Schizophrenia/Psychosis

Question 1

Three primary neurotransmitters involved in schizophrenia

Answer 1

dopamine
serotonin
glutamine

Question 2

One of the biggest treatment barriers in schizophrenic patients

Answer 2

adherence

Question 3

List of negative signs/symptoms

Answer 3

lack of emotion
social withdrawal
loss of motivation (avolition) 
lack of speech (alogia)
poor hygiene

Question 4

list of positive signs/symptoms

Answer 4

hallucinations
delusions
disorganized thinking/behavior

Question 5

What are some drugs that can cause psychotic symptoms?

Answer 5

anticholinergics (high doses)
dextromethorphan
dopamine agonists (common in parkinson's patients)
stimulants
systemic steriods 
illicit substances

Question 6

Main mechanism of antipsychotics

Answer 6

block dopamine receptors

newer drugs also block serotonin receptors

Question 7

what type of symptoms do the drugs aim to treat

Answer 7

positive

Question 8

What is first-line treatment and why?

Answer 8

second gen antipsychotics

less extrapyramidal symptoms (EPS)

Question 9

What are some common EPS

Answer 9

dystonia (muscle contractions)
dyskinesias (abnormal movement)
tardive dyskinesia (repetitive movement)
akathisia (restlessness)

Question 10

What should occur if a patient experiences tardive dyskinesia

Answer 10

d/c drug

this can be irreversible

Question 11

What is a common “cocktail” to schizophrenic patients to add sedative effects and reduce dystonias

Answer 11

IM antipsychotic + BZD + anticholinergic

Question 12

Which antipyschotic should absolutely not be given with BZDs due to excessive sedation

Answer 12

Olanzapine

Question 13

What’s important to know about antipyschotics and elderly patients

Answer 13

Should NOT be used in dementia-related psychosis due to increased risk of mortality/stroke

Question 14

All antipsychotics carry a warning for _____

Answer 14

falls

Question 15

MOA FGA (first gens)

Answer 15

block D2 reception with little to no serotonin receptor blockade

Question 16

List of low potency FGAs

Answer 16

chlopromazine

thioridazine

Question 17

List of mild potency FGAs

Answer 17

loxapine

perphenazine

Question 18

list of high potency FGAs

Answer 18

haloperidol

Question 19

what drug can be used for Tourette syndrome

Answer 19

haloperidol

Question 20

How often is haldol deconate injected?

Answer 20

monthly

Question 21

how often is fluphenazine deconate injected

Answer 21

q 2 weeks

Question 22

Which FGAs are especially known for QT prolongation

Answer 22

thioridazine
haloperidol
chlorpromazine

Question 23

Warnings with FGAs

Answer 23

NMS (neuroleptic malignant syndrome) 
hyperprolacinemia 
EPS
CNS depression 
anticholinergic effects 
Tachycardia

Question 24

What side effect profile are the lower potency FGAs known for

Answer 24

higher sedation, lower EPS

Question 25

What side effect profile are the high potency FGAs known for

Answer 25

less sedation, more EPS

Question 26

Which drugs can be given with FGAs to limit dystonic reactions

Answer 26

benztropine | diphenhydramine

Question 27

Which SGAs are partial agonists for DA and serotinin

Answer 27

aripiprazole brexpiprazole cariprazine

Question 28

Side effects of aripiprazole

Answer 28

``` akathisia QT prolongation EPS in children sedation/activation constipation ```

Question 29

which drug can be used in irritability with Tourette's or autistic patients?

Answer 29

aripiprazole

Question 30

When can clozapine be used and why?

Answer 30

3rd line agent | severe side effect potential (metabolic effects and neutropenia)

Question 31

Which SGA has a REMS program

Answer 31

clozapine

Question 32

Boxed warnings clozapine

Answer 32

neutropenia/agranulocytosis cardiomyopathy seizures

Question 33

Highest starting dose for clozapine and why?

Answer 33

12.5mg qd or bid due to seizure risk

Question 34

What is the lab parameter that must be considered before starting clozapine

Answer 34

baseline ANC must be >/= 1500mm^3

Question 35

At what ANC value must clozapine be stopped?

Answer 35

<1000

Question 36

Luradisone side effect profile

Answer 36

somnolence, EPS, nausea | almost weight, lipid, and glucose neutral

Question 37

olanzapine boxed warning/side effect profile

Answer 37

after injection, must be monitored for 3 hours for delirium/sedation somnolence, metabolic syndrome

Question 38

Paliperidone side effects

Answer 38

increased prolactin (sexual dysfunction) EPS metabolic syndrom

Question 39

Invega Trinza frequency

Answer 39

q 3 months (must have received Sustenna prior to use)

Question 40

Quetiapine side effect profile

Answer 40

somnolence, metabolic syndrome low EPS risk take without food

Question 41

which SGA can be used in Parkinson's pyschosis due to low EPS risk?

Answer 41

quetiapine

Question 42

risperidone side effect

Answer 42

metabolic disorder EPS increased prolactin

Question 43

ziprasidone CI

Answer 43

QT prolongation

Question 44

Which drugs would we avoid in a cardiac/QT risk patient?

Answer 44

ziprasidone, haloperidol, thioridazine, chlorpromazine

Question 45

Which drugs would we avoid in a patient with hx of movement disorder or parkinsons?

Answer 45

FGAs risperidone paliperiodone

Question 46

Which drug is preferred in parkinsons or patient with hx of movement disorder?

Answer 46

quetiapine

Question 47

Which drugs should we avoid in overweight patients

Answer 47

olanzapine | quetiapine

Question 48

Which drugs are good options in overweight patients

Answer 48

aripiprazole ziprasiodne lurasidone asenapine

Question 49

Which drugs would be good option in homeless patients

Answer 49

long acting injections!

Question 50

What drug is used during acute psychosis in a patient refusing meds?

Answer 50

haloperidol IM

Question 51

What is pimavanserin?

Answer 51

Indicated for parkinson's pyschosis due to not affecting dopamine receptors

Question 52

Medications approved for TD treatment

Answer 52

valbenazine | deutetrabenazine (hepatic impairment)

Question 53

NMS signs/symptoms

Answer 53

hyperthermia muscle rigidity mental status change increased creatine phosphokinase and WBC

Question 54

How to treat NMS

Answer 54

taper off antipsychotic quickly supportive care cool patient down bzd or dantrolene for muscle relaxation