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85 Cards in this Set
- Front
- Back
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Average lifetime prevalence
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1%
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Gender prevalence
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Equal between sexes
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Typical onset
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Late teens and mid 30's
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Describe the co-morbidity associated with schizophrenia
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75% Nicotine
30-50% EtOH abuse 60% have MDD |
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What is the Nigrostriatal area function?
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Extrapyrimidal system, movement
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Describe the mesolimbic function
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Arousal, memory, stimulus processing, motivational behavior
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In schizo, what brain part has elevated DA?
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Mesolimbic
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Describe Mesocortical function
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Cognition, communication, social Fx, stress response
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Function of tuberoinfundibular
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Regulate prolactin release
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Where do we want to increase DA in the brain?
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Mesocortical
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Where do we want to block DA actions in the brain?
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Mesolimbic
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Minimal period of Sx for diagnosis of Schizo
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1 month
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Describe Positive Symptoms
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Things that they see that aren't really there.
Delusions (Persecutory, grandiose, religious, somatic) Hallucinations (Auditory, olfactory, visual, gustatory, tactile) |
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What is the hallmark positive symptom?
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Hallucinations
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Define Anhedonia
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Loss of interest
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Where do we want to block DA actions in the brain?
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Mesolimbic
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Minimal period of Sx for diagnosis of Schizo
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1 month
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Describe Positive Symptoms
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Things that they see that aren't really there.
Delusions (Persecutory, grandiose, religious, somatic) Hallucinations (Auditory, olfactory, visual, gustatory, tactile) |
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What is the hallmark positive symptom?
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Hallucinations
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Define Anhedonia
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Loss of interest
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Describe Negative Symptoms and give examples
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Things people should see that are there.
BLUNTED EFFECT ANHEDONIA AVOLITION POVERTY OF SPEECH POOR HYGIENE |
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What are the two low potency typical AP's?
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Chlorpromazine
Thioridazine CT |
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Typical AP MOA
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D2 Antagonists (D2>D1). After 21 days of Tx there is decreased DA release or DA inactivation.
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Describe the affinity of Low potency Typical AP's for Dopamine receptors.
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Less specificity (Thus more anti-cholinergic...etc)
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Describe overall Low potency ADR's vs. High potency
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LOWER EPS
More sedation More Postural hypotension More effect on Szr threshold More anticholinergic REMEMBER, LOWER POTENCY ARE LESS SPECIFIC |
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Histamine blockade is associated with?
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Sedation
Weight Gain |
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Alpha 1 blockade is associated with?
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Orthostatic hypotension and reflex tachycardia
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Dopamine 2 receptor blockade is associated with what ADRs?
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EPS, Prolactin elevation
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Describe Dystonia
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EPS: Sustained muscle contraction, RAPID onset, occurs within 1-4 days of dose admininstration or change in dose.
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Dystonia Risk factors (2)
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Young males
High potency |
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Tx of Dystonia
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Benztropine
Diphenhydramine |
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Describe Tx length for Dystonia
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Tx with anticholinergics for 1month after dystonia is resolved.
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Describe Px for Dystonia
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Prophylactic Benztropine may be given at initiation of High potency AP
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Describe Akathisia
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EPS: Subjective feeling of motor restlessness. Takes days to weeks to appear.
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Describe objective signs of Akathisia
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Pacing, tapping feet, inability to sit still
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Tx of Akathisia
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Propranolol
OR Diazepam |
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4 Cardinal symptoms of Pseudoparkinsonism
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1.Akinesia, bradykinesia, bradyphrenia
2.Resting Tremor 3.Cogwheel rigidity 4.Postural abnormalities |
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Risk factors for Pseudoparkinsonism
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Female >40, high potency
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Tx of Pseudoparkinsonism
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Benztropine
Trihexyphenidyl Diphenhydramine Amantadine |
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Describe Tx duration for Pseudoparkinsonism
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Continued for 6 weeks to 3 months after symptoms resolve
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Tx of Tradive Dyskinesia
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PREVENTION IS KEY
1.Decrease dose of Typical 2.Switch to Atypical 3.Vitamin E 4.BZD 5.Botulinum toxin 6.Clozapine |
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Describe NON-EPS ADR's of Typical AP's
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1. Seizures
2. Neuroleptic Malignant syndrome 3.ECG changes 4.Endocrine effects |
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Which AP's have the highest potential to cause seizures?
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Clozapine, Chlorpromazine
The 2 C's make you Seize! |
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Describe Neuroleptic Malignant Syndrome
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Non-eps syndrome involving hyperpyrexia, altered MS, tachycardia, fluctuating BP, sweating, urinary and fecal incontinence and rigidity.
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What labs would you expect to be messed up for Neuroleptic Malignant syndrome?
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CPK,LFTs
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What are risk factors for Neuroleptic Malignant Syndrome
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1.High potency
2.Injectible 3.Depot APs |
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Tx of Neuroleptic Malignant Syndrome
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1.Discontinue AP
2.DA agonists (Bromo) 3.Dantrolene (Muscle relaxant) |
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Which Typical AP has a black box warning for ECG changes?
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Thioridazine
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Which AP's are most likely to cause ECG changes and prolong QTC interval?
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Thioridazine and Ziprasidone(Geodon)
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Elevated prolactin levels can result in what 5 conditions
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1.Amenorrhea
2.Galactorrhea 3.Gynecomastia 4.Sexual dysfunction 5.Osteoporosis |
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2 AP's most likely to cause Prolactin level increases
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1.Typical AP's
2.Risperidone |
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What two typical agents are available in Decanoate formulations?
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Fluphenazine and Haloperidol
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Major timing consideration as far as deconoate typical AP injections
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Must overap period of oral form to maintain control of symptoms.
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What must patients have tried before they can be put on clozapine?
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Must have failed 2 adequate trials of other agents
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Clozapine ADR
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Hypersalivation (Drool)
Tachycardia Constipation Weight Gain Glucose dysregulation Increased Lipids AGRANULOCYTOSIS MYOCARDITIS SEIZURES ORTHOSTASIS |
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Describe Clozapine monitoring in terms of the agranulocytosis risk
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Weekly CBC for 6 months, then q 2 w for 6 months, then q month
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Reason for CBZ interaction between Clozapine and CBZ?
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Agranulocytosis
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ADR for Risperidone
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EPS PROLACTIN ELEVATION
Agitation, anxiety, HA, insomnia, sedation, orthostasis, weight gain, constipation, dyspepsia |
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What prerequisite must be accomplished before using the decanoate formulation of risperidone?
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Must establish oral tolerability
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Risperidone Interactions
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1.DA agonists
2.SSRIs (Fluoxetine, Paroxetine) 3.Trazodone, Antihypertensive |
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Olanzapine ADR
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Metabolic: Weight gain, glucose dysregulation, increased lipids
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Olanzapine Interactions
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1.DA agonists, levodopa
2.Smoking |
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What is the IM injection of Olanzapine for?
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For agitation, not for maintenance
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Major ADR's of Quetiapine
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Drowsiness, Metabolic, orthostasis, agitation
MUST EXAM LENS TO DETECT CATARACT FORMATION AT INITIATION AND Q 6 MONTHS |
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Quetiapine - Major disadvantage
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Only available in tablet, pt can cheek tablet
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Olanzapine ADR
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Metabolic: Weight gain, glucose dysregulation, increased lipids
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Olanzapine Interactions
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1.DA agonists, levodopa
2.Smoking |
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What is the IM injection of Olanzapine for?
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For agitation, not for maintenance
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Major ADR's of Quetiapine
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Drowsiness, Metabolic, orthostasis, agitation
MUST EXAM LENS TO DETECT CATARACT FORMATION AT INITIATION AND Q 6 MONTHS |
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Quetiapine - Major disadvantage
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Only available in tablet, pt can cheek tablet
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Quetiapine Interactions
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1.DA agonists
2.Phenytoin, CBZ (Decrease) 3.Ketoconazole, nefazodone (Increase) |
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Which atypical if used in lower dose is good for sleep?
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Seroquel
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MAJOR ADR of Ziprasidone
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1.Stomach upset (Take with food)
2.EPS effects 3.QTC Prolongation |
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Ziprasidone Interactions
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1.CBZ
2.Ketoconazole 3.QTC acting agents |
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Aripiprazole MOA
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Partial agonist at D2 and 5-HT1A, Antagonist at 5-HT2A, has adrenergic blockade and antihistaminergic blockade
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Arpiprazole ADR
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HA, NV, INSOMNIA, AKATHISIA
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MONITORING PARAMETERS FOR ATYPICAL AP'S
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1.Wt/Ht=Baseline,4 wk,8wk,12wk, then q 3 mo
2.Waist circumference, Baseline then annual 3.Fasting glucose;baseline, 12 weeks then q year 4.Fasting lipid;baseline, 12 weeks then q year 5.BP;Baseline,12 weeks, annually |
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Which two agents are worst Metabolically?
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Clozapine and olanzapine
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Which agents are most benign as far as metabolic?
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Geodon, Abilify
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Which Atypical is this?
Weight gain, lipids, Glucose dyregulation (Main 3, not clozapine) |
Olanzapine
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Which atypical has black box warnings for Agranulocytosis, myocarditis, seizures and Orthostasis?
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Clozapine
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Which Atypical AP has EPS and prolactin elevation?
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Risperidone
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Which Atypical AP's main ADR that stands out is drowsiness?
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Quetiapine
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Which Atypical AP's main ADR's include QTC prolongation and must be taken with food?
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Ziprasidone
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Which Atypical AP is characterized most by Insomnia
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Abilify/Aripiprazole
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