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Flashcards in Schizophrenia/ Psychosis Deck (55):
0

Whats schizophrenia?

Debilitating thot disorder xterized by chronic, relapsing and remitting episodes that are a result of EXCESS DOPAMINE and other changes in brain

1

Main xteristic of Schizophrenia?

Hallucinations

Delusions (false beliefs)

Disorganized thinking and behavior

2

Main MOA of antipsychotics?

Block DA receptors

Newer agents also block serotonin receptor

3

List NEGATIVE s/sx of Schizophrenia

Loss of interest in everyday activities

Lack of emotion

Inability to plan or carry out activities

Poor hygiene

Social withdrawal

Loss of motivation (Avolition)

Poverty (lack of) speech (alogia)

4

List POSITIVE s/sx of Schizophrenia

Hallucinations: hearing voices (auditory hallucinations) visual hallucinations

Delusions: beliefs the pt has, but are w/o a basis in reality

Disorganized thinking/behavior, incoherent speech, purposeless behavior or difficulty speaking

Difficulty paying attention

5

What sx MUST be present for a pt to be diagnosed schizophrenic?

Delusions

Hallucinations

Disorganized speech

+ 2 or more other sx

6

Medications that can cause Psychotic sx?

Amphetamines, Methamphetamines, Ice, Crack

Cannabis, Cocaine

Dextromethropan

Phencyclidine (PCP), MDPV (bath salts)

Lyse thick acid diethylamide (LSD) and other hallucinogens

Anticholinergics (centrally-acting, high doses)

Dopamine or dopamine agonist used for PD (Requip, Mirapex, Sinemet etc)

Interferons

Steroids (+ lack of sleep - ICU psychosis)

Stimulants (esp, is already at risk) including ADHD drugs, modafinil etc

7

What must be evaluated b4 changes is made to initial tx?

Adequate trial time (at least 4-6 wks)

Adequate dose

Adherence/compliance

Previous tve or negative hx with antipsychotics should be a guide therapy

8

Main SE of Clozapine? Role of Clozapine in therapy?

BBW of Agranulocytosis

Others: seizures, myocarditis, high metabolic risk

Used only when pt has had no or poor response to 2 trials of antipsychotic med (at least 1 should be a SGA)

9

Common SEs of FGAs such as Haloperidol?

Associated with high risk of eps effects

Moderate risk of sedation

10

In which antipsychotic is QT prolongation risk significant?

Thioridazine

Ziprasidone

11

SEs of SGAs? (esp, Clozapine, Olanzapine & Quetiapine)

Weight gain

Lipid & glucose abnormalities (metabolic SE)

12

Common SE of Risperidone and Palioperidone?

Moderate risk of metabolic SE

13

According to American Diabetes Association (ADA), what should be screened for and routinely monitored when initiating antipsychotics?

Overweight and obesity

Dyslipidemia

Hyperglycemia

HTN

Personal or FH of risk

14

Which SGAs should be avoided if pt has cardiovascular risk?

Ziprasidone -greatest risk

High risk
Phenothiazines in general, Thioridazine in particular

15

Which SGAs should be avoided if pt is overweight, has little physical activity or has metabolic issues?

Most notably Olanzapine and Quetiapine

16

Which SGAs should be considered if pt is overweight, has little physical activity or has metabolic issues?

LAAZ

Lurasidone

Aripiprazole

Asenapine

Ziprasidone





All these have the least risk of metabolic SE and wipeight gains

17

Whats a concern with Risperidone and Paliperidone, esp with higher doses?

High prolactin levels =>

Galactorrhea (milk production w/o pregnancy)
Sexual dysfxn
Gynecomastia (painful, swollen breast tissue)
Irregular or missed periods
Osteoporosis (after several yrs)

18

Which SGAs should be avoided if pt has hx of Tardive dyskinesia (TD), or any movement disorder?

Risperidone

Paliperidone

Lurasidone

19

Which SGAs should be recommended if pt has hx of Tardive dyskinesia (TD), or any movement disorder?

Quetiapine (low risk and recommended agent for psychosis in pt with PD)

20

BBW of Antipsychotics (APs)?

Risk of mortality in elderly pts with dementia-related psychosis, primarily due to an increased risk of stroke and infection

21

Signs of Neuroleptic Malignant Syndrome (NMS) - rare, but fatal?

Hyperthermia (high fever, with profuse sweating)

Extreme muscle rigidity (called "lead pipe" rigidity)

Mental status changes

Other signs can include Tachycardia and tachypnea and BP changes

22

Tx of NMS?

Stop APs

Provide supportive care

Cool them down: cooling bed, antipyretics, cooled IV fluids

Muscle relaxants

Airway support

23

MOA of FGAs?

Block D2 and 5HT2A receptors

24

List low potency FGAs? (Higher sedation and lower EPS)

Chlorpromazine

Thioridazine (BBW - QT prolongation)

25

List mid-potency FGAs?

Loxapine (Adasuve inhalation powder for acute agitation)

Perphenazine

26

List high potency FGAs? (Lower sedation and Higher EPS)

Fluphenazine (available in 2-wk Decanoate)

Haloperidol (Haldol)

Trifluoperazine

Thiothixene (Navane)

27

Brand name of Haloperidol? Class of meds? Howz haloperidol Decanoate doses?

Haldol

Butyrophenones

Monthly

28

SEs of FGAs?

All are sedating and all cause EPS

Dystonias (higher risk in younger males)

Akathisia (restlessness + anxiety + inability to remain still)

Parkinsonism

Tardive Dyskinesias (TD) - abnormal facial movements, esp, in tongue or mouth

Dyskinesias - abnormal movements

29

What can be used as prophylaxis for dystonias?

Centrally-acting anticholinergic (diphenhydramine, benztropine)

30

Akathisia (restlessness + anxiety + inability to remain still) tx?

Anticholinergics

BZD

Propranolol

31

In what population is the highest risk of Tardive Dyskinesias (TD)? TX of TD?

Elderly females

Stop drugs ASAP (TD can be irreversible)

32

Cardiovascular effects caused by FGAs, esp, IV Haloperidol?

Orthostasis

Tachycardia

QT prolongation

33

MOA of SGAs? Exception?

Block D2 and 5HT2A

Aripiprazole is unique - acts as D2 and 5HT1A partial agonist and 5HT2A

34

List SGAs

Clozapine (Clozaril)

Olanzapine (Zyprexa)

Risperidone (Risperdal; M-Tabs ODT)

Quetiapine (Seroquel; XR)

Ziprasidone (Geodon)

Aripiprazole (Abilify, Abilify Discmelt ODT)

Paliperidone (Invega)

Iloperidone (Fanapt)

Asenapine (Saphris)

Lurasidone (Latuda)

35

Brand name of Clozapine (SGAs)?

Clozaril

36

Brand name of Olanzapine (SGAs)?

Zyprexa

37

Brand name of Risperidone (SGAs)?

Risperdal

Risperdal M-Tabs ODT (also approved for autism)

Risperdal Consta, 2 wk injection

38

Brand name of Quetiapine (SGAs)?

Seroquel

Seroquel XR

39

Brand name of Ziprasidone (SGAs)?

Geodon

40

Brand name of Aripiprazole (SGAs)?

Abilify

Abilify Discmelt ODT

41

Brand name of Paliperidone (SGAs)?

Invega

42

Ses of Clozapine (Clozaril)? REMS drug

Agranulocytosis

Seizures

Myocarditis

43

SEs of Olanzapine (Zyprexa) - SGAs?

Sedation

Wt gain, increased lipids and glucose

44

SEs of Risperidone (Risperdal) & Paleperidone (Invega) - SGAs?

EPS, esp at higher doses

Increased Prolactin => sexual dysfxn, galactorrhea, irregular/missed
periods

Weight gain, increased lipids and glucose

45

SEs of Quetiapine (Seroquel) - SGAs?

Sedation, Orthostasis

Weight gain, increased lipids and glucose

46

SEs of Ziprasidone (Geodon) - SGAs?

Prolongs QT interval; CI with QT risk

47

SEs of Aripiprazole (Abilify) - SGAs?

Anxiety

Insomnia

48

Which SGA is to be used without food/drink for 10 mins after dose?

Asenapine (Saphris) SL

49

SEs of Asenapine (Saphris) SL - SGA?

Tongue/mouth numbness

50

Smoking and APs?

Smoking may reduce plasma levels of Olanzapine and Clozapine

Pts who smoke may req higher doses

51

Formulations of Haloperidol

Oral tabs

IM inj

Long-acting monthly Decanoate

Oral soln

52

SEs from Haloperidol?

Painful dystonic rxns

TD

QT prolongation + possible arrhythmia risk

53

EPS is still a risk with Risperdal Consta? (2-wkly dose of Risperidone)

T

54

Value of WBC and ANC needed to start Clozapine (Clozaril)?

WBC >= 3,500/mm^3

ANC >= 2,000/mm^3

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