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P&T > Schizophrenia and Bipolar > Flashcards

Schizophrenia and Bipolar Flashcards

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0
Q

The most common cause of chronic psychosis

A

schizophrenia

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1
Q

Mental state in which the individual appears to have lost touch with reality

A

Psychosis

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2
Q

A belief not based on fact or reality

A

delusion

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3
Q

3 classes of symptoms seen in schizophrenia

A
  1. positive symptoms
  2. negative symptoms
  3. cognitive impairment
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4
Q

2 most consistent anatomical correlations to schizophrenia

A
  1. decreased brain volume (decreased brain volume)

2. enlarged ventricles

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5
Q

Area of the brain that is important in higher cognitive function and working memory and has decreased metabolic activity in schizophrenia

A

prefrontal cortex

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6
Q

First drug discovered to treat schizophrenia

A

chlorpromazine

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7
Q

Neurotransmitter most commonly associated with schizophrenia

A

dopamine

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8
Q

Antagonism at this receptor in the striatum is thought to increase striatal DA release and may help to counteract D2 blockade, theory for why SGAs have less EPS than FGAs

A

5HT2A receptor

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9
Q

Mechanism of antipsychotic drugs

A

D2 dopamine receptor antagonists

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10
Q

involuntary movements usually to the face and tongue but also to the trunk and limbs that develops after months to years of antipsychotic therapy and can be irreversible

A

tardive dyskinesia

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11
Q

A perception disturbance in sensory experiences of the environment

A

Hallucination

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12
Q

Brain system involved in the negative symptoms of schizophrenia

A

mesocortical

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13
Q

Drug that marked the transition the SGAs and differed from FGAs in its significant decrease in motor SEs

A

Clozapine

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14
Q

Assigning importance to things that aren’t important

A

aberrant salience

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15
Q

Antipsychotic that is a D2 receptor partial agonist and acts as a dopamine stabilizer

A

aripiprazole

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16
Q

Antipsychotic that has proven to be superior in treatment resistant patients

A

clozapine

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17
Q

A person diagnosed with schizophrenia must have at least 2 of the following 3 things

A
  1. delusions
  2. hallucinations
  3. disorganized speech
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18
Q

Length of symptoms needed for diagnosis of schizophrenia

A

6 months

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19
Q

2 low potency SGAs

A
  1. clozapine

2. quetiapine

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20
Q

Inhibition of these 2 receptors is thought to be lead to weight gain associated with antipsychotics

A

H1 and 5HT2C

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21
Q

Diagnosis of symptoms of schizophrenia have occurred for less than 6 months

A

schizophreniform disorder

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22
Q

schizophrenia + bipolar disorder

A

schizoaffective disorder

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23
Q

Symptom of psychosis that responds best to medications

A

hallucinations

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24
Most common form of hallucination
auditory
25
minimum length of antipsycholic drug therapy for schizophrenia
1-2 years, usually lifelong
26
3 medium potency FGAs
1. loxapine 2. perphenazine 3. thiothixene
27
3 extrapyrimidal SEs that result from disruption of DA signaling in the substantia nigra to the striatum, important for motor function
1. akathisia (uncontrollable restlessness) 2. dystonia (involuntary movements) 3. parkinsonism (bradykinesia, tremor)
28
4 medications that can be used adjunctively in schizophrenia if aggression or hostility is present
lamotrigine, divalproex, topiramate, lithium
29
2 characteristics of drugs that have the highest risk of movement disorders
1. high potency | 2. slow dissociation (most FGAs)
30
SGA that has the highest risk of akathisia
aripiprazole
31
antagonism at this receptor results in side effects such as blurred vision, urinary retention, dry mouth, and constipation
M1
32
Antagonism at this receptor leads to sedation SE of antipsychotics
H1
33
3 high potency FGAs
1. trifluoperazine 2. fluphenazine 3. haloperidol
34
The most activating antipsychotic (take in the morning)
aripiprazole
35
Potency of meds that have the most anticolinergic SEs and sedation
low potency
36
antagonism of this receptor results in hypotension SE of antipsychotics
alpha-1
37
antipsychotics that have the highest risk of hypotension
low potency and lloperidone
38
Minimum time needed to see full effect of antipsychotics
12 weeks
39
Antipsychotics that have the highest risk of hyperprolactinemia
FGAs and risperidone/paliperidone
40
3 receptors that are involved in metabolic issues associated with SGAs
5HT2C, M3 and H1
41
2 SGAs that have the highest risk of Torsades de Pointes
1. ziprasidone | 2. Iloperidone
42
Symptoms of schizophrenia that are new mental phenomena which unaffected people do not normally experience (hallucinations, delusions)
Positive symptoms
43
2 SGAs that have the highest risk of metabolic issues
1. clozapine | 2. olanzapine
44
5 SGAs that have intermediate risk of metabolic issues
quetiapine, risperidone, paliperidone, Iloperidone, asenapine
45
3 most important antipsychotics to not abruptly discontinue
1. clozapine 2. quetiapine 3. Ilperidone
46
FGA that has an intermediate risk of metabolic issues
chlorpromazine
47
3 SGAs that have a low risk of metabolic SEs
ziprasidone, lurasidone, aripiprazole
48
All FGAs have a higher risk of Torsades de Pointes than SGAs but this FGA has the highest risk
Thioridazine
49
3 antipsychotics included in FDA warning for increased incidence of stroke in elderly patients with dementia
1. risperidone 2. olanzapine 3. aripiprazole
50
Dietary restriction with ziprasidone
take with at least 500 calories
51
4 drug characteristics that lead to increased risk of neuroleptic malignant syndrome
1. high dose 2. high potency 3. IV 4. dehydration
52
Antipsychotic that has the highest risk of seizures
clozapine
53
4 SEs that clozapine has the highest incidence of
1. metabolic changes 2. sedation 3. constipation 4. sialorrhea (drooling)
54
Antipsychotic that has the lowest risk of seizures
Quetiapine
55
2 SEs that clozapine has the lowest incidence of
1. movement disorders | 2. NMS
56
2 drugs that can be used IM to treat dystonia
1. benztropine | 2. benadryl
57
Antipsychotic that is technically a FGA but has some 5HT2A activity and is often used in children
loxapine
58
Rare but life-threatening SE of antipsychotics that involves fever, encephalopathy, unstable vitals, elevated enzymes and muscle rigidity
Neuroleptic malignant syndrome
59
Schedule for CBC monitoring with clozapine
weekly for 6 months, then every 2 weeks for 6 months then monthly thereafter
60
2 antipsychotics that are long acting injections given every 1-4 weeks and are good for poor adherance
1. fluphenazine decanoate | 2. haloperidol decanoate
61
A potentially fatal drop in WBC associated with clozapine
agranulocytosis
62
Enzyme that tobacco induces and cloazpine is a substrate
CYP1A2
63
5 black-box warnings for clozapine
1. agranulocytosis 2. seizures 3. myocarditis 4. orthostasis 5. antipsychotics in elderly
64
Dietary restriction with asenapine
no food or drink for 10-15 minutes
65
Brain system involved in the positive symptoms of schizophrenia
mesolimbic
66
Dietary restriction with lurasidone
take with at least 350 calories
67
2 low potency FGAs
1. chlorpromazine | 2. thioridazine
68
2 high potency SGAs
1. risperidone | 2. paliperidone
69
Symptoms of mania but less severe and episodes are not severe enough to cause marked impairment
hypomanic episode
70
Symptoms of schizophrenia in which the individual has a loss of normal mental functions (amotivation, social withdraw)
Negative symptoms
72
Route of elimination of lithium
kidney
73
therapeutic window of lithium
0.6-1.5 mM
74
Cation that lithium mimics in excitable tissues
Na+
75
Neurotransmitters whose release is inhibited by lithium
NE and DA
76
Second messenger created via PIP2 hydrolysis that activates calcium release from intracellular stores
IP3
77
Manic episode + major depressive episode
Bipolar I disorder
78
Duration of time in which a persistently elevated, expansive or irritable mood must occur to classify as a manic episode
7 days, but if hospitalization is required there is no minimum duration
79
4 AEDs that can be used in the management of bipolar disorder
Valproic acid, lamotrigine, carbamazepine, oxcarbazine
80
Only medication used in bipolar disorder that is truly a mood stabilizer
Lithium
81
Time required to see initial response in treatment of acute manic episode (see improvements in sleep and agitation first)
7-14 days
83
SE that is the reason why lamotrigine must be titrated slowly
Stephen-Johnson syndrome
84
Order of increasing risk of mood switch for antidepressants
Bupropion < SSRIs < Venlafaxine < MAOIs < TCAs
86
5 drugs that are not recommended as monotherapy for bipolar mania
1. Gabapentin 2. Lamotrigine 3. Tiagabine 4. Topiramate 5. Verapamil
87
EKG abnormality seen with lithium toxicity
flat or inverted T waves
88
Amount of time that the acute phase lasts for bipolar disorder
sustained response >4 weeks
89
Time required to see full response in treatment of an acute manic episode
4-8 weeks
90
Second messenger generated via hydrolysis of PIP2 that activates protein kinase C
DAG
91
The most effective agent for classic euphoric mania
Lithium
92
3 SGAs that are both anti-manic and anti-depressive
1. Quetiapine 2. Lurasidone 3. Olanzapine + fluoxatine
93
AED that has mostly anti-depressant effects and should not be used as monotherapy for manic episodes
Lamotrigine
94
Amount of time the continuation phase lasts in bipolar depression treatment
full response for 4-6 months
95
6 medications that have FDA approval for prevention of recurrence of bipolar disorder
1. Lithium 2. Lamotrigine 3. Olanzapine 4. Aripiprazole 5. Risperdal consta 6. ziprasidone (adjunct)
96
5 medications that are not recommended for monotherapy in bipolar depression
1. Gabapentin 2. Aripiprazole 3. Ziprasidone 4. Parozetine 5. Levetiracitam
97
Drug class that tends to be best for disphoric mania
AEDs
100
Hypomania + major depressive episode
Bipolar II disorder
101
How often a patient on antipsychotic therapy should get an AIMS (abnormal involuntary movement scale) assessment
At baseline and every 6 months
102
How often a patient on anti psychotic therapy needs to get a lipid panel and glucose checked
every 3 months

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