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181 Cards in this Set
- Front
- Back
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onset of schizophrenia
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late adolescence to early adulthood
rarely before adolesence or after 40 rs |
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who has an earlier onset men or women
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men: 20's
women: late 20's, early 30's |
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who's more prone to schizophrenia men or women
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both are equal
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% who commit suicide?
suicide attempt? |
10%
20-40% attempt |
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risk for schizophrenia
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male
< 45 yo depressive sx unemployed recent hospital visit increase in post psychotic periods |
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% chance of having schiz w/ 1st degree relative?
2nd degree? |
10%
3% |
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% chance of having schiz w/ both parents
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40%
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neurodevelopment model of schiz can occur during which trimester
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2nd
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neuropsycho there's a delay in reaching --- milestone and abnorm ----
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motor
movements |
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there's an increase --- in the prain and this explains --symptoms
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Da
positive |
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glutaminergic dysfunction there's a defiency which mimics --- hyperactivity
this explians --- impairment, -- symptoms, and ---- |
Da
cognitive negative delusions |
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there's an increase in --- which explains the neg symptoms
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serotonin
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first episode of schizo is usu --- followed by -- symptoms
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sudden
residual |
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pt have an increased risk of ----, --- ---- disorder and -- disorder
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anxiety
OCD panic |
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what % abuse nicotine
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80-90%
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false -- created by pts
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reality
hallucinations delusions |
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ideas of influence:
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belief that another person or force contrls behavior
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pts have poor --- ---- skills
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self care
dirty, poor hygiene |
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pt unable to learn from ---
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experiences
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primary tx
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medication
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initiate med tx for acute
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decrease postitve symtoms and the pt to eat and sleep
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ok to use ---- in addition to antipsychotic for combative behavior
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lorazepam
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for acute titrate to ---- effective dose over a few days
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avg
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when would you change agent for acute tx
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if absolutely no improvement in 3-4 wks
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what type of meds would you give for non-compliance
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liquids
disintegrating tabs |
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what meds to you give for severely agitated pts
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IM antipsychotics
IM lorazepam |
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goals of stabilization tx
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improve socialization, self care and mood
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stab tx --- improvent over 6-12 weeks
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continuous
neg symptoms tougher to tx |
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when do you change agent if there's not significant improvement for stab tx
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8-12 weeks
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dose titration for stab tx
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q 1-2 wks w/o side effects
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adequate time on dose at least --- months for stab tx
-- months for clozapine |
3
6 |
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best indicator for med response for stab tx
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adequate time on dose
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goal of maintenance tx
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prevention of relapse
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relapse rate for those on tx
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18-32 %
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relaspe rate for thos one placebo
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60-80%
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how long should the pt be on tx before they are tapered off
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12 months
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t/f
ok to give intermittent tx |
f
cuz can have acute episodes |
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--- tx required for most pts
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lifetime
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d/c of maintenance tx requires tapering off over -- weeks
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2
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what dose do you restart the pt on if having withdrawal s/s?
and taper at a ----- ---- |
lowest dose
slower rate |
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when switching meds you taper 1st agent over -- to --- weeks after ------
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1-2 weeks
after 2nd antipsy has been started |
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t/f
combo tx better than single tx |
f
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when starting med monitor weight q --- months then ---, then --- once stablizied
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3
quaterly annually |
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when do you f/u w/ meds
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q 3 mo or when changing
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t/f
2nd gen have effects on serum prolactin |
f
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2nd gen prototypical agent
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clozapine
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2nd gen have increased effectiveness for
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neg symptoms
cognition |
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ae of 2nd gen
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weight gain
orthostatic hypotension elevated glucose ekg changes increased triglycerides and cholesterol sedatoin anticholinergic seizures sex dysfunction photosensitivity |
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which meds ahve the greates wt gain
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clozapine
olanzapine |
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which meds have least weight gain among 2nd gen
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ziprasidone
aripiprazole |
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which med can cause new onset dm in 52% of pts
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clozapine
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t/f
orthostatic hypotension will last thru med course |
f
tolerance in 2-3 mo decrease dose or change med if symptoms continue |
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when do you d/c med w/ ekg changes
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QT > 500ms
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when do you get a baseline ekg
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> 50 yrs old
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which meds will cause sedation
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clozapine
olanzapine quetiapine |
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when would you dose sedative meds: clozapine, olanzapine, quetiazpine
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q hs
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sedation may be ---
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transient
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which mes will have anticholinergic effects
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clozapine
olanzapine |
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how to tx dry mouth
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increase fluids
oral lubricants ice chilps sugarless gum/candy |
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how to tx constipation
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increase fluids
fiber exercise med if necessary |
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which meds have the greatest seizure risk
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clozapine
olanzapine |
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risk factorsfor seizures
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pre-existing sz disorder
hx of drug induced sz abnorm ekg head trauma cna pathololgy |
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seizures usu occure w/
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higher doses
rapid dose increases initiation of tx |
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when do you decrease dose for sz
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for isolated sz incident
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which med has the lowest seizure risk
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risperidone
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which 2nd gen will have a higher ability to decrease libido
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riperidone
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t/f
both schizo and meds will decrease libido |
t
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tx photosensitivity
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sunscreen
protective clothing hat sunglasses |
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which gen will have least risk of photosensitivity and sex dysfunciton
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2nd gen
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what limits use of clozapine
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agranulocytosis
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who's at increased risk for agranulocytosis
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increased age
female 1-6 mon w/in tx pts need weekly cbc for 6 mo then 2 weeks |
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clozapine is beneficial for --- and --- pts
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suicidal
resistant |
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clozapine pts havae a higher risk for --- ----
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orthostatic hypotension
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what can increase clozapine
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fluvoxamine
this might increase seizures |
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what can decrease clozapine
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carbamazepine
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what combo can increase clozapine
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fluoxetine/erythromycin
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black box warning on clozapine
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agranulocytosis
cardiac complications seizures |
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--- --- is higher in pts taking clozapine
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weight gain
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clozapine has --- side effects
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anticholinergic
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clozapine can cause neuroleptic --- ---
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malignant syndrome
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clozapine can have -- ----- symptoms
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obsessive-complusive
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clozapine can cause drooling aka
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sialorrhea
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caution in thses pts using clozapine
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dm
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monitor ---, ---, --- and --- in clozapine pts
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cbc
bg lipid weight gain |
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when would you d/c clozapine w/ wbcs
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WBC < 2000
absolute neutrophil < 1000 |
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what can you give w/ clozapine if wbcs low but need the med
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lithium
GCF |
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how can clozapine cause PE/DVT
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increased platelet aggregation
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what can help sialorrhea
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clonidine
benzotropine |
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wehn do se of clozapine increase
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w/ increase serum conc
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when do u measure clozapine levels
before levels reach: |
before > 600 mg/day
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measure clozapine levels when the pt has --/--- se, presence of --- ----, and for --- testing
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unusual/sever
drug interactions adherance |
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measure clozapine levels when pts are ---- or other factors affecting -----
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elderly
pharmcokinetics |
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whcih has a higher weight gain risk clozapine or olanzapine
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olanzapine
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olanzapine has --- se
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anticholinergic
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t/f
im and oraly-disintegrating table available for olanzapine |
t
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what can increase con of olanzapine
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cyp1A2 inhibitors
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---- enhance olanzaine elimination
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carbamazepine
50% increase in elimination |
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which has less weight gain olanzapine, clozapine or aripiprazole
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aripiprazole
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whichmed has he least risk of lipid change
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aripiprazole
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--- soln f aripiprazole available
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oral
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what can decrease conc of aripiprazole
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carbamazepine
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what might you see when starting aripiprazole
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agitation
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which has less weight gain ziprasidone or clozapine
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ziprasidone
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ziprasidone has less risk for -- changes
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lipid
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response rate for ziprazidone increases at >
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80mg/day
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doses above ---- for effectiveness of quetiapine
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500 mg
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quetiapine need baseline and f/u --- exams
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eye
due to possible cataracts |
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w/ quetiapine there's increased se w/ --- ---- inhibiors
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cyp3A4
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what may decrease clearance of quetiapine
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fluoxetine
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this med is a good consideration if other meds causing too much weight gain
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quetiapine
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which med has extended release tabs
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paliperidone
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don't ---, --- or divide paliperidone
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crush
chew |
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risperidone has low incidences of --- at doses </= 6 mg
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EPS
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risperidone has less risk of -- changes
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lipid
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w/ risperidone there's a risk for --- ----
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cholestatic hepatitis
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w/ risperidone monitor for ----
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eps
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what increases conc of risperidone
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paroxetine
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what will decrease conc of risperidone
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carbamazepine
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iloperidone approved for --- tx
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acute
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iloperidone can cause --- ---
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orthostatic hypotension
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how do you dose iloperidone
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increase dose over several days
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how would you adjust the dose of iloperidone w/ cyp3a4 and2d6 inhibitors
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give 50% of the dose
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iloperidone can prolong --- ---
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QT interval
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what does iloperidone antagonize
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DA
5HT |
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iloperidone has a low affinity for
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antihistamine
so low risk for somunulence |
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iloperidone has a high affinity for
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alpha 2 (cognitive se)
alpha 1 (orthostatic hypotension) |
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what two meds does iloperidone interact w/
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fluoxetine
paroxetine ketoconazole |
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t/f
continue iloperidone beyond acute phase |
t
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iloperidone se
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dizziness
dry mouth fatigue increased hr weight gain |
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low potency 1st gen
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chlorpromazine
mesoridazine thioridazine |
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ae of 1st gens
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elevated prolactin levels
orthostatic hypotension ekg changes increased triglycerides and cholesterol anticholinergic se eps pseudoparkinsonism akathisia tardive dyskinesia |
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what can elevate prolactin levels
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risperidone
fga |
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due to elevated prolactin levels what can occure in women?
men |
women: galactorrhea and menstrual irregularities
men: gynecomastia and galactorrhea |
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if elevated prolactin levels what do you do
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switch to sga
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which fgas will cause ekg changes
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thioridazine
mesoridazine |
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fga can increase --- and ---
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tg's
cholesterol |
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due to ---- se of fga you shold avoid in the elderly
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anticholinergic
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tx of elevated prolactin levels
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bromocriptine
amantatine |
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it pt has elevated cholesterol on fgas what do you do
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change drug
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severe muscle spasm, scary, painful
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dystonia
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risk of dystonia
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male
young high potency fga high doses |
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tx fo dystonia
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im/iv anticholinergic or benzodiazepines
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if can't switch fga and pt's having dystonia what do u do
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add benadryl
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when does the pt begin to experience the dystonia
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24-96 hrs of initiatiion of med or dose increase
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if dystonia what do you do
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switch to sga
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risks of pseudoparkinsonism
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inceasing age
female initiation of med or dose increase |
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tx of pseudoparkinsonism
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benztropine
trihexyphenidyl benadryl amandatine |
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inner or outer restlessness
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akathisia
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which meds caus akathisia
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fga
sga |
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tx akathisia
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benzodiazepines
bb |
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these meds have lower risk of akathisia
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quetiapine
clozapine |
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if akathisia what do you do w/ med
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swtich to sga
lower fga dose |
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when does tardive dyskinesia worsen
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w/ stress
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risks of tardive dyskinesia
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increased age
acute eps poor response to threapy organic mental d/o dm mood d/o female duration of tx high doses total accumulative dose |
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w/ tardive dsykinesia the pt might have an increased risk of
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CV
oral ulcers. . . pt might not be able to wear dentures |
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what med is preferred for tardive dyskinesia and might actually reverse mod to severe td
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clozapine
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what do you monitor w/ tardive dyskinesia
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family hx baseline and annually
efficacy eps td pseudoparkinsonism vitals lipids bg weight |
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according to catie wihc meds were tolerated by more pts
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olanzapine
risperidone |
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according to catie which med was effective
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olanzapine
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according to catie which med worked well for pts that failed other sgas
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clozapine
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which med will increase risk of eps
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metoclopramide
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which med if give w/ antipsy will increase sedation
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diphenydramine
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wwhich med will increase risperidone conc
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paroxetine
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aripiprazole and -- will increase sedation and orthostatic hypotension
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lorazepam
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which med will decrease risperidone conc
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carbamazepine
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which med will if give w/ olanzapine via iv or im will increase the olanzapine conc
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benzodiapines
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what might decrease effective of antipsychotics
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st. john's wort
it's an inducer |
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smoking induces cyp1A2 and might decrease the effectiveness of ----- and decrease conc of ---
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olanzapine
clozapine |
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long acting agents mainly for pts who are ---
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noncompliant
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long acting agents
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risperidone 25-50 mg im q 2 weeks
fluphenazine decanoate 1.2 - 1.6 times oral haldolperidol 10-15 times oral |
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long acting agents best used when pts --- ---- --
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stabilized on oral
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which long acting is given via Z tract IM
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fluphenazine
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ok to overlap oral fluphenazine for -- week
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1
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how often to give haldol long acting
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q month
overlap w/ oral for 1 month decrease dose 25% 2nd and 3rd month |
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prob w/ long acting
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long t1/2
long se |
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adjunct tx w/ antipsy
|
antidepressants
benzodiazepines (anxiety, panic) mood stabilizers bb (aggression) |
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which med is the most studied and has no teratongenic effects
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haldol
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which meds have an increased gestational dm risk
|
second gen
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t/f
antipsy excreted in milk |
t
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t/f
recommened to breast fed if taking antipsy |
f
although not CI |
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which has birth defects
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low potency 1st gen
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