Mcphs Clinical Therapeutics Exam Ii, Treatment Of Schizophrenia

Front 1

What defines positive symptoms in schizophrenia?

Back 1

Hallucinations, delusions, disorganization

Front 2

What defines negative symptoms in schizophrenia?

Back 2

Reduction in drive, motivation, or interest

Front 3

What defines affective symptoms in schizophrenia?

Back 3

Depression, Anxiety

Front 4

What defines cognitive symptoms in schizophrenia?

Back 4

Problems with learning, memory, etc.

Front 5

What are two major comorbidities with schizophrenics?

Back 5

Respiratory problems due to high smoking rates

Diabetes

Front 6

What are two of the oldest atypical antipsychotics?

Back 6

Clozapine 1990
Risperidone 1993

Front 7

What are two of the newer atypical antipsychotics?

Back 7

Fanapt (iloperidone) 2009
Saphris (asenapine) 2009

Front 8

What conditions usually call for the use of antipsychotics?

Back 8

Schizophrenia

Schizoaffective disorder

Bipolar disorder

Agitation

Psychosis

Tourettes

Adjunct to SSRI for depression and some anxiety disorders.

Front 9

Typical and atypical antipsychotics are about the same when treating what type of schizophrenia symptoms?

Back 9

Positive symptoms

haloperidol about 25% reduction
olanzapine about 25% reduction

Front 10

Atypical antipsychotics have an increased efficacy in treating what type of schizophrenia symptoms?

Back 10

Negative symptoms

Haloperidol: Minimal reduction or cause secondary symptoms.

Olanzapine: About a 15-20% reduction in symptoms.

Front 11

Compared to the placebo, risperidone causes an increase in what side effects?

Back 11

Tachycardia
Somnolence

Front 12

Compared to the placebo, olanzapine causes an increase in what side effects?

Back 12

Somnolence
Dizziness
Constipation
Pharyngitis

Front 13

Compared to the placebo, quetiapine causes an increase in what side effects?

Back 13

Somnolence
Dizziness
Constipation
Agitation

Front 14

Compared to the placebo, Ziprasidone 80mg causes an increase in what side effects?

Back 14

Somnolence
Nausea

Front 15

Compared to the placebo, Ziprasidone 160mg causes an increase in what side effects?

Back 15

Somnolence
Dizziness
Dyspepsia

Front 16

Compared to the placebo, Aripiprazole 20mg causes an increase in what side effects?

Back 16

Insomnia
Psychosis
Agitation
Vomiting
Anxiety
Headache

Front 17

Compared to the placebo, Aripiprazole 30mg causes an increase in what side effects?

Back 17

Headache
Agitation
Anxiety
Vomiting

Front 18

Compared to the placebo, iloperidone 24mg causes an increase in what side effects?

Back 18

Tachycardia
Dry mouth
Increased HR
Orthostasis
Sedation
Dizziness

Front 19

Compared to the placebo, ziprasidone 160mg causes an increase in what side effects?

Back 19

Sedation
Dry Mouth
Increased HR
Dizziness
Tachycardia

Front 20

Compared to the placebo, asenapine causes an increase in what side effects?

Back 20

Vomiting
Nausea
Insomnia
Somnolence
Psychosis

Front 21

What are the two safest atypical antipsychotics?

Back 21

Seroquel (Quietapine) and Abilify (Aripiprazole)

Front 22

Which atypical antipsychotic is recommended for a patient who is suffering from Parkinsons?

Back 22

Seroquel (Quietapine)

Front 23

Physical symptoms, including tremor, slurred speech, akathisia, dystonia, anxiety, distress, paranoia, and bradyphrenia, that are primarily associated with improper dosing of or unusual reactions to neuroleptic (anti-psychotic) medications.

Back 23

Extrapyramidal Side Effects

Front 24

When giving an atypical antipsychotic you want to try and localize any of the extrapyramidal side effects where?

Back 24

To the neck/jaw area.

Front 25

If you raise prolactin levels from giving a atypical antipsychotic what are the possible consequences? 6 of them.

Back 25

Sexual dysfunction

Amenorrhea

Osteoporosis

Glactorrhea

Impotence

Gynecomastia

Front 26

What two atypical antipsychotics cause the most QTc prolongation (Torsades)?

Back 26

Geodon (Ziprasidone)

Seroquel (Quietapine)

Front 27

What two atypical antipsychotics cause the most weight gain?

Back 27

Zyprexa (Olanzapine)

Fanapt (Iloperidone)

Front 28

What drug caused the greatest amount of weight gain in the CATIE trial?

Back 28

Zyprexa (Olanzapine)

Front 29

What drug therapies are used to combat weight gain associated with atypical antipsychotic use?

Back 29

Addition of an H2 antagonist - Nizatedine 300 bid

Metformin - 850 bid with exercise and diet counseling.

Topiramate - 200-400mg a day

Amantadine - 100-300 mg a day, but can worsen psychosis

Rosiglitazone added to clozapine

Front 30

CVA's, especially in elderly patients, are reported more frequently in patients treated with what atypical antipsychotics?

Back 30

Risperidone, Olanzapine, Quietiapine, Aripiprazole

Front 31

These are facial and truncal spastic (choreiform) movements.

Back 31

Tardive Dyskinesia

Front 32

This occurs in 20-70% of patients taking atypical antipsychotics. The risk is increased with age, long duration of tx and high dose. This can occur with minimal use of neuroleptics.

Back 32

Tardive Dyskinesia

Front 33

What things have been shown effective in treating tardive dyskinesia?

Back 33

Clozapine, buspirone, Vitamin E

Front 34

This is an antiemetic that can cause mild dopamine blockade which leads to extrapyramidal side effects.

Back 34

Metoclopramide

Front 35

These three drugs have been shown to have prodopaminergic effects which leads to psychosis occuring in schizophrenic patients.

Back 35

Modafinil

Psychostimulants (methylphenidate and amphetamine)

Buptopion = Wellbutrin/Zyban - atypical antipsychotic/smoking cessation aid

Front 36

These drugs will have an additive effect with varying degrees to the atypical antipsychotics?

Back 36

Anticholinergic medications

Front 37

These drugs carry an increased risk for orthostasis with antihypertenstives, or medications that effect alpha 1 such as terazosin, TCAs, or labetalol.

Back 37

Alpha 1 related medications

Front 38

Increased QT prolongation can occur if atypicals are given with other meds that increase QT. Examples include what four drug types?

Back 38

Antiarrythmics

Macrolide Antibiotics

SSRIs

TCAs

Front 39

Concomitant use of dopamine blockers have shown a higher risk of developing EPS. Neuroleptic malignant syndrome (NMS) has developed with concomitant use of clozapine.

Back 39

Risperidone

Front 40

This drug has a possible blockade of amphetamine reward. Valium and alcohol increase orthostasis when coadministered with this drug. Orthostasis can be additive with any medication that also produces orthostasis (alpha 1 blockers such as terazosin, nitro products).

Back 40

Zyprexa (Olanzapine)

Front 41

This drug causes a possible increase in QTc interval prolongation when given with lovastatin. Possible increased sedation especially if added to medications with alternate mechanisms for inducing sedation.

Back 41

Seroquel (quetiapine)

Front 42

Medications that could potentially increase the QTc interval may result in an additive risk of arrythmia when given with this medication. TCAs and SSRIs may produce an additive effect or toxicity since this drug has a moderate inhibition of NE and 5-HT reuptake.

Back 42

Geodon (Ziprasidone)

Front 43

Buspirone with this drug may have an additive/toxic effect at 5-HT1A, both fluoxetine and parosetine have resulted in neuroleptic malignant syndrome when added to this drug. It is theoretically possible, but quiet unlikely, that serotonin syndrome could occur in a patient with multiple proserotonergic medications.

Back 43

Abilify (aripiprazole)

Front 44

These drugs have a risk of increased orthostasis when added to other medications that can lower BP or block alpha 1 receptors.

These drugs are also predicted to have dopaminergic interactions.

Back 44

INVEGA (paliperidone)

Fanapt (iloperidone)

Front 45

This is predicted to have dopaminergic interactions due to binding potency at dopamine receptors.

Risk of increased orthostasis or dizziness when added to other medications that can lower BP or block alpha 1 receptors.

Back 45

Saphris (Asenapine)

Front 46

What atypical antipsychotics are metabolized by CYP450 1A2?

Back 46

Olanzapine, Asenapine

Front 47

What atypical antipsychotics are metabolised by CYP450 2D6?

Back 47

Risperidone,

Front 48

What atypical antipsychotics are metabolized by CYP450 3A4?

Back 48

Quetiapine, Ziprasidone

Front 49

What atypical antipsychotics are metabolized by CYP450 2D6 and 3A4?

Back 49

Aripiprazole, Iloperidone

Front 50

Any compound that inhibits 2D6 will increase serum levels of what drug?

Back 50

Risperidone

Front 51

What drug has a history of inhibiting 2D6 to such a high level that it actually caused the death of a patient taking risperidone?

Back 51

Paroxetine

Front 52

What are compounds that induce risperidone metabolism?

Back 52

Carbamazepine lowers risperidone levels by 50%, tetracycline

Front 53

Increase in cigarette smoking will decrease levels of this drug, and smoking cessation will increase levels of this drug in serum.

Back 53

Olanzapine - due to cigarette's effects on CYP 450 1A2

Front 54

Any compound that inhibits or induces CYP450 3A4 will effect serum levels of this drug. Things that cause this are carbamazepine 4 fold, and phenytoin 5 fold.

Back 54

Quetiapine

Front 55

Any compound that inhibits or induces CYP 450 3A4, specific drugs such as ketoconazole increases levels by 33% and carbamazepine decreases levels by 36%.

Back 55

Ziprasidone

Front 56

Any compound that inhibits or induces CYP 450 2D6 or 3A4 will affect the serum levels of this drug. Specific examples - Ketoconazole has increased this drug by 63% and Carbamazepine has lowered this drugs levels by 70%.

Back 56

Aripiprazole

Front 57

Any compound that inhibits or induces CYP 450 2D6 will have only a small effect on this drug. Paroxetine increases this drug by 16%.

Back 57

Paliperidone

Front 58

Any compound that inhibits or induces CYP 450 2D6 or 3A4 will effect serum levels of this drug. Ketoconazole causes a 57% increased level of this drug.

Back 58

Iloperidone

Front 59

Any compound that inhibits or induces CYP450 1A1/2 or glucoronidation could effect serum levels of this drug. Fluvoxamine has increased levels of this drug by 29%, smoking did NOT effect levels of this drug.

Back 59

Asenapine

Front 60

This CYP is induced by cigarette smoking, omeprazole, phenobarbital, phenytoin.

This CYP is inhibited by cimetidine, ciprofloxacin, fluvoxamine.

What drugs are affected by this?

Back 60

CYP1A2

Olanzapine, clozapine, asenapine

Front 61

What drug has one case report of dramatically increasing INR when given to a patient on warfarin?

Back 61

Quetiapine

Front 62

HIV Therapy can have what effect on CYP?

Back 62

The drugs used for HIV therapy can inhibit/induce CYP 3A4 affecting the atypical antipsychotics that are metabolized by CYP 3A4.

Front 63

This drug will actually cause a patients dopamine levels to rise for a short period of time if they have been on dopamine suppression from another drug.

Back 63

Abilify

Front 64

How is risperidone dosed?

Back 64

2-8mg qd divided BID

Consta (long acting IM) 25-50mg q 2 weeks

Front 65

How is olanzapine dosed?

Back 65

po: 10-20 mg qd

IM: 2.5-10mg

Front 66

How is quetiapine dosed?

Back 66

150-750mg qd divided BID

XR 300-800mg QHS (before bedtime)

Front 67

How is Ziprasidone dosed?

Back 67

po: 40-160mg qd divided BID

IM: 10-20mg

Front 68

How is aripiprazole dosed?

Back 68

po: 10-30mg qd

IM: 9.75mg

Front 69

How is paliperidone dosed?

Back 69

6-12mg qd

Front 70

How is iloperidone dosed?

Back 70

po: 12mg bid

Sustenna (long acting IM): 39-234mg q 4 weeks

Front 71

How is asenapine dosed?

Back 71

SL: 5-10mg bid

Front 72

What are two reasons for giving high doses?

Back 72

Kinetic reasons: Fast metabolizers, concomitant enzyme inducers.

Dynamic reasons: Refractory disease, poor receptor recognition of the compound.