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Flashcards in SchizophreniaPsychFC Deck (58):
1

Schizophrenia symptoms and pathophysiology

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

There is increased dopamine in the mesolimbic pathway

2

Negative Signs and Symptoms of schizophrenia

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)

3

Positive Signs and Symptoms of schizophrenia

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

4

Medications that Can Cause Psychotic Symptoms

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

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Antipsychotics MOA

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

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Antipsychotics BBW

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

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Neuroleptic Malignant Syndrome (NMS): symptoms and treatment

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

8

First Generation Antipsychotics (FGAs) names

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

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first gen Aps Se

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

10

bbw of thioridazine

thioridazine has BBW for QT prolongation

11

Second Generation Antipsychotics

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)

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zyprexa or zydis

Olanzapine (Zyprexa, Zydis ODT, Relprevv inj)

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risperidal

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

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seroquel generic

Quetiapine (Seroquel, Seroquel XR)

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geodon generic

Ziprasidone (Geodon, Geodon inj)

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abilify generic

Aripipazole (Abilify, Abilify Discmelt ODT, Abilify inj)

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Invega generic

Paliperidone (Invega, Invega Sustenna inj)

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Fanapt generic

Iloperidone (Fanapt)

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Saphris generic

Asenapine (Saphris)

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Latuda generic

Lurasidone (Latuda)

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Clorazril generic

Clozaril, FazaClo ODT

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clozapine when to use?

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

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SE clozapine

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

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dose of cloazpine

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

25

where must clozapine be registered?

REMS: must register with Clozaril Registry

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mx clozapine

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

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zyprexa generic

Olanzapine

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olanzapine se

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

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olanzapine dose

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

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olanzapine mx

Monitor: metabolic effects

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olanzapine must be registered as ?

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

32

Risperidone

Risperdal, Risperdal M-Tabs ODT, Consta inj

33

Three indications of risperidone ?

Also approved for autism and for psychosis and schizophrenia

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se ripseridone

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

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dose of risperidone

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

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mx risperidone

Monitor: metabolic effects

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Quetiapine

Seroquel, Seroquel XR

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quetiapine SE

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

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quetiapine dose

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

40

quetiapine XR how to take

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

41

mx quetiapine

Monitor: metabolic effects

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Ziprasidone

Geodon, Geodon inj

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ziprasidone CI

-CI: prolongs QT interval; contraindicated with QT risk

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ziprasidone Se

SE: sedation, respiratory tract infection

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ziprasidone Dose

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

46

Aripiprazole brand

Abilify, Abilify Discmelt ODT, Abilify inj

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aripiprazole Se

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

48

aripiprazole dose

-Dose: 10-15 mg QAM

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Paliperidone

Invega, Invega Sustenna inj

50

MOA of paliperidone

Active metabolite of Risperidone

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paliperidone SE

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

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paliparidone dose

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

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paliperidone long acting inj brand name

Sustenna is long-acting monthly inj

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mx paliperidone

Monitor: metabolic effects

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Lurasidone

Latuda

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SE of latuda

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

57

latuda dose

-Dose: 40-80 mg/day

58

Choosing a SGA Based on the Side Effect Profile

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