Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

BCPS > Schizophrenia & Antipsychotics > Flashcards

Schizophrenia & Antipsychotics Flashcards

(62 cards)

Start Studying
1
Q

Schizophrenia criteria for diagnosis

A

Must have 1 of delusions, hallucinations, or disorganized speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Anosognosia

A

Patient lack of awareness or insight into schizophrenia illness

Occurs in about 57-98%

Most common predictor of nonadherence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Positive symptoms

A

Antipsychotics most effective

Clinically significant = acute phase schizo

Hallucinations
Delusions
Paranoia/suspiciousness
Conceptual disorganization
Hostility
Grandiosity
Excitement
Loose associations
Thought broadcasting
Thought insertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Negative symptoms

A

Antipsychotics may not be completely effective

Flat affect
Social withdrawal
Lack of personal hygiene
Prolonged time to respond
Poor rapport
Poor abstract thinking
Lack of spontaneity, flow of convo
Emotional withdrawal
Ambivalence
Asociality
Amotivation
Anhedonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cognitive symptoms

A

No current medications effectively treat

Poor executive function
Impaired attention
Impaired working memory (does not learn from mistakes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Stages of Schizophrenia

A

Prodromal (gradual development of symptoms but not super noticeable)

Acute (clinically significant positive sypmtoms)

Stabilization (acute phase decreasing)

Stable (positive symptoms declined, possible to have negative or cognitive symptoms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Neurotransmitters involved in schizophrenia

A

Dopamine
Serotonin
Glutamate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Low potency FGA

A

Chlorpromazine
Thioridazine

Low potency = low affinity for DA receptor = more drug available to go to other receptors = more side effects

AC = Sedation = OH > EPS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Moderate potency FGA

A

Loxapine
Perphenazine
Trifluoperazine

Moderate AC, sedative, OH, EPS ADE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

High potency FGA

A

Haloperidol
Fluphenazine
Pimozide
Thiothixene

EPS&raquo_space;> AC = sedative = OH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

FGA side effect based on receptor

A

Anticholinergic: dry mouth, constipation, blurred vision, urinary hesitancy

Antihistamine: sedation (dose related)

Alpha blockade: orthostatic hypotension

Dopamine blockage (in nigrostriatal pathway): EPS, hyperprolactinemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SGA Partial dopamine agonists

A

Aripiprazole
Brexipiprazole
Cariprazine

Stabilizes dopamine transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

SGA with D3 receptor blockade

A

Cariprazine - may have benefit at negative and cognitive symptoms

Aripiprazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SGA with serotonin 1A partial activity

A

Aripiprazole
Brexipiprazole
Cariprazine
»
Clozapine
Quetiapine
Ziprasidone

May benefit cognition, decrease EPS, and improve mood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Monitoring parameters for ALL SGAs

A

Baseline & periodically

BMI
Blood pressure
Fasting glucose
Lipids
Waist circumference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Antipsychotics with highest risk of weight gain, diabetes

A

Olanzapine
Clozapine

> > >

Quetiapine
Risperidone

Low potency FGA > High potency FGA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

SGA with no EPS

A

Lumateperone (caplyta)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

SGA with no glucose or lipid effect

A

Lumateperone (caplyta)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most sedating SGA

A

Clozapine
Quetiapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

SGA with most orthostasis

A

Clozapine
Iloperidone - has strict titration schedule to minimize OH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SGA with warning for suicidal ideation

A

Aripiprazole
Brexipiprazole
Cariprazine
Lumateperone
Lurasidone
Quetiapine

These are also used for treatment of mood disorders (depression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pseudoparkinsonism

A

EPS

Bradykinesia, rigidity, tremor, akinesia

  1. Reduce dose
  2. Change to another antipsychotic with less risk
  3. If cannot change, add on diphenhydramine, trihexyphenidyl, benztropine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

SGA with highest Parkinsonism risk

A

Paliperidone
Risperidone
Lurasidone
Olanzapine

Parkinsonism Risk Lay On

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Dystonia

A

Acute EPS - usually from high dose parenteral agents

Torticollis, laryngospasm, oculogyric crisis (upward deviation of both eyes)

  1. Treat using IM anticholinergics
  2. Prevent with PO anticholinergics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Akathisia
EPS Restlessness, inability to stay calm 1. Reduce antipsychotic dose 2. Change to agent with less risk 3. If unable, lipophilic BB 4. If cannot do BB, then benzo, mirtazapine, trazodone, cyproheptadine Responds POORLY to anticholinergics!
26
SGA with low akathisia
Clozapine Iloperidone Quetiapine
27
Tardive Dyskinesia
EPS Abnormal, involuntary movements of orofacial muscles. May be irreversible. Risk highest with high doses, >54 y/o, women 1. Lower dose 2. Change agent - but caution as their disease may be stable at the current agent 3. Use Valbenazine or Deutetrabenazine DO NOT GIVE ANTICHOLINERGICS
28
Agents with lowest Tardive Dyskinesia Risk
Clozapine -- not associated with TD. SGAs have low potential
29
Valbenazine (Ingrezza)
VMAT2 inhibitor used for TD Adjust for strong CYP3A4, 2D6 inhibitors ADR: sleepiness, depression, QTc prolongation
30
Deutetrabenazine (Austedo)
VMAT2 inhibitor for TD Adjust for strong CYP2D6 inhibitors ADR: sleepiness, depression, QTc prolongation BBW: increased risk of suicide
31
Neuroleptic Malignant Syndrome
Medical Emergency Agitation, confusion, muscle rigidity, fever, tachycardia, autonomic instability, diaphoresis 1. D/C Antipsychotic 2. Supportive cares 3. Bromocriptine or dantrolene 4. Wait at least 14 days before restarting antipsychotic Highest risk with high potency FGAs
32
Hyperprolactinemia highest risk and lowest risk
Breast enlargement, galactorrhea, sexual dysfunction, infertility, menstrual changes Highest risk: FGAs, risperidone, paliperidone Aripiprazole may lower prolactin concentrations
33
QTc prolongation
Chlorpromazine IV haloperidol Thioridazine Clozapine Ziprasidone Iloperidone
34
Antipsychotics that lower seizure threshold
Chlropromazine Cariprazine Clozapine
35
Antipsychotics with lowest seizure risk
Aripiprazole Fluphenazine Haloperidol Pimozide Rispseridone Thioridazine Trifluoperazine
36
CYP1A2 substrates, inducer, inhibitor
Sub: Clozapine Asenapine Ziprasidone Olanzapine Inducer: Cannabis Tobacco Inhibitor: Caffeine
37
CYP2D6 sub, inhib
Substrate: Brexipiprazole Iloperidone Perphenazine Aripiprazole Risperidone Inhibitor Cannabis Chlorpromazine Fluphenazine
38
CYP3A4 subs
CHILL ZAP QB Cariprazine Haloperidone Iloperidone Lumateperone (avoid with inducers, inhibitors) Lurasidone Ziprasidone Aripiprazole Pimavanserin Quetiapine Brexipiprazole
39
Haldol & Fluphenazine decanoate
Require bridging with oral therapy Made with sesame oil
40
BBW for clozapine
Agranulocytosis OH, Bradycardia, syncope, cardiac arrest (titrate slowly) Seizure Myocarditis, cardiomyopathy
41
ANC monitoring for normal ANCs (>1500, or >1000 (BEN)) on clozapine
Initiation - 6 months: weekly 6 mo-12 mo: every 2 weeks >12 mo: monthly If >30 day treatment interruption, will restart monitoring
42
Mild neutropenia on clozapine
ANC 1000-1499 Continue treatment Monitor ANC 3x weekly until >1500 then resume normal monitoring
43
Severe neutropenia on clozapine
ANC <500 Stop and do not rechallenge Monitor ANC daily until >1000 (or >500 for BEN) Monitor 3x weekly until >1500 (or >baseline for BEN)
44
Unique side effect from aripiprazole & brexipiprazole
Pathological gambling, other compulsive behavior
45
Aripiprazole LA-I and overlap
Ability Maintena, Asimtufi: 14 days Aristada Initio: 1 dose of 30mg Aristada: if not given with Initio, then needs 21 day overlap
46
Can you bathe or swim with asenapine patch?
Unknown But you can shower
47
Brexipiprazole dose reduction needed when..
CrCl < 60 Moderate hepatic impairment
48
Antipsychotics CI with severe hepatic impairment
LICAR (b/c liquor is bad for liver) Lumateperone Iloperidone Cariprazine Asenapine Risperidone
49
Cariprazine half life
2-4 days, metabolites have longer Dose changes may not be clinically seen for a while
50
Lumateperone unique MOA
-Presynaptic partial agonism for D2 -Postsynaptic antagonism D2 -60x more affinity for Serotonin 2A than D2 -Glutamatergic activity moderator May be why low incidence of EPS
51
Lurasidone administration
At least 350kcal of food
52
Olanzapine-samidorphan
Combination to help mitigate weight gain Delay for a minimum of 7 days after opioids (14 days if long acting)
53
Paliperidone LA-I
Establish tolerability with paliperidone first but no bridging required Must have one-time pretreatment with Sustenna before going to 3-month (Trinza) or 6-month (Hafyera) form
54
Renal adjustments needed
Brexpiprazole (<60ml/min) Lurasidone Paliperidone Risperidone (<30ml/min)
55
Risperidone LA-I
Establish tolerability first Risperdal Consta (IM) requires 3 week bridge with oral risperidone SC Perseris and Uzedy do not require oral overlap
56
Ziprasidone administration
Must be taken with 500 calories
57
Ziprasidone warning
DRESS -- can be fatal Cutaneous skin reactions, eosinophilia, fever Hepatitis, nephritis, pneumonitis, myocarditis, pericarditis
58
Treatment initiation
FGA or SGA is reasonable, individualize approach If has history of use with antipsychotics, can be more aggressive Older adults with other physical issues may need 1/4-1/2 normal starting dose
59
Time to effect
2-4 weeks - reassess 2-4 weeks after reaching therapeutic dose
60
Changing or discontinuing antipsychotics
Gradual discontinuation to avoid withdrawal
61
Treatment resistant schizophrenia DOC
Clozapine
62
Adjunctive options
Lamotrigine (add to clozapine if partial response) Benzos during acute phase Antidepressants if depressed Precedex in acute setting for agitation

BCPS (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions