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88 Cards in this Set

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  • Back
what is the average lifetime prevelance of schizophrenia?
1%
which gender is affected more?
prevelance is equal
when is the peak onset in men and in women?
men 15-25
women 25-35
co-morbidiy: common/uncommon?
common
what are some possible etiologies?
genetics
environmental factors
structural/functional brain changes
neurochemical alterations
(DA excess in mesolimbic, DA hypoactivity in mesocortical)
what medications are associated w/ schizo?
levodopa
bupropion
amphetamines
cocaine
what is the nigrostriatal tract responsible for controlling?
EP system, movement
what is the mesolimbic system responsible for controlling?
how is it affected by schizo?
arousal, memory, stimulus processing, motivational behavior
DA is increased in schizo
what is the mesocortical tract and what is it resposible for controlling?
how is it affected by schizo?
cognition, communication, social fx, stress response
DA is decreased in schizo
what is the tuberoinfundibular tract and what is it responsible for controlling?
regulates prolactin release
what are some positive sx associated w/ schizo?
delusions: persecutory, grandiose, religious, somatic
hallucinations: auditory* visual, tactile, olfactory, gustatory
what are some prodromal sx are associated w/ schizo
somatic complaints, decreased fx capacity in social/education/occupation/personal activities
interest in abstract ideas
peculiar behavior:mood swings, peculiar speech, strange perceptual experiences
what are some negative sx associated w/ schizo?
alogia, avolition, hygiene defecits, blunted affect, anhedonia
what is the mechanism of action of typical APs?
DA antagonist D2>D1
after 21 days of tx, decreased DA release/dopaminergic inactivation occurs
typical APs are divided into what to categories?
low and high potency
describe the diffences in characteristics of low and high potency typical APs
high: moderate antichol/alpha block/sedation
high EPS
elevate prolacting
cause NMS
low: high antichol/alpha block/sedation
moderate EPS
elevate prolactin
cause NMS
describe the sx of dystonia
sustained muscle contration, neck stuck to one side
speed of onset of dystonia?
rapid (1-4 days)
risk factors for dystonia?
young males, high potency APs
what is the treatment for dystonia?
benztropine
give for at least after dystonia has resolved
may also be given prophylactically
what are the sx of akathisia?
subjective feeling of motor restlessness: pacing, tapping feet, inability to sit still
speed of onset for akathisia?
days to weeks
which EPS is the most common?
akathisia
what is the tx for akathisia?
propranolol
diazepam
what are the four cardinal sx of parkinsonism?
akinesia/bradykinesia
resting tremor
cogwheel rigidity
postural abnormality
what is the speed of onset of parkinsonism?
1-2 weeks
what are risk factors for devloping parkinsonism
high potency AP, age>40, female
what is the treatment of parkinsonism?
benztropine
describe tardive dyskinesia
abnormal involuntary movements
facial tics, grimaces, blinking, chewing, smacking lips
true or false: tardive dyskinesia is irreversible
true
what is the speed of onset of tardive dyskinesia?
insidiuos, late in treatment
what risk factors are associated w/ tardive dyskinesia
increasing age, occurence of acute EPS, poor AP response, DM, mood disorder, female
what is the treatment for tardive dyskinesia?
Prevention is KEY!!!
decrease dose of AP
switching to atypical AP
Vitamin E
BZDs
botulinum toxin
clozapine
which two antipsychotics have the greatest potential to cause seizure?
clozapine
chlorpromazine
true or false: all APs can lower the seizure threshold
true
what sx are associated w/ neuroleptic malignant syndrome?
hyperpyrexia, altered mental status, rigidity, tachycardia, fluctating BP, sweating, urinary/fecal incontinence; labs: increased CPK, LFTs
what are the risk factors associated w/ NMS?
high potency AP, injectible or depot APs
what is the tx of NMS?
d/c AP
DA agonist - bromocriptine
skel muscle relaxant - dantrolene
what effects do APs have on ECG?
direct myocardial depression - antagonize sym nervous system
changes = tachycard, flattened T waves, ST seg depression, prolong QT an PR interval
use w/ caution in pts w/ cardiac dx and elderly
which two APs are most likely to cause ECG changes and prolong the QTC interval?
thioridazine (black box)
ziprasidone
elevated prolactin levels can lead to...
amenorrhea, galactorrhea, gynecomastia, sex dysfx, osteoporosis
which agents are most likely to cause an increase in prolactin levels?
typical APs
risperidone
which two typical APs are have long acting decanoate formalations? what effects does this have on the half life of these drugs?
fluphenazine
haloperidol
increases the half life from days to weeks
**overlapping period of oral form req'd to control sx
initial injection of haloperidol decanoate should not exceed what dose?
100 mg
which agents have higher incidence of EPS: typical or atypical APs?
typical
which agents are better at treating negative sx: typical or atypical?
atypical
which agents are most likely to cause elevated prolactin: typical or atypical?
typical (except atyp risperidone)
which agents are more likely to cause metabolic complications: typical or atypical?
atypical
name the advantages to using atypical APs
improved response of - sx
mood stabilizing effects
positive response in pts refractory to traditional agents
reduced risk of EPS and TD
minimal effect on prolactin (except risperidone)
improved compliance
what is the black box warning that is given to ALL atypical APs?
caution use in dementia patients due to an increase in mortality
what is the MOA of most atypicals?
5HT and DA blockade
what are the FDA indications for clozapine?
schizo (tx resistant)
suicidal behavior
which pts is clozapine reserved for?
refractory to at least two adequate trials of other APs
how many black box warnings does clozapine have and what are they?
1. dementia pts
2. orthostasis
3. myocarditis
4. agranulocytosis/granulocytopenia
5. seizures
what are the side effects associated w/ clozapine?
anticholinergic: dry mouth, const, urinary retention, blurred vision
antihistaminergic: drowsiness, sedation, wt gain
alpha1 block:orthostasis, tachycardia
hypersalivation, drooling
HA
hyperlipidemia/glycemia
seizures
angranulocytosis
myocarditis
what special monitoring parameter is associated w/ clozapine?
CBC: q week for first 6 months, qow for next 6, q4w thereafter
which drug, when used w/ clozapine, increases risk of agranulocytosis?
carbemazepine
which drug inx is of concern w/ clozapine?
smoking: induces 1A2; if pts wants to quit may need change dose
what are the FDA incications for risperidone?
schizophrenia
bipolar mania (acute)
which atypical is not used as first line?
clozapine
what side effects are associated w/ risperidone?
agitation, anxiety, HA, insomnia
antihistamine: sedation, wt gain
alpha1 block: orthostasis
constipation, dyspepsia, rhinitis, rash
increase in glucose/lipids
EPS (high dose >6mg)
prolactin elevation (>6mg)
which atypical is associated w/ the greatest increase in prolactin levels?
risperidone
which atypical AP is the only one available in a long acting depot form?
risperidone
what are the FDA indications for olanzapine?
shizo
bipolar mania (acute)
bipolar maintenance
agitation associated w/ schizo or bipolar mania (short acting injection)
what ADRs are associated w/ olanzapine?
antichol: dry mouth, const, urinary retention, blurred vision
antihist: sedation, wt gain
increase lipids, glucose
dizziness, akithisia, agitation, rhinitis, HA
alpha1 block - orthostasis
what drug inx is of concern w/ olanzapine?
smoking: induces enzymes and decreases drug levels. concerns w/ drug levels when quitting
when is the short acting injection form of olanzapine used?
for agitation associated w/ scizo or bipolar mania
what are the FDA indications for quetiapine?
schizophrenia
bipolar mania (acute)
what are the ADRs associated w/ quetiapine?
antihistamine: very sedating* wt gain
alpha1 block: orthostasis
somnloence, HA, const, agitation, dry mouth, dizziness
increase glu/lipids
cataracts?
which atypical AP is associated w/ cataracts?
quetiapine
which atypical is available only in tablet form, making compliance an issue?
quetiapine
doses of quetiapine <300mg are generally used for what purpose?
sleep
what are the FDA indications for ziprasidone?
schizo
agitation associated w/ schizo
bipolar mania
what is different about the MOA of ziprasidone?
it has some SNRI properties
which atypical AP must be taken w/ food due to nausea?
zaprasidone
what are the side effects associated w/ ziprasidone?
EPS and prolactin elevation (not as much as risperidone)
orthostasis,
nausea*
diarrhea, constipation, akasthisia, dizziness, rhinitis, rash
QTC prolongation
what agents when combined w/ ziprasidone can increase QTC interval?
TCAs, amiodarone, thioridazine, quinolones
when is the short acting injection form of ziprasidone used?
acute agitation
which two atypical APs are available as short acting injections for agitation?
olanzapine and ziprasidone
what are the FDA indications for aripirazole?
shizophrenia
bp mania
what is different about the MOA of aripiprazole?
partial agonist of D2 and 5HT1A receptors
5HT2 antagonist
moderate alpha1 block and antihist block
what are the side effects associated w/ aripiprazole?
HA, N/V, constipation, anxiety, dizzy, rash
insomnia (give in am)
akithisia
which atyps are associated w/ highest risk of metabolic complications?
clozapine, olanzapine
which atyps are associated w/ medium risk of metab comp
risperidone, quetiapine
whicn atyps are associated w/ low risk of metab comp?
ziprasidone and aripirazole
describe the monitoring parameters for atypical APs
wt & ht: baseline, week 4, week 8, week 12, quarterly
waist circumference: baseline, annually
FBG, FLP, BP: baseline, 12 weeks, annually
how can noncompliance be improved?
long acting injections: fluphenazine, haloperidol, risperidone
ODTs: clozapine, risperidone, olanzapine, aripiprazole
which atyps are available as ODTs?
risperidone, clozapine, olanzapine, aripiprazole