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Board Review > SchizophreniaPsychFC > Flashcards

SchizophreniaPsychFC Flashcards

1
Q

Schizophrenia symptoms and pathophysiology

A

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

There is increased dopamine in the mesolimbic pathway

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2
Q

Negative Signs and Symptoms of schizophrenia

A

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)

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3
Q

Positive Signs and Symptoms of schizophrenia

A

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

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4
Q

Medications that Can Cause Psychotic Symptoms

A

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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5
Q

Antipsychotics MOA

A

-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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6
Q

Antipsychotics BBW

A

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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7
Q

Neuroleptic Malignant Syndrome (NMS): symptoms and treatment

A

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

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8
Q

First Generation Antipsychotics (FGAs) names

A

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

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9
Q

first gen Aps Se

A

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

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10
Q

bbw of thioridazine

A

thioridazine has BBW for QT prolongation

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11
Q

Second Generation Antipsychotics

A

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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12
Q

zyprexa or zydis

A

Olanzapine (Zyprexa, Zydis ODT, Relprevv inj)

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13
Q

risperidal

A

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

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14
Q

seroquel generic

A

Quetiapine (Seroquel, Seroquel XR)

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15
Q

geodon generic

A

Ziprasidone (Geodon, Geodon inj)

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16
Q

abilify generic

A

Aripipazole (Abilify, Abilify Discmelt ODT, Abilify inj)

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17
Q

Invega generic

A

Paliperidone (Invega, Invega Sustenna inj)

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18
Q

Fanapt generic

A

Iloperidone (Fanapt)

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19
Q

Saphris generic

A

Asenapine (Saphris)

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20
Q

Latuda generic

A

Lurasidone (Latuda)

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21
Q

Clorazril generic

A

Clozaril, FazaClo ODT

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22
Q

clozapine when to use?

A

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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23
Q

SE clozapine

A

-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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24
Q

dose of cloazpine

A

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

25
Q

where must clozapine be registered?

A

REMS: must register with Clozaril Registry

26
Q

mx clozapine

A

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

27
Q

zyprexa generic

A

Olanzapine

28
Q

olanzapine se

A

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

29
Q

olanzapine dose

A

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

30
Q

olanzapine mx

A

Monitor: metabolic effects

31
Q

olanzapine must be registered as ?

A

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

32
Q

Risperidone

A

Risperdal, Risperdal M-Tabs ODT, Consta inj

33
Q

Three indications of risperidone ?

A

Also approved for autism and for psychosis and schizophrenia

34
Q

se ripseridone

A

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

35
Q

dose of risperidone

A

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

36
Q

mx risperidone

A

Monitor: metabolic effects

37
Q

Quetiapine

A

Seroquel, Seroquel XR

38
Q

quetiapine SE

A

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

39
Q

quetiapine dose

A

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

40
Q

quetiapine XR how to take

A

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

41
Q

mx quetiapine

A

Monitor: metabolic effects

42
Q

Ziprasidone

A

Geodon, Geodon inj

43
Q

ziprasidone CI

A

-CI: prolongs QT interval; contraindicated with QT risk

44
Q

ziprasidone Se

A

SE: sedation, respiratory tract infection

45
Q

ziprasidone Dose

A

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

46
Q

Aripiprazole brand

A

Abilify, Abilify Discmelt ODT, Abilify inj

47
Q

aripiprazole Se

A

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

48
Q

aripiprazole dose

A

-Dose: 10-15 mg QAM

49
Q

Paliperidone

A

Invega, Invega Sustenna inj

50
Q

MOA of paliperidone

A

Active metabolite of Risperidone

51
Q

paliperidone SE

A

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

52
Q

paliparidone dose

A

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

53
Q

paliperidone long acting inj brand name

A

Sustenna is long-acting monthly inj

54
Q

mx paliperidone

A

Monitor: metabolic effects

55
Q

Lurasidone

A

Latuda

56
Q

SE of latuda

A

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

57
Q

latuda dose

A

-Dose: 40-80 mg/day

58
Q

Choosing a SGA Based on the Side Effect Profile

A

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

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