Schizophrenia

Front 1

RF for schizophrenia

Back 1

• (+) family history of schizophrenia
• Winter or Spring birth (highest Feb-Mar)
• Urban living (especially prior to age 15)

Front 2

general medical condition etiologies of an acute psychotic episode

Back 2

meningitis, tumor, myocardial infarction, thyroid disorder, seizures, hypoxia

Front 3

drug induced etiologies in an acute psychotic episode

Back 3

corticosteroids, digitalis, indomethacin, pentazocine, amphetamines, cocaine, phencyclidine, marijuana

Front 4

Positive sx include

Back 4

delusions, hallucinations, bizarre behavior, disorganization, and catatonia

Front 5

negative sx include

Back 5

flat affect, alogia, anhedonia, avolition, asociality, ambivalence, and lack of insight

Front 6

list the five subtypes of schizophrenia

Back 6

paranoid, disorganized, undifferentiated, residual, catatonic

Front 7

 Symptoms: Prolonged tonic contraction; severe “muscle spasm”; involving neck, back, eyes, larynx (laryngospasm can be fatal)
 Incidence: 2-64% (FGA)
 Risk factors: high potency antipsychotic; high dose; young males
 Onset: usually during first 5 days of therapy initiation or dosage increase
 Pathophysiology: acute imbalance between DA and Ach (↓ Dopamine = ↑ Acetylcholine)
 Treatment:

Back 7

 ¬¬¬¬¬¬¬Acute Dystonia

Front 8

tx for acute dystonia

Back 8

benztropine 1 mg IM followed with bentropine 1 mg PO BID for 1 week

Front 9

 Resembles idiopathic Parkinson’s disease
 Symptoms: akinesia, bradykinesia or ↓ motor activity; tremor; cogwheel rigidity; postural abnormalities
 Incidence: 15-36% (FGA)
 Risk Factors: high potency, high dose, age >40, female
 Onset: 1-2 weeks after therapy initiation or dosage increase
 Pathophysiology: ↓ Dopamine = ↑ Acetylcholine

Back 9

 Pseudoparkinsonism

Front 10

tx for psuedoparkinsonism

Back 10

benztropine 1 mg PO BID x 2 months

Front 11

 Symptoms: extreme motor restlessness/inability to sit still
o Subjective: inner restlessness, compulsion to remain in constant motion
o Objective: pacing, shifting, shuffling, tapping feet
 Incidence: 20-40% (FGA)
 Risk Factors: high-potency, high-dose
 Onset: 2-4 weeks after therapy initiation or dosage increase
 Pathophysiology: unknown

Back 11

 Akathisia

Front 12

tx for akathesia

Back 12

propranolol 10 mg PO TID x 2 months

Front 13

• Symptoms: fever >38°C (100.4°F), rigidity, altered level of consciousness, autonomic dysfunction (tachycardia, labile blood pressure, diaphoresis, urinary/fecal incontinence), increased WBC and CPK
• Incidence: 0.5-1% of patients receiving FGA’s, less common with SGA’s
• Risk Factors: high-potency FGA’s, IM/depot forms, dehydration, physical exhaustion
• Onset: varies from early in treatment to months later; develops rapidly (over 24-72 hours)
• Pathophysiology: possibly disruption of central thermoregulatory process or excess production of heat secondary to skeletal muscle contractions
• Mortality: 4-10% (due to CV, renal, and respiratory failure)

Back 13

Neuroleptic Malignant Syndrome (NMS)

Front 14

what is the starting, maintenance, and max dose of haloperidol

Back 14

2-5 mg BID-TID, 0.5 - 20 mg daily, 40 mg max

Front 15

what is the starting, maintenance, and max dose of fluphenazine

Back 15

2-10 mg daily, 0.5 - 20 mg daily, 40 mg max

Front 16

what is the starting, maintenance, and max dose of loxapine

Back 16

10 mg BID, 25 - 250 mg divided, 250 mg max

Front 17

what is the starting, maintenance, and max dose of chlorpromazine

Back 17

30-75 mg daily divided, 200-800 mg daily divided, 2000 mg max

Front 18

what is the general tx for a cocktail

Back 18

haloperidol 2 mg IM q 4 hr prn for agitation, bentropine 1 mg BID, lorazepam 1 mg IM q 30 min prn for agitation

Front 19

what is the dosing for haloperidol depot formulation

Back 19

10 -15 times PO dose round up to nearest 50 mg with oral overlap for 1 month - administer monthly - initial de[ot can't exceed 100 mg

Front 20

what is the dosing for fluphenazine depot formulation

Back 20

1.2 times the oral dose rounding up to the nearest 12.5 mg dose and overlap with oral for 1 week. should be given weekly for 4 weeks then biweekly

Front 21

what must you obtain before giving out clozapine and how recent must it be

Back 21

CBC: WBC >3500 and ANC >2000
within 7 days of dispensing

Front 22

What is the dosing for clozapine

Back 22

12.5 mg daily titrating to 300-450 mg/ day divided

Front 23

What are unique SE to clozapine

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agranulocytosis and seizures

Front 24

how often should you get a CBC

Back 24

weekly X 6 months then bi-weekly for 6 months, then monthly

Front 25

what two drugs should you never give with clozapine

Back 25

CBZ and epinephrine

Front 26

what is the starting and maintenance dose for oral risperidone

Back 26

1 mg BID, 4 - 16 mg /day divided

Front 27

what is the starting and maintenance dose of IM risperidone

Back 27

25 mg IM q 2 weeks, increase to 50 mg IM q 2 weeks continue oral for first 3 weeks

Front 28

What is a unique SE to risperidone

Back 28

prolactinemia

Front 29

What is the initial and max dosing for oral olanzapine?

Back 29

5 -10 mg QHS, max 30 mg/day

Front 30

what is the rapid tranquilazation dosing for IM olanzapine

Back 30

2.5-10 mg IM q 2-4 hr prn

Front 31

What is the dosing for quetiapine XR

Back 31

25 mg QHS

Front 32

what can increase the risk of QT prolongation with Ziprasidone

Back 32

hypokalemia and hypomagnesemia

Front 33

What is the oral dosing for Ziprasidone

Back 33

20 mg BID WITH FOOD

Front 34

what is the rapid tranquilization dosing for IM ziprasidone

Back 34

20 mg IM q 2hr max 2 doses

Front 35

what is the oral dosing for aripiprazole

Back 35

10 -30 mg daily

Front 36

what is the rapid tranquilization dosing for aripiprazole

Back 36

9.75 mg IM q 2 hours max 3 doses

Front 37

these AP's cannot be given w/ BZD's

Back 37

ziprasidone and olanzepine

Front 38

do you need dose adjustments in hepatic or renal dysfunction?

Back 38

hepatic - start at half the normal dose