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85 Cards in this Set

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Average lifetime prevalence
1%
Gender prevalence
Equal between sexes
Typical onset
Late teens and mid 30's
Describe the co-morbidity associated with schizophrenia
75% Nicotine
30-50% EtOH abuse
60% have MDD
What is the Nigrostriatal area function?
Extrapyrimidal system, movement
Describe the mesolimbic function
Arousal, memory, stimulus processing, motivational behavior
In schizo, what brain part has elevated DA?
Mesolimbic
Describe Mesocortical function
Cognition, communication, social Fx, stress response
Function of tuberoinfundibular
Regulate prolactin release
Where do we want to increase DA in the brain?
Mesocortical
Where do we want to block DA actions in the brain?
Mesolimbic
Minimal period of Sx for diagnosis of Schizo
1 month
Describe Positive Symptoms
Things that they see that aren't really there.
Delusions (Persecutory, grandiose, religious, somatic)
Hallucinations (Auditory, olfactory, visual, gustatory, tactile)
What is the hallmark positive symptom?
Hallucinations
Define Anhedonia
Loss of interest
Where do we want to block DA actions in the brain?
Mesolimbic
Minimal period of Sx for diagnosis of Schizo
1 month
Describe Positive Symptoms
Things that they see that aren't really there.
Delusions (Persecutory, grandiose, religious, somatic)
Hallucinations (Auditory, olfactory, visual, gustatory, tactile)
What is the hallmark positive symptom?
Hallucinations
Define Anhedonia
Loss of interest
Describe Negative Symptoms and give examples
Things people should see that are there.
BLUNTED EFFECT
ANHEDONIA
AVOLITION
POVERTY OF SPEECH
POOR HYGIENE
What are the two low potency typical AP's?
Chlorpromazine
Thioridazine
CT
Typical AP MOA
D2 Antagonists (D2>D1). After 21 days of Tx there is decreased DA release or DA inactivation.
Describe the affinity of Low potency Typical AP's for Dopamine receptors.
Less specificity (Thus more anti-cholinergic...etc)
Describe overall Low potency ADR's vs. High potency
LOWER EPS
More sedation
More Postural hypotension
More effect on Szr threshold
More anticholinergic
REMEMBER, LOWER POTENCY ARE LESS SPECIFIC
Histamine blockade is associated with?
Sedation
Weight Gain
Alpha 1 blockade is associated with?
Orthostatic hypotension and reflex tachycardia
Dopamine 2 receptor blockade is associated with what ADRs?
EPS, Prolactin elevation
Describe Dystonia
EPS: Sustained muscle contraction, RAPID onset, occurs within 1-4 days of dose admininstration or change in dose.
Dystonia Risk factors (2)
Young males
High potency
Tx of Dystonia
Benztropine
Diphenhydramine
Describe Tx length for Dystonia
Tx with anticholinergics for 1month after dystonia is resolved.
Describe Px for Dystonia
Prophylactic Benztropine may be given at initiation of High potency AP
Describe Akathisia
EPS: Subjective feeling of motor restlessness. Takes days to weeks to appear.
Describe objective signs of Akathisia
Pacing, tapping feet, inability to sit still
Tx of Akathisia
Propranolol
OR
Diazepam
4 Cardinal symptoms of Pseudoparkinsonism
1.Akinesia, bradykinesia, bradyphrenia
2.Resting Tremor
3.Cogwheel rigidity
4.Postural abnormalities
Risk factors for Pseudoparkinsonism
Female >40, high potency
Tx of Pseudoparkinsonism
Benztropine
Trihexyphenidyl
Diphenhydramine
Amantadine
Describe Tx duration for Pseudoparkinsonism
Continued for 6 weeks to 3 months after symptoms resolve
Tx of Tradive Dyskinesia
PREVENTION IS KEY
1.Decrease dose of Typical
2.Switch to Atypical
3.Vitamin E
4.BZD
5.Botulinum toxin
6.Clozapine
Describe NON-EPS ADR's of Typical AP's
1. Seizures
2. Neuroleptic Malignant syndrome
3.ECG changes
4.Endocrine effects
Which AP's have the highest potential to cause seizures?
Clozapine, Chlorpromazine

The 2 C's make you Seize!
Describe Neuroleptic Malignant Syndrome
Non-eps syndrome involving hyperpyrexia, altered MS, tachycardia, fluctuating BP, sweating, urinary and fecal incontinence and rigidity.
What labs would you expect to be messed up for Neuroleptic Malignant syndrome?
CPK,LFTs
What are risk factors for Neuroleptic Malignant Syndrome
1.High potency
2.Injectible
3.Depot APs
Tx of Neuroleptic Malignant Syndrome
1.Discontinue AP
2.DA agonists (Bromo)
3.Dantrolene (Muscle relaxant)
Which Typical AP has a black box warning for ECG changes?
Thioridazine
Which AP's are most likely to cause ECG changes and prolong QTC interval?
Thioridazine and Ziprasidone(Geodon)
Elevated prolactin levels can result in what 5 conditions
1.Amenorrhea
2.Galactorrhea
3.Gynecomastia
4.Sexual dysfunction
5.Osteoporosis
2 AP's most likely to cause Prolactin level increases
1.Typical AP's
2.Risperidone
What two typical agents are available in Decanoate formulations?
Fluphenazine and Haloperidol
Major timing consideration as far as deconoate typical AP injections
Must overap period of oral form to maintain control of symptoms.
What must patients have tried before they can be put on clozapine?
Must have failed 2 adequate trials of other agents
Clozapine ADR
Hypersalivation (Drool)
Tachycardia
Constipation
Weight Gain
Glucose dysregulation
Increased Lipids
AGRANULOCYTOSIS
MYOCARDITIS
SEIZURES
ORTHOSTASIS
Describe Clozapine monitoring in terms of the agranulocytosis risk
Weekly CBC for 6 months, then q 2 w for 6 months, then q month
Reason for CBZ interaction between Clozapine and CBZ?
Agranulocytosis
ADR for Risperidone
EPS PROLACTIN ELEVATION
Agitation, anxiety, HA, insomnia, sedation, orthostasis, weight gain, constipation, dyspepsia
What prerequisite must be accomplished before using the decanoate formulation of risperidone?
Must establish oral tolerability
Risperidone Interactions
1.DA agonists
2.SSRIs (Fluoxetine, Paroxetine)
3.Trazodone, Antihypertensive
Olanzapine ADR
Metabolic: Weight gain, glucose dysregulation, increased lipids
Olanzapine Interactions
1.DA agonists, levodopa
2.Smoking
What is the IM injection of Olanzapine for?
For agitation, not for maintenance
Major ADR's of Quetiapine
Drowsiness, Metabolic, orthostasis, agitation
MUST EXAM LENS TO DETECT CATARACT FORMATION AT INITIATION AND Q 6 MONTHS
Quetiapine - Major disadvantage
Only available in tablet, pt can cheek tablet
Olanzapine ADR
Metabolic: Weight gain, glucose dysregulation, increased lipids
Olanzapine Interactions
1.DA agonists, levodopa
2.Smoking
What is the IM injection of Olanzapine for?
For agitation, not for maintenance
Major ADR's of Quetiapine
Drowsiness, Metabolic, orthostasis, agitation
MUST EXAM LENS TO DETECT CATARACT FORMATION AT INITIATION AND Q 6 MONTHS
Quetiapine - Major disadvantage
Only available in tablet, pt can cheek tablet
Quetiapine Interactions
1.DA agonists
2.Phenytoin, CBZ (Decrease)
3.Ketoconazole, nefazodone (Increase)
Which atypical if used in lower dose is good for sleep?
Seroquel
MAJOR ADR of Ziprasidone
1.Stomach upset (Take with food)
2.EPS effects
3.QTC Prolongation
Ziprasidone Interactions
1.CBZ
2.Ketoconazole
3.QTC acting agents
Aripiprazole MOA
Partial agonist at D2 and 5-HT1A, Antagonist at 5-HT2A, has adrenergic blockade and antihistaminergic blockade
Arpiprazole ADR
HA, NV, INSOMNIA, AKATHISIA
MONITORING PARAMETERS FOR ATYPICAL AP'S
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
Which two agents are worst Metabolically?
Clozapine and olanzapine
Which agents are most benign as far as metabolic?
Geodon, Abilify
Which Atypical is this?
Weight gain, lipids, Glucose dyregulation
(Main 3, not clozapine)
Olanzapine
Which atypical has black box warnings for Agranulocytosis, myocarditis, seizures and Orthostasis?
Clozapine
Which Atypical AP has EPS and prolactin elevation?
Risperidone
Which Atypical AP's main ADR that stands out is drowsiness?
Quetiapine
Which Atypical AP's main ADR's include QTC prolongation and must be taken with food?
Ziprasidone
Which Atypical AP is characterized most by Insomnia
Abilify/Aripiprazole