SchizophreniaPsychFC

Question 1

Schizophrenia symptoms and pathophysiology

Answer 1

Debilitating brain disorder characterized by chronic, relapsing, and remitting episodes
Hallucinations, delusion, disordered thinking and behavior

There is increased dopamine in the mesolimbic pathway

Question 2

Negative Signs and Symptoms of schizophrenia

Answer 2

Normal behaviors that are missing:
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 of speech (alogia)

Question 3

Positive Signs and Symptoms of schizophrenia

Answer 3

Hallucinations: hearing voices
Delusions: beliefs the patient has, but are without basis in reality
Thought disorders, or difficulty speaking and organizing thoughts, such as stopping in mid-sentence or jumbling together meaningless words
difficulty paying attention

Question 4

Medications that Can Cause Psychotic Symptoms

Answer 4

Methamphetamine, ice, crack
Cannabis (low risk)
Cocaine
Dextromethorphan
Phencyclidine (PCP), MDPV (bath salts)
Lysergic acid diethylamide (LSD)
Anticholinergics
dopamine agonist
Interferons
Steroids
Stimulants

Question 5

Antipsychotics MOA

Answer 5

-MOA: primarily dopamine2 (D2) receptor blockers; all second generation antipsychotics (SGAs) block D2 and block 5HT2A recpetors, with aripiprazole also a 5HT1A partial agonist

Question 6

Antipsychotics BBW

Answer 6

BBW: increase risk of mortality in elderly patients with dementia-related psychosis, primarily due to an increased risk of stroke
-Neuroleptic Malignant Syndrome (NMS):

Question 7

Neuroleptic Malignant Syndrome (NMS): symptoms and treatment

Answer 7

signs: hyperthermia, extreme muscle rigidity, mental status changes, tachycardia, tachypnea, and BP changes
treatment: stop antipsychotic; provide supportive care; cool them down (cooling bed, antipyretics, cooled IV fluids); dantrolene

Question 8

First Generation Antipsychotics (FGAs) names

Answer 8

-Drugs: chlorpromazine, thioridazine, loxapine (Loxatine), perphenazine, fluphenazine (2-wk Prolixin), haloperidol (Haldol, Haldol decanoate monthly), trifluoperazine, thiothixene (Navane)

Question 9

first gen Aps Se

Answer 9

SE: sedating (less with haloperidol), cause EPS (less with chlorpromazine), tardive dyskinesias, dystonias, akathisia, sexual dysfunction, cardiovascular effects, orthostasis, tachycardia, QT prolongation

Question 10

bbw of thioridazine

Answer 10

thioridazine has BBW for QT prolongation

Question 11

Second Generation Antipsychotics

Answer 11

Clozapine (Clozaril, FazaClo ODT)
Olanzapine (Zyprexa, Zydis ODT, Relprevv inj)
-Risperidone (Risperdal, Risperdal M-Tabs ODT, Consta inj)
Quetiapine (Seroquel, Seroquel XR)
Ziprasidone (Geodon, Geodon inj)
Aripipazole (Abilify, Abilify Discmelt ODT, Abilify inj)
Paliperidone (Invega, Invega Sustenna inj)
Iloperidone (Fanapt)
Asenapine (Saphris)
Lurasidone (Latuda)

Question 12

zyprexa or zydis

Answer 12

Olanzapine (Zyprexa, Zydis ODT, Relprevv inj)

Question 13

risperidal

Answer 13

-Risperidone (Risperdal, Risperdal M-Tabs ODT, Consta inj)

Question 14

seroquel generic

Answer 14

Quetiapine (Seroquel, Seroquel XR)

Question 15

geodon generic

Answer 15

Ziprasidone (Geodon, Geodon inj)

Question 16

abilify generic

Answer 16

Aripipazole (Abilify, Abilify Discmelt ODT, Abilify inj)

Question 17

Invega generic

Answer 17

Paliperidone (Invega, Invega Sustenna inj)

Question 18

Fanapt generic

Answer 18

Iloperidone (Fanapt)

Question 19

Saphris generic

Answer 19

Asenapine (Saphris)

Question 20

Latuda generic

Answer 20

Lurasidone (Latuda)

Question 21

Clorazril generic

Answer 21

Clozaril, FazaClo ODT

Question 22

clozapine when to use?

Answer 22

Use only if failed to respond to treatment with 2 standard AP treatment, or had significant ADRs
has decrease risk of EPS and TD

Question 23

SE clozapine

Answer 23

-SE: risk of agranulocytosis and seizure; myocarditis, orthostasis (with or without syncope), weight gain, increase lipids, increase glucose, and QT prolongation

Question 24

dose of cloazpine

Answer 24

-Dose: start with 25 mg and titrate to 300-900 mg/day divided (tirate off when discontinuing)

Question 25

where must clozapine be registered?

Answer 25

REMS: must register with Clozaril Registry

Question 26

mx clozapine

Answer 26

-Monitor: WBC must be >3500 and ANC >2000 (test weekly x6mo, then biweekly x6mo, then montly); also monitor metabolic effects

Question 27

zyprexa generic

Answer 27

Olanzapine

Question 28

olanzapine se

Answer 28

SE: sedation, weight gain, increase lipids, increase glucose, EPS, QT prolongation

Question 29

olanzapine dose

Answer 29

-Dose: 10-20 mg QHS; Relprevv inj lasts 2-4 weeks

Question 30

olanzapine mx

Answer 30

Monitor: metabolic effects

Question 31

olanzapine must be registered as ?

Answer 31

-Relprevv restricted use REMS drug; can cause sedation and/or delirium after injection

Question 32

Risperidone

Answer 32

Risperdal, Risperdal M-Tabs ODT, Consta inj

Question 33

Three indications of risperidone ?

Answer 33

Also approved for autism and for psychosis and schizophrenia

Question 34

se ripseridone

Answer 34

-SE: sedation, EPS, increase prolactin (sexual dysfunction, galactorrhea, irregular/missed periods), orthostasis, weight gain, increase lipids, increase glucose, QT prolongation

Question 35

dose of risperidone

Answer 35

-Dose: 4-16 mg/day divided; Consta (2 week inj) 25-50 mg

Question 36

mx risperidone

Answer 36

Monitor: metabolic effects

Question 37

Quetiapine

Answer 37

Seroquel, Seroquel XR

Question 38

quetiapine SE

Answer 38

SE: sedation, orthostasis, weight gain, increase lipids, increase glucose, little risk EPS, some QT prolongation

Question 39

quetiapine dose

Answer 39

-Dose: 400-800 mg/day BID, or QHS for XR

Question 40

quetiapine XR how to take

Answer 40

XR is taken at night without food, or with light meal

Question 41

mx quetiapine

Answer 41

Monitor: metabolic effects

Question 42

Ziprasidone

Answer 42

Geodon, Geodon inj

Question 43

ziprasidone CI

Answer 43

-CI: prolongs QT interval; contraindicated with QT risk

Question 44

ziprasidone Se

Answer 44

SE: sedation, respiratory tract infection

Question 45

ziprasidone Dose

Answer 45

-Dose: 40-160 mg/day BID; 10-20 mg acute injection

Question 46

Aripiprazole brand

Answer 46

Abilify, Abilify Discmelt ODT, Abilify inj

Question 47

aripiprazole Se

Answer 47

-SE: anxiety, insomnia, constipation, some QT prolongation; no weight gain

Question 48

aripiprazole dose

Answer 48

-Dose: 10-15 mg QAM

Question 49

Paliperidone

Answer 49

Invega, Invega Sustenna inj

Question 50

MOA of paliperidone

Answer 50

Active metabolite of Risperidone

Question 51

paliperidone SE

Answer 51

SE: increase prolactin, EPS, tachycardia, HA, sedation, anxiety, QT prolongation (avoid Use with QT risk), weight gain, increase lipids, increase glucose

Question 52

paliparidone dose

Answer 52

-Dose: 3-12 mg/day (3 mg if CrCl <50)

Question 53

paliperidone long acting inj brand name

Answer 53

Sustenna is long-acting monthly inj

Question 54

mx paliperidone

Answer 54

Monitor: metabolic effects

Question 55

Lurasidone

Answer 55

Latuda

Question 56

SE of latuda

Answer 56

-SE: sedation, EPS, dystonias, nausea, agitation, akathisia; nearly weight, lipid, and glucose neutral

Question 57

latuda dose

Answer 57

-Dose: 40-80 mg/day

Question 58

Choosing a SGA Based on the Side Effect Profile

Answer 58

Overweight, little physical activity, metabolic issues: avoid agents that cause metabolic risk (Olanzapine, Quetiapine) Increasing prolactin levels: avoid Risperidone and Paliperidone -History of TD: avoid risperidone and paliperidone; quetiapine and clozapine has low risk Cost: cheapest agents are Olanzapine, Risperidone, Quetiapine, Ziprasidone, and Clozapine