NAPLEX > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

thought disorder

A

schizophrenia

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2
Q

hallmark symptoms of schizophrenia (positive s/sx)(must be present for dx)

A

hallucinations
delusions
disorganized speech/behavior

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3
Q

basis of diagnosis for schizophrenia

A

positive and negative s/sx
DSM5

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4
Q

negative s/sx of schizo

A

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

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5
Q

patho of schizo likely includes

A

DA
5HT
glutamine

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6
Q

meds that can cause psychotic symptoms

A

anticholinergics, dextromethorphan, DA or agonists, efavirenz, interferons, ketamine, levetiracetam, quinolones, stimulants, systemic steroids

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7
Q

illicit drugs that can cause psychotic symptoms

A

cannabis
cocaine
LSD
methamphetamine
phencyclidine
synthetic cathinones

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8
Q

first gen APS (FGAs) have higher incidence of which AEs

A

extrapyramidal symptoms (EPS)

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9
Q

second gen APS (SGAs) or atypicals are preferred due to lower risk of

A

EPS

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10
Q

SGAs (atypicals) work by blocking

A

serotonin 5-HT2A and D2 receptors

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11
Q

group of side effects related to irregular movements that can be caused by APS; regimen should be adjusted if they occur

A

EPS

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12
Q

4 main EPS

A

akathisia
dystonia
parkinsonism
tardive dyskinesia

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13
Q

EPS that occurs in days to weeks
restlessness with anxiety and inability to remain still

A

akathisia

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14
Q

how to treat akathisia EPS

A

benzos
propranolol

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15
Q

EPS that occurs in 24-96 hours
prolonged contraction of muscles, including painful muscle spasms; life threatening if the airway is compromised; higher risk in young males

A

dystonia

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16
Q

what can be used for ppx or treatment of dystonia

A

centrally acting anticholinergics

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17
Q

EPS that occurs in days to weeks
looks similar to parkinson disease with tremors, abnormal gait, and bradykinesia

A

parkinsonism

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18
Q

how to treat parkinsonism EPS

A

anticholinergics, alt amantadine

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19
Q

since adherence to APS is poor, what formulation options can help

A

long acting injections
ODTs - prevent cheeking
oral solns/susps
acute IM injections

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20
Q

IM APS can be mixed in cocktails to manage

A

dystonia
ex. mix with anticholinergic or BZD

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21
Q

do not mix IM olanzapine in a cocktail with

A

parenteral BZDs

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22
Q

BBW for APS

A

not indicated for agitation in older adults with dementia related psychosis - inc mortality
stroke
falls

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23
Q

work by blocking D2 receptors, many are in the phenothiazine class

A

FGAs

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24
Q

high potency FGA that is a butyrophenone

A

haloperidol

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25
examples of FGAs
chlorpromazine > thioridazine > loxapine > perphenazine > haloperidol > fluohenazine > thiothixene > trifluoperazine
26
additional BBW for thiordazine
QT prolongation
27
warnings with FGAs
QT prolongation (inc w/ parenteral, thioridazine, haloperidol, chlorpromazine), orthostasis, falls anticholinergic effects CNS depression EPS (inc with injectables) hyperprolactinemia neuroleptic malignant syndrome (NMS)
28
AEs of FGAs
sedation, dizziness, anticholinergic, inc prolactin, EPS
29
ALL FGAs cause which AEs
sedation & EPS
30
lower potency FGAs have inc and dec risk of what AEs
inc sedation dec EPS
31
higher potency FGAs have inc and dec risk of what AEs
dec sedation inc EPS
32
examples of SGAs
aripiprazole, clozapine, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone, asenapine, cariprazine, brexpiprazole, iloperidone, lumateperone
33
brand name aripiprazole
Abilify
34
clozapine brand name
Clozaril
35
AEs of aripiprazole
akathisia, activating
36
clozapine use is reserved for treatment of
treatment-resistant schizo (resistant to >=2 other APS)
37
BBWs for clozapine
neutropenia/agranulocytosis myocarditis, cardiomyopathy seizures
38
AEs of clozapine
agranulocytosis, seizures, constipation, increase weight, increase salivation
39
monitoring for clozapine
ANC >= 1500/mm3 REMS no longer required
40
stop clozapine if ANC is
<1000/mm3
41
how to dose clozapine to reduce AEs
titrate slowly
42
brand name lurasidone
Latuda
43
AEs of lurasidone
somnolence, EPS (dystonia), nausea DECREASED RISK OF METABOLIC SYNDROME VS OTHERS
44
brand name olanzapine
Zyprexa
45
BBW for Zyprexa Relprevv (olanzapine injection)
monitor for 3 hours post injection (Sedation, delirium)
46
AEs of olanzapine
somnolence, metabolic syndrome (inc weight, BG, lipids)
47
brand name of paliperidone
Invega
48
how often if Invega Trinza injection given? Hafyera?
Trinza- 3 months Hafyera- 6 months
49
AEs of paliperidone
inc prolactin EPS (esp at higher doses) metabolic syndrome (inc weight, BG, lipids)
50
brand name quetiapine
Seroquel
51
AEs of quetiapine
somnolence metabolic syndrome (inc weight, BG, lipids) LOW EPS RISK - may be used for psychosis in Parkinsons
52
how to take XR quetiapine
without food or a light meal
53
which SGA has low EPS risk and may get used in Parkinson psychosis
quetiapine
54
brand name risperidone
Risperdal
55
AEs of risperidone
inc prolactin EPS (esp higher doses) metabolic syndrome
56
brand name ziprasidone
Geodon
57
ziprasidone can be used for acute management as
Geodon IM injection
58
counseling for ziprasidone
take with food
59
contraindication for ziprasidone
QT prolongation - DO NOT USE if risk
60
counseling for taking asenapine
no food or drink for 10 minutes
61
AE of asenapine
tongue numbness
62
APS with high metabolic risk (inc weight, BG, cholesterol, TGs) should be monitoring closely and avoided if there is
diabetes or CV disease
63
SGA with highest efficacy but many BBWs
clozapine
64
when assessing APS treatment, evaluate whether there has been an adequate trial of ___, if there was adherence, if it worked, and was tolerated
6 weeks
65
avoid which APS if cardiac or QT prolongation risk
ziprasidone, haloperidol, thiordazine, chlorpromazine
66
avoid which APS if history of movement disorder
avoid high EPS risk- FGAs, risperidone, paliperidone (high doses) quetiapine preferred
67
if overweight/metabolic risk do not use ___ or ___ - if you have to, consider adding __
clozapine, olanzapine metformin
68
metabolic risk is lower with which 4 APS (SGAs)
aripiprazole ziprasidone lurasidone asenapine
69
what to use if patients have poor adherence or are unhoused
LAIs
70
treatment options if needed STAT for acute psychosis and refusal of PO meds
haloperidol or olanzapine IV/IM +/- diphenhydramine & lorazepam alt- ziprasidone IM
71
which APS are available as long acting IM or SC injections for non adherent patients
IM paliperidone IM aripiprazole SC, IM risperidone IM haloperidol IM olanzapine IM fluphenazine
72
which 3 SGAs are available as ODT
aripiprazole, olanzapine, risperidone
73
which SGA is SL
asenapine
74
which 4 APS are available as oral liquid
aripiprazole fluphenazine haloperidol risperidone
75
which SGA is available as a patch
asenapine
76
atypical APS that is only approved for psychosis in parksinsons
pimavanserin
77
DDI for all APS- avoid drugs that
can prolong QT thioridazine is highest risk
78
complication with DA blockade, can cause irreversible symptoms such as uncontrollable movements in the tongue, face, trunk, and extremities
tardive dyskinesia
79
treatments for TD that reversibly inhibit VMAT2, a transporter that regulates monoamine uptake
valbenazine deutetrabenazine
80
warning for valbenazine & deutetrabenazine
somnolence
81
contraindication to deutetrabenazine
hepatic impairment
82
rare but lethal AE most common with FGA due to D2 blockage, medical emergency with hyperthermia and muscle rigidity
neuroleptic malignant syndrome (NMS)
83
how to manage NMS
stop APS dantrolene to relax muscles
84
IM paliperidone options have what durations
monthly 3 months 6 months
85
IM aripiprazole options have what durations
2 months, 1 month
86
SC risperidone options have what durations
1-2 months
87
IM haloperidol is given how often
monthly
88
IM olanzapine is given how often
2-4 weeks
89
IM fluphenazine is given how often
2 weeks
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