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56 Cards in this Set
- Front
- Back
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What is the diagnostic criteria for Schizophrenia?
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2 of the following 5 symptoms:
1. Hallucinations 2. Delusions 3. Disorganized speech 4. Disorganized behavior 5. Negative symptoms |
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What are the positive symptoms of Schizophrenia?
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Hallucinations
Delusions Disorganized behavior Disorganized speech |
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What are the negative sypmtoms of Schizophrenia?
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No facial expression
Poor grooming Poor social skills Alogia - thought/speech Avolition - motivation/drive |
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Difference between Typical & Atypical antipsychotics?
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Typicals block DA2 and affects (+) symptoms.
Atypicals block 5HT2 & dopamine so it affects both (+/-) symptoms. |
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Schizophrenia SE?
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***WASHMEN
Weight gain Anticholinergic effects Sedation Hypotension Movement disorders (Tardive Dyskenisia) EPSE Neuroleptic Malignant Syndrome (NMS) |
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What has high levels in Schizophrenia?
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Dopamine levels are high.
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What is EPS? What are the types of EPS?
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Extrapyramidal Side effects
- due to Dopamine antagonist activity - types: 1. Dystonia (hrs-days): painful muscle spasm/laryngospam 2. Akathisia (days-weeks): restlessness 3. Pseudoparkinsonism (weeks-months) |
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What drugs have the highest risk for EPS?
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Typicals and Risperidone
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What drug has the lowest risk for EPS?
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Clozapine
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What is the DoC for dystonia?
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Laryngospasm, DoC: IV diphenhydramine 25-50mg
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What is Tardive Dyskenisia?
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This is due to prolonged blockade of dopamine resulting to tongue, lip, jaw, face & extremity movement.
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What is NMS due to? S/Sx?
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NMS is due to depletion of DA in the CNS, which results to disruption of muscle contraction & thermostat system.
S/Sx: rigidity, fever, diaphoresis (sweating) altered consciousness, increase in BP & HR |
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What are the labs to monitor with NMS?
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Increase CPK
Increase WBC (CBC) LFT |
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Management of NMS?
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1. D/C antipsychotic
2. Supportive therapy (IV fluid, cooling) 3. Increase in CA by DA agonist (Bromocriptine) 4. Dantrolene (muscle relaxant - tx for malignant hyperthermia) (1mg/kg rapid IV push) |
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What happens to the prolactin levels when using dopamine antagonists?
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Prolactin levels increase, resulting to GALACTORRHEA, AMENORRHEA, GYNECOMASTIA and IMPOTENCE.
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List some Typicals for Schizophrenia
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Chlorpromazine (Thorazine)
Thioridazine (Mellaril) Perphenazine (Trilafon) Trifluoperazine (Stelazine) Thiothixene (Navane) Fluphenazine (Prolixin) Haloperidol (Haldol) Pimozide (Orap) - QT prolongation |
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List the Atypicals used for Schizophrenia
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***CROQZAPIA
Clozapine (Clozaril) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Aripiprazole (Abilify) Paliperidone (Invega) Iloperidone (Fanapt) Asenaphine (Saphris) |
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What are the Bipolar meds that come in IM form?
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***HAZO
Haloperidol (Haldol): 5-10mg Q1H PRN Aripiprazole (Abilify): 7.5mg/mL, Q2H; max: 30mg/day Ziprasidone (Geodon): max=40mg Olanzapine (Zyprexa IM): may repeat Q2H, max: 30mg Ziprasidone Olanzapine |
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What is a major SE of Zyprexa IM?
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Severe orthostatic hypotension
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What Bipolar meds come in long acting form (deconate)? Given to whom?
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Deconoate: given to patients with good response to oral but non-compliant.
Haldol: 10-15x oral QMonth Fluphenazine (Prolixin): oral dose/15 Q2 weeks Risperdal Consta: IM Q2Weeks for >18 yo Paliperidone (Invega): 234mg on Day 1, 156mg after a week, then maintenace QMonth |
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What is Clozaril? Dosing? Benefits (3)?
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Clozapine (Clozaril)
Dose: BID - start 12.5mg TITRATE Benefits: doesn't cause EPS, can treat TD, NO effect on prolactin |
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Side effects of Clozapin?
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Clozaril (Clozapine) SE:
*Agranulocytosis: don't start if WBC <3500/mm. Anti-cholinergic effects except for salivation & sweating. Seizure Hyperglycemia, hyperlipidemia, weight gain |
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What do you have to check with Clozapin? How often?
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Clozapin (Clozaril), check CBC QWeek x 6 months, then bi-weekly x 6 months, then QMonth thereafter. Don't start if WBC <3500/mm.
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Who must be registered with what organization before you can dispense Clozapine (Clozaril)?
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Prescriber must be registered with the Clozaril National Registry (CNR).
Patient must be registered, too. Pharmacy must be registered with the CNR to be able to purchase Clozapine. |
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The ANC/WBC values sent by the prescriber to the pharmacy must be drawn within how many days?
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7 days
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What is Risperidone? Forms?
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Risperdal
Forms: tabs, ODT, solution, IM injection (Consta) ***Not compatible with cola/tea |
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What are the indications for Risperidone? Age range?
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Schizophrenia: 13 - 17 YO
Bipolar Mania: 10 - 17 YO Autism: 5 - 16 YO, given to treat aggression, deliberate self injury and temper tantrums |
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How often do you give Consta?
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15mg IM every 2 weeks for > 18 YO
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What are the limitations to using Risperdal?
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Weight gain
EPS Slight increase of prolactin |
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What is Olanzapine? Max dose? Forms?
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Zyprexa, Zydis (ODT), Relprevv (ER injectable susp.)
Max: 20mg QDay, never BID b/c of long half life |
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How do you take Zydis?
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Zyprexa (Zydis), remove from foil with dry hands. Place on top of tongue (ODT).
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What are the monitoring parameters when taking Zyprexa?
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Weight
Glucose: FBG & A1C Lipids ***Orthostatic hypotension (IM) |
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Who should be enrolled in what program before you can dispense the Olanzapine ER injectable suspension?
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Zyprexa Relprevv Care Program
- Prescriber - Patient - Pharmacy |
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What is Latuda? Indication?
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Latuda (Lurasidone HCl tabs)
Indication: Schizophrenia, 40mg - 80mg QD WITH FOOD |
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Latuda is contraindicated in the use with? SE?
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Contraindications: Inhibitors/Inducers
SE: similar to other atypicals (weight gain, hyperlipidemia, hyperglycemia) NEUTROPENIA/LEUKOPENIA |
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What is Seroquel? Forms? Indications?
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Quetiapine (Seroquel/Seroquel XR)
Indications: Schizophrenia/Bipolar, MDD (XR form) |
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What is the sig for Seroquel XR?
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Take QHS, empty stomach.
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What is Ziprasidone? Dosing? Max?
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Geodon (Ziprasidone), 20mg BID with food. Max: 160mg/day
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What is the Geodon dose of acute agitation?
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Acute agitation: 10-20mg IM
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Why do you need to give Geodon with food?
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Geodon bioavailability goes down by 60% if not taken with food.
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Indications for Abilify?
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Abilify (Aripiprazole)
- Schizophrenia - Bipolar disorder - Depression - Autism: aged 6-17 YO |
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Abilify comes in what forms?
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Tabs
Abilify DISMELT - contains phenylalanine 1mg/mL solution IM injection |
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What are the advantages of Abilify?
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Advantages:
- long half life - low risk of weight gain - no cardiac effects - low risk of EPS |
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What is the dosing for Abilify? Dose when given with inhibitors/inducers?
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Give 1/2 the dose with CYP3A4 & 2D6 (Fluoxetine, Quinidine) inhibitors and double when with inducers
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What is Paliperidone? Comes in what forms?
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Invega (Paliperidone), comes in tabs (ER) and IM injection
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What is the dose range for PO Invega?
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Invega (Paliperidone) range: 3-12mg QDay
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What is the dosing for Invega tabs in renal patients?
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Mild renal impairment, max: 6mg
Moderate to severe, max: 3mg |
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What is the dosing for Invega IM injection?
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Day 1: 234mg IM
A week later: 156mg IM Maintenance: IM inj/month, recommened dose is 117mg/dose |
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Invega MoA?
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Blocks:
- D2 (dopamine type 2) - S2 (serotonin type 2) - A2 (alpha 2 adrenergic) |
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What is Fanapt? Dosing?
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Fanapt (Iloperidone) is titrated slowly to avoid hypotension.
Starting dose: 1mg BID |
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Fanapt interacts with what drugs?
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Fanapt (Iloperidone) interacts with CYP3A4 & CYP2D6 inhibitors and inducers.
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What is Asenapine? Form? Dosing?
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Asenaphine (Saphris), comes in sublingual form (5 & 10mg tabs) given BID.
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Asenaphine indications?
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Asenaphine (Saphris) is indicated for schizophrenia & bipolar disorder
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What Schizophrenia medications can you give if worried about QT prolongation?
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***LAZy
Lurasidone (Latuda) Aripiprazole (Abilify) Ziprazidone (Geodon) |
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What are the Schizophrenia medications to avoid if there is a high risk in QT prolongation?
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***FIG
Fanapt Ivega Geodon |
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What should you give for resistant depression?
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Seroquel XR
Abilify Zyprexa |
