Schizophrenia

Question 1

What is schizophrenia?

Answer 1

• a chronic, severe and disableing thought disorder

Question 2

What are some of the common symptoms of schizophrenia?

Answer 2

• Hallucinations (sensing somthing thats not there)
• Delusions (belief about something real that nots true)
• Diorganized thinking/behavoir (cant focus or communicate)

Question 3

What are the Extrapyramidal Side Effects? What are the definitions of them?

Answer 3

• Dystonia: Prolonged contractions of muscles during drug initations (painful, life-threatening if in lungs)
• Akathisia: Restlessness with anxiety
• Parkinsonism: Similar to parkinsons (treamors , gait, bradykinesia)
• Tardive: abnormal facial movements
• Dyskinesias: abnormal movements

Question 4

What is the way that schizophrenia is diagnosed?

Answer 4

• on positive and negative signs and symptoms that the DSM-5 lays out

Question 5

What are the Negative signs and symptoms of schizophrenia

Answer 5

• Loss of interest in daily activities
• lack of emotions
• Inability to plan
• Poor hygine
• Social withdrawal
• Loss of motivation
• Lack of speech

Question 6

What are some of the Positive signs and symptoms of Schizophrenia?

“Common Symptoms”

Answer 6

• Hallucinations
• Delusions
• Disorganized thinking/behavior

Question 7

What are some medications that could cause psychotic symptoms?

Answer 7

• Anticholinergics
• Dextromethorphan
• Dopamine agonists (ropinirole, pramipexole, carbadopa/levadopa)
• Interferons
• Stimulants (amphetamines)
• Systemic steroids (with lack of sleep)
• Illegal Drugs (cannabis, cocaine, LSD, Meth, PCP, Bath salts)

Question 8

What is the MOA of the antipsychotic medications?

Answer 8

• blocking dopamine receptors BUT the newer agents block serotonin and other receptors

Question 9

What are some of the formulations that are associated with the antipsych medications?

Answer 9

• Long acting injecitons (eliminates oral dosing)
• ODTs (help with those that cant swallow and prevents cheeking)
• Oral solutions/suspensions (useful for kids and those with feeding tubes)
• Acute IM injections (“stat” relief - Haldol [haloperidol, lorazepam, benadryl])

Question 10

What are the boxed warnings that are important for all Antipsychotics?

Answer 10

• NO best for thoses elderly patients with agitation control with dementia-related psychosis = increased mortality risk
• Increased stroke risk
• Fall risk

Question 11

What is the MOA of the 1st generation antipsychotics?

Answer 11

• Mainly work by blocking dopamine-2 receptors with low serotonin blockage

Drug class: Phenothiazine - “-azines”

Question 12

What are the 1st generation antipsychotics drugs that are used?

Low? Mild? High Potencies?

Answer 12

• Low Potency - Chlorpromazine, Thioridazine
• Mid Potency - Loxapine, Perphenazine
• High Potency - Haloperidol (Haldol), Fluphenazine, Thiotixene, Trifluoperazine

Question 13

What else is haloperidol used for other than schizophernia/psychosis?

Drug class: Butyropheenone

Answer 13

• Tourette Syndrome

Question 14

What are some boxed warnings for 1st genereation antipsychotics?

Answer 14

• Elderly patients with dementia-related psychosis = increased risk of death
• Thioridazine: QTc Prolongation

Question 15

What are some Warnings for 1st genereation antipsychotics?

Answer 15

• Cardio: QTc Prolongation (especially with Thioridazine, Haloperidol, Chlorpromazine)
• CNS Depression
• Anticholinergic effects
• EPS (mentioned on other slide)
• Hyperprolactinemia (infertility, fewer mensual periods, ED, decreased libido)
• NMS

Question 16

What are some side effects for 1st genereation antipsychotics?

Answer 16

• Sedation, Dizziness, Anticloinergics (constipation, dry mouth, blurred vision, urinary retention)
• EPS (Tardive)

Question 17

What are some additional notes for 1st genereation antipsychotics?

Answer 17

• lower potency drugs have increased sedation & decreased EPS and higher potency drugs have decreased sedation & increased EPS

Question 18

What are the MOA for the 2nd generation antipsychotics

Answer 18

• Blocks both dopamine-2 and serontonin receptors

Question 19

What are the 2nd generation antipsychotics that are used?

Answer 19

• Aripiprazole (abilify)
• Clozapine (clozaril)
• Lurasadone (latuda)
• Olanzapine (Zyprexa)
• Paliperidone (invega)
• Quetiapine (seroquel)
• Reisperidone (risperdal)
• Ziprasidone (geodon)

Question 20

What are some side effects for Aripiprazole?

Answer 20

• Akathisia (restlessnes w/ anxiety), activiting or sedating, headache, anxiety, constipation
• Lower risk of weight gain, some QTc Prolongation, EPS (in kids)

Question 21

What are some Boxed warnings for clozapine?

Answer 21

• Neutropenia/Angranulocytosis (REMS)
• Myocarditis and Cardiomyopathy (DC is suspected)
• Seizures (start at no higher tan 12.5 mg once or twice daily)

Question 22

What are some side effects for clozapine?

Answer 22

• Agranulocytosis, Seizures, Constipation, Increased wieght gain, Hypersalivation

Question 23

What are some things to monitor for clozapine?

Answer 23

• REMS: pharmacies/prescribers MUST be certified with Clozapine REMS
• Start treatment: ANC baseline MUST be > 1500. Check weekly x 6 months; then biweekly x 6 months; then monthly (STOP if ANC < 1000)

Question 24

What are some side effects for Lurasidone?

Answer 24

• Somnolence, EPS (Dystonias), Nausea, Lower risk of metabolic syndrome

Question 25

What are some **boxed warnings** for **Olanzapine**?

Answer 25

- Injections: monitor for **3 hours** post inject (sedation [including coma] and delirium are at the highest then)

Question 26

What are some **side effects** for **Olanzapine**?

Answer 26

- Somnolence, Metabolic syndrome (increased weight, increased BG, increased lipids), Orthostasis

Question 27

What are some **side effects** for **Paliperidone**?

Answer 27

- Incresaed Prolactin (sexual dysfunction, galactorrhea, missed periods) - EPS (especially at HIGH doses) - Incresed weight, incrased BG, increased lipids ## Footnote same as Risperidone

Question 28

What are some **additional notes** for **Paliperidone**?

Answer 28

- IM injection Sustenna - monthly - IM injections **TRI**nza - x 3 months - IM injection **HAFYER**a - x 6 months

Question 29

What are some **side effects** for **Quetiapine**?

Answer 29

- Somolence, Increased wieght, increased blood glucose, increased lipids - Low EPS risk - often used for psychosis in parkisons disease

Question 30

What are some **additional notes** for **Quetiapine**?

Answer 30

- XR: take **at night, without food or with light meal**

Question 31

What are some **side effects** for **Risperidone**?

Answer 31

- Incresaed Prolactin (sexual dysfunction, galactorrhea, missed periods) - EPS (especially at HIGH doses) - Incresed weight, incrased BG, increased lipids ## Footnote Same as Paliperidone

Question 32

What are some **Side effects** for **Ziprasidone**?

Answer 32

- Somnolence, EPS, Dizziness, Nausea

Question 33

What are some **contraindications** for **Ziprasidone**? ## Footnote Should take with food

Answer 33

- QTc Prolongation: DO NOT used with QT risk

Question 34

If a patient has **cardiac risks/QTc Prolongation risk**, which medications should not be used?

Answer 34

- Ziprasidone, Haloperidol, Thioridazine, Chlorpromazine

Question 35

If a patient has **history of movement disorders**, which medications should not be used?

Answer 35

- 1st gens, risperidone, paliperidone (high doses) = HIGH RISK OF EPS - **Queitpine is preferred**

Question 36

If a patient is **overweight/metabolic risk**, which medications should not be used?

Answer 36

- Olanzapine or Quetiapine - **Aripiprazole, ziprasidone, lurasidione, asenapune are preferred**

Question 37

What **antipsychotic** helps with **psychosis in parkinson disease**?

Answer 37

- Normally **quetiapine** BUT **pimavanserin** is FDA approved (it affects serontonin receptors but NOT dopamine)

Question 38

What is the way that **tardive dyskineisa** occurs?

Answer 38

- when antipsychotics block the dopamine receptors

Question 39

What are some of the **symptoms** of **tardive dyskinesia**?

Answer 39

- uncontrollable movements of face, tongue, trunk, extremities

Question 40

What are the **medications** that can help with **Tardive** and what is there **MOA**?

Answer 40

- Valbenazine & Deutetrabenazine - Work by **reversibly inihibit VMAT2** (a transporter that regulates monoamine uptake)

Question 41

What are some **warnings** for **valbenazine**?

Answer 41

- Somnolence, QTc Prolongation

Question 42

What are some **contraindiations** for **Deutetrabenazine**?

Answer 42

- Hepatic impairment