy adjunct to valproate or lithium combo w/ fluoxetine (Symbyax)
38
zyprexa as monotherapy for tx resistant depression
No
39
peak concentration of olanzapine
5 hours
40
half-life of olanzapine
31 hours daily dosing
41
available formulations of olanzapine
disintegrating tablet IM PO
42
what should you not administer with olanzapine
benzodiazepines
43
starting dose for PO olanzapine
5-10mg
44
starting dose for olanzapine in acute mania
10-15mg
45
how fast can you titrate olanzapine
weekly intervals
46
why would you use an IM olanzapine
acute agitation
47
what is the name of olanzapine depot
Relprevv
48
where do you administer relprevv
gluteal only not approved for deltoid
49
how often do you give relprevv and how do you monitor
q2-4 weeks monitor for 3 hours post injection d/t risk of delirium sedation
50
other name for quetiapine
seroquel
51
indications for quetiapine
-schizophrenia -acute mania in bipolar 1 -monotherapy for depression associated with bipolar 1 -maintenance for bipolar 1 -adjunct to antidepressants for MDD
52
peak plasma and steady state for quetiapine
1-2 hours and 7 hours
53
how often do you dose quetiapine
2-3x daily
54
dosage for quetiapine
start 25mg BID and increase by 25-50mg q2-3 days up to 300-400mg daily
55
why can quetiapine be dosed daily if it has a short half-life
receptor occupancy remains when concentration has markedly declined
56
dosage of quetiapine for insomnia
25-300mg
57
when should you dose quetiapine
evening with food
58
when should you NOT give quetiapine
-with other drugs that increase QT interval -hx of cardiac arrythmia -hypokalemia or hypomagesemia
59
which antipsychotic other than clozapine is least likely to cause EPS
quetiapine
60
other name for ziprasidone
geodon
61
indications for ziprasidone
schizophrenia monotherapy for acute manic/mixed episode of bipolar 1 adjunct to lithium or valproate
62
peak plasma and steady state for ziprasidone
2-6 hours and 1-3 days BID dosing
63
what doubles bioavailability of ziprasidone
food
64
peak concentration and half life of ziprasidone IM
1 hour and 2-5 hours
65
available formulations of ziprasidone
PO IM
66
dosage of IM ziprasidone
10mg q2h or 20mg q4h Max daily dose is 20mg
67
initial dose of PO ziprasidone
40mg
68
what drugs interact with ziprasidone
ones that prolong QT interval
69
the other name for aripiprazole
abilify
70
indications for aripiprazole
schizophrenia acute manic/mixed and maintenance for bipolar 1 adjunct to antidepressants for MDD irritability associated w/ autism
71
peak concentration and half-life of aripiprazole
3-5 hours and 75 hours once daily dosing
72
how does aripiprazole work
as a modulator rather than a blocker
73
can you give aripiprazole as an adjunct to lithium or valproate? why?
No because interaction prevents them from reaching steady state
74
starting dose for aripiprazole
10-15mg but 5mg may improve tolerability
75
weight gain, prolactin, QT interval with aripiprazole
not significantly effected
76
other name for asenapine
saphris
77
indications for asenapine
schizophrenia acute/mixed episodes of bipolar 1 with or w/o psychotic features
78
peak plasma concentration of asenapine
1 hour
79
route of asenapine
SL because bioavailability so low with digestion
80
dosage of asenapine for schizophrenia
5mg BID
81
dosage of asenapine for bipolar
10mg BID
82
asenapine effect on QT interval and prolactin
elevate and prolong
83
other name for clozapine
clozaril
84
indications for clozapine
schizophrenia sever psychotic depression huntington's disease idiopathic parkinson's disease tx resistant mania
85
peak levels and steady state of clozapine
2 hours and less than 1 week
86
half-life of clozapine
12 hours
87
initial dosage of clozapine
25mg once or twice daily
88
titration of clozapine
can increase by 25mg q2-3 days up to 300mg daily in divided doses
89
clozapine and lithium
increased risk for seizures
90
monitoring of clozapine
weekly WBC for first 6 months then q 2 weeks
91
when to dc clozapine
WBC<3000 or granulocyte <1500
92
other name for iloperidone
fanapt
93
indications for iloperidone
schizophrenia in adults
94
does clozapine prolong QT interval
yes
95
titration of clozapine
comes in titration pack effective dose reached in 4 days start 1mg and increase by 1mg each day for 4 days
96
other name for lurasidone
latuda
97
indications for lurasidone
schizophrenia
98
titration of lurasidone
not required
99
dosage and range of lurasidone
start at 40mg effective 40-120mg
100
adjustments to lurasidone for renal and hepatic impairment
renal NTE 80mg daily hepatic NTE 40mg daily
101
other name for lumateperone
caplyta
102
how long until you have to restart titration of an atypical
if you miss for 36 consecutive hours
103
what drugs need tapered down when discontinuing to avoid cholinergic rebound
olanzapine and clozapine
104
which atypical requires informed consent
clozapine
105
which atypicals lack anticholinergic effects
risperidone, ziprasidone, and quetiapine
106
how do you mitigate the risk of cholinergic rebound
give anticholinergic temporarily while weening off antipsychotic
107
which atypical can you give if there has been agranulocytosis with clozapine
olanzapine
108
109
what is considered late onset schizophrenia
after age 45
110
diagnostic rating scales for schizophrenia
PANSS (+ and - sx scale) BPRS (brief psychiatric rating scale)
111
rating scales to track EPS
SAS (Simpson Angus scale) AIMS BARS (Barnes akathisia rating scale)
112
what typically predicts patients course of schizophrenia
pattern during first 5 years
113
schizophrenic sx categories severity over time
positive sx tend to get less severe negative sx tend to get more severe
114
antipsychotics most likely to cause EPS
risperidone olanzapine ziprasidone
115
which antipsychotic can actually decrease severe tardive dyskinesia
clozapine
116
when would you consider using clozapine
after treatment failure of 2 other antipsyhotics
117
what is an adequate trial of antipsychotic medication
4-6 weeks
118
seasonality of birth r/t schizophrenia
more likely to be born in winter or early spring
119
what prenatal infection can predispose to schizophrenia
prenatal exposure to the flu
120
dopamine hypothesis of schizophrenia
sx result from dopamine excess
121
serotonin hypothesis of schizophrenia
serotonin excess can cause + and - sx AEB increased efficacy of meds with robust serotonergic activity
122
cognitive remediation
computer exercises to influence neural networks and improve cognition
123
GABA in schizophrenia
patients can have a loss of GABA neurons in the hippocampus which leads to an increase in dopamine activity as GABA has regulatory effect on dopamine

Diagnosis_Management 1 (16 decks)

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