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78 Cards in this Set
- Front
- Back
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How is schizophrenia diagnosed?
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based on behavior which should include positive and negative symptoms and signs
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What neurotransmitter is affected in schizophrenia and how?
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dopamine is increased
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What is the main MOA of drugs that treat schizophrenia
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dopamine blockers
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What are the 2 categories of signs and symptoms of schizophrenia
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negative or positive
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Define a negative sign of schizophrenia
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negative signs are normal behaviors that are missing
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Name negative signs and symptoms of schizophrenia
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-loss of interest in everyday activities
-lack of emotion -inability to plan or carry out activities -poor hygiene -social w/drawal -loss of motivation -poverty of speech |
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Define avolition
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loss of motivation
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Define alogia
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poverty of speech
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Name positive symptoms of schizo
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-hallucinations
-delusions -thought disorders or difficulty speaking -difficulty paying attention |
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Describe the positive sign of thought disorders/difficulty speaking
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trouble organizing thoughts such as stopping mid sentence or jumbling together meaningless words
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What natural product is being used to treat psychosis
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fish oils
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Why should you not recommend cod liver oil
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due to risk of vit a toxicity
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Name medications that can cause psychosis
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-amphetamines
-methamphetamine, ice, crack -cannabis -cocaine -phencyclidine (PCP) -Lysergic acid diethylamide (LSD) and other hallucinogenics -anticholinergics (centrally acting) -dopamine or dopamine agonist used for Prakinsons disease -interferons -steroids -stimulants (including ADHD drugs) |
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When are steroids though to cause psychotic symptoms
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when the person also has a lack of sleep
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Define delusions
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beliefs that the pt has but are w/out a basis in reality
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in general which type of antipsychotics are considered first line and why
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second generation antipsychotics (SGA)
-bc they have less extrapyramidal side effects (EPS) |
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How long is considered an adequate trial of an antipsychotic before determining that it has failed
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4-6 wks
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Give pros and cons of the use of clozapine
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pros- it has superior efficacy
cons- causes agranulocytosis, myocarditis, seizures, metabolic risks |
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When should the use of clozapine be considered
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for a pt that has had poor or no response to at least 2 other antipsychotics and one of them was a SGA or if the pt has significant ADRs
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Contrast the SE b/t high and low potency FGA and what characteristics do most FGAs share
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high potency:
-high risk of EPS -moderate risk of sedation -low risk of orthostatic hypotension, tachycardia, anticholinergic effects low potency: -low risk of EPS -high risk of orthostatic hypotension, tachycardia, sedation anticholinergic effects In general all FGAs have: -high risk of sexual side effects -moderate risk of weight gain -low risk of metabolic effects |
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What is one of the most common SE wit the SGAs that are used the most (clozapine, olanzapine, quetiapine and possibly risperidone and paliperidone)
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weight gain
metabolic side effects |
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Name the antipsychotics that come in long acting INJECTIONS and how long does the formulation last
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->Haldol deconate (haloperidol)- 4 weeks (monthly)
->Risperidal Consta (resperidone)- 2 weeks ->Invega Sustenna (paliperidone)- 4 weeks -> Prolixin (fluphenazine)- 2 weeks AND -Relprev v (olanzapine)- 2-4wks....in REMS program w/ restricted use |
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What is the advantage of ODTs (orally disintegrating tablets)
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prevents the patient from cheeking or holding the tablet in the mouth,the ODT will dissolve fast and does not require water
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Name the SGAs that come in ODT formulations
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clozapine (Clozaril)
olanzapine (Zyprexa) risperidone (Risperidal) asenapine (Saphris) |
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How long does it take for IM injections to work and why are they useful
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they work stat and help to come down an aggravated psychotic pt
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Which FGA has a BBW for QT prolongation
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thioridazine
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If the pt has cardiovascular risk which SE of antipsychotics would you look out for and name the drugs that have this SE
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-if cardiac risk do not use drugs that have QT prolongation and arrhythmias
These drugs are: -All FGAs, especially thioridazine because it has a BBW for QT prolongation -SGAs: ziprasidone, risperidone, paliperidone, iloperidone, asenapine |
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What is considered metabolic issues
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elavated blood glucose
elevated lipids |
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What drugs should be avoided in patients that are overweight, have little physical activity and have metabolic issues and which has the highest risk for metabolic issues
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olanzapine (has highest risk of metabolic issues)
quetiapine clozapine causes metabolic issues but it is used regardless in refractory cases |
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Give the effects of having increased prolactin levels and what can it ultimately lead to
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-galactorrhea (milk production w/o pregnancy)
-sexual dysfxn -gynecomastia -irregular/missed periods -ultimately leading to osteoporosis |
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What drugs can cause an increase in prolactin levels
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the SGAs:
risperidone(Risperdal) paliperidone (Invega) |
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What drugs should be avoided if the patients has a history of tardive dyskinesia or any type of movement disorder
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risperidone (Risperdal)
paliperidone (Invega) |
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Which antipsychotics have the lowest risk of TD or movement disorders
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Quetiapine (Seroquel)
Clozapine (Clozaril) |
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-What MOA is shared by FGA and SGA?
-Give MOA of SGA? |
-FGA and SGA all block D2 receptors
-SGAs block D2 and 5HT2A receptors - |
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Which SGA has a different MOA from the other SGA and what is it
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Aripiprazole (Abilify)
-is a D2 and 5HT1A partial agonist and a 5HT2A antagonist **this is different from other SGAs because they block D2 and 5HT2A receptors |
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What black box warning goes with all antipsychotcis
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increased risk of mortality in elderly pts with dementia relatd psychosis primarily due to increased risk of stroke
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What type of antipsychotic is most commonly associated with NMS (neurleptic malignant syndrome) and why does NMS occur
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FGAs,
NMS is caused by blocking of the dopamine receptors |
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Give signs of NMS (neuroleptic malignant syndrome)
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-hyperthermia (sweating and fever)
-extreme muscle rigidity -mental status changes -tachycardia -tachypenia -blood pressure changes |
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Give the treatment options for a patient that develops NMS
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1. stop the antipsychotic
2. cool them down 3. open the airway if the pt can not breathe 4. Dantrolene a muscle relaxant |
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Name the 1st generation antipsychotics (FGA)
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1. chlopromazine
2. thioridazine 3. loxapine 4. pephenazine 5. fluphenazine 6. haloperidol 7. trifluoperazine 8. thiothixene |
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What can haloperidol be used for other than psychosis
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tics and vocal outburts due to Tourette syndrome
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Name the general SE of FGAs
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Sedation
cause EPS movement disorders sexual dysfunction cardiovascular effects orthostasis tachycardia QT prolongation |
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Give the contrast of sedation b/t the low potency FGAs with the high potency FGSa
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low potency= low EPS and high sedation
high potency = high EPS and low sedation |
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What type of movements occur with TD (tardive dyskinesia)
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facial movements
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How should one with tardive dyskinesia due to an antipsychotic be treated
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stop the antipsychotic bc TD can be irreversible
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Define dystonia and when is it most likely to occur
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prolonged muscle contractions that can be painful...it is most likely to occur at the start of therapy
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How can dystonia be treated when caused by antipsychotis
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prophylax with anticholinergics since it occurs at therapy initiation such as diphenhydramine or benztropine
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Define akathisia
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restlessness with anxiety and an inability to remain still
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define dyskinesias
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abnormal movements
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Name the SGAs
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1. clozapine (Clozaril, FazaClo ODT)
2. Olanzapine (Zyprexa) 3. Risperidone (Risperidal) 4. Quetiapine (Seroquel) 5. Ziprasidone (Geodon) 6. Aripiprazole (Abilify) 7. Paliperidone (Invega) 8. Iloperidone (Fanapt) 9. Asenapine (Saphris) 10. Lurasidone (Latuda) |
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Name the antipsychotics that have a REMS program that patients must register with and why
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Clozaril (Clozapine)- due to risk of agranulocytosis and seizures
Relprevv inj (Olanzapine)- due to sedation including coma and delirium after the injection |
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What is a normal ANC
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1.5 -8 (1500-8000)
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Does clozapine (Clozaril) have increased or decreased EPS/TD
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decreased
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Give SE of clozapine
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angranulocytosis
seizures mycoarditis weight gain increase lipids increase glucose orthostasis |
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What must the ANC and WBC be to use clozapine
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WBC > or = 3500/mm3
ANC > or = 2000/mm3 |
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How often does the WBC and ANC be checked while taking clozapine
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check WBC and ANC
weekly * 6 months every 2 weeks * 6 months monthly from then on |
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Major SE of olanzapine
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weight gain
increase lipids increase glucose |
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What other disease does Risperidone have approval for
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autism
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Give SE of risperidone
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sedation
EPS esp @ high doses increased prolactin weight gain increase lipids increase glucose QT prlongation |
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What effect does food when taken with quetiapine
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increases absorption
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When should the extended release formulation of quetiapine be taken
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at night without food, since food increases absorption of the quetiapine
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Give SE of quetiapine
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sedation
orthostasis weight gain increase lipids increase glucose **little EPS risk |
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Why would quetiapine be used for psychosis in Parkinsons disease
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bc it has a small risk for EPS
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Give a contraindication for the use of Ziprasidone (Geodon)
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contraindicated with QT prolongation
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Give SE of aripiprazole (Abilify
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insomnia (bc it is activating)
anxiety constipation |
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What is the parent compound of Invega
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risperidone
generic invega (paliperidone) |
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What is the only formulation of Saphris
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sublingual
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Define agranulocytosis
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low white blood cells
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Define myocarditis
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inflammation of the heart
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When is the risk the highest for myocarditis when being treated with clozapine
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in the first month
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Give signs and symptoms of myocarditis
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weakenss
difficult/rapid breathing chest pain swelling of the ankles/legs |
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Which drugs are monitored for metabolic issues and what are these issues
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clozapine
olanzapine quetiapine risperidone paliperidone signs/symptoms: elevated :lipids, blood pressure, blood glucose |
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Give counseling tips for the use of Asenapine (Saphris)
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place the SL tablet under the tongue it will dissolve
-do not eat or drink for 10 minutes -the tongue may feel numb |
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Give SE of Asenapine (Saphris)
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tongue/mouth numbnesss
EPS prolong QT intervla |
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Which formulations can be a problem for pts with PKU
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ODTs contain phenylalanine
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What can the oral solution of Risperdal be mixed with
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Mix with:
water coffee orange juice low fat milk Do NOT use with: coffee tea |
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How should you counsel a patient on Seroquel XR
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tell the patient to take at night with no food or a light meal because food increases the absorption of the drug
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When should olanzapine be taken and how many times a day
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once daily at night
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