dopamine (D2, specifically - does not explain everything - serotonin may be involved as well)
What neurotransmitter are we worried about in schizophrenia?
typical (older - explains more side effects)
_____ antipsychotics work on dopamine, histamine, alpha-adrenergic and muscarinic receptors
Atypical (newer - less side effects)
____ antipsychotics work on 5HT2, with lower affinity for dopamine receptors
typical (more sedating)
____ antipsychotics treat positive symptoms
atypical (work on serotonin)
____ antipsychotics treat negative symptoms
FALSE (they can be either or both)
TRUE/FALSE - patients need to exhibit positive and negative symptoms in order to be considered schizophrenic
TRUE (most patients will die early, usually from getting into some kind of trouble/danger)
TRUE/FALSE - schizophrenia has a poor outcome prognosis
marijuana, LSD, cocaine, meth, PCP, anticholinergics (high dose)
What drugs typically can induce schizophrenia?
life long (it's not a curable disease - need to tell patients this up front)
Therapy for schizophrenia will typically last how long?
FALSE (helps patients deal with stressors - we need to get them used to stressors of life)
TRUE/FALSE - counseling is typically not helpful for schizophrenic patients
TRUE (but side effects are easier to tolerate)
TRUE/FALSE - atypical agents are less effective at treating delusions
antipsychotics, benzos (rapid sedation is sometimes used to stop patient from acting out - chemical restraint - nothing to treat psychosis)
Scheduled ___ and prn ____ are considered first line therapy for schizophrenia
TRUE (atypical treat negative symptoms better, typical treat positive symptoms better)
TRUE/FALSE - all antipsychotic medications are equally efficacious
6 months (on the right dose - they calm the patient down quickly, but deal with symptoms, like hallucinations, slowly)
What is considered adequate trial length for a antipsychotic agent?
FALSE (1-2 years for a single episode - lifelong if they displayed harm to themselves or others or multiple episodes)
TRUE/FALSE - all schizophrenia patients should receive lifelong therapy
a few hours for sedation, months for symptom improvement (hallucinations, delusions, apathy, poor insight and judgement)
What is the onset of action for antipsychotics?
All schizophrenia patients should receive therapy for how long after a single episode?
5 years (at least - possibly life long)
All schizophrenia patients should receive therapy for how long after multiple episodes or harm to others?
higher, decrease (over time -20% every 3-6 months)
Typically, initially doses of antipsychotics are ____ than maintenance doses. Maintenance doses will gradually _____
haloperidol, risperidone, fluphenazine (injectable, increase compliance, must use oral first to check for safety and efficacy)
What antipsychotics are available in Depot formulations?
FALSE (no approved serum concentration that we can use)
TRUE/FALSE - serum concentrations are useful in antipsychotic therapy
Pseudoparkinsonism, Dystonia, Akathesia, Neuroleptic Malignant Syndrome, Tardive Dyskinesia Hematologic (low WBCs/agranulocytosis), Ocular, Psychogenic polydipsia (Water craving), Sexual dysfunction, seizures, Weight gain
Name the side effects of antipsychotic drugs (there are a lot)
reduce antipsychotic dose (primary), use anticholinergic (secondary)
What is the primary treatment for pseudo-parkinsonism (as a side effect of antipsychotic treatment)?
anticholinergic (primary)(don't remove the antipsychotic because this side effect is short-lived)
What is the primary treatment for Dystonia (as a side effect of antipsychotic treatment)?
Discontinue antipsychotic (primary), anticholinergics possible (secondary)
What is the primary treatment for Akathesia (driven to move) as a side effect of antipsychotic treatment?
Discontinue antipsychotic (primary), anticholinergics (secondary - for rigidity)
What is the primary treatment for Neuroleptic Malignant Syndrome
reduce antipsychotic dose (use minimal dose - DON'T COMPLETELY REMOVE antipsychotic - can worsen symptoms), add anticholinergic (secondary)
What is the primary treatment for Tardive Dyskinesia as a side effect of antipsychotic treatment?
clozapine (corrects WBC changes associated with antipsychotic therapy)
What is the primary treatment for Agranulocytosis as a side effect of antipsychotic therapy?
pseudoparkinsonism, tardive dyskinesia,
Which side effects of antipsychotics are slow to onset?
Dystonia, Akathesia, NMS
Which side effects of antipsychotics are fast to onset?
FALSE (increased prolactin - leads to amenorrhea, sexual dysfunction, weight gain)
TRUE/FALSE - antipsychotic therapy is associated with decreased prolactin levels
Photosensitivity is most common with which antipsychotic?
Cataracts are most common with which antipsychotic?
Which antipsychotic is least likely to cause seizures
weeks 6-10 (there are no specific teratogenic effects - need to keep mom and baby safe)
What specific period during pregnancy should antipsychotics be avoided?
clozapine (CLOZARIL - atypical)
Which antipsychotic has 5 black box warnings for agranulocytosis, seizures, myocarditis, CV SEs, respiratory SEs, and dementia?
clozapine (CLOZARIL - atypical)
Which antipsychotic has the highest risk of seizures?
WBCs, EKG, EEG (lots of tests because it has 5 black box warnings - don't use it)
CLOZARIL requires what labs/monitoring?
Most likely atypical to cause hyperprolactinemia
(RISPERDAL) rash, increased orthostatic hypotension, sedation, priapism (rare), rhinitis, dyspepsia, anxiety, loathing/nausea
What are the common ADRs of risperidone?
antihypertensives (orthostatic hypotension threat)
Patients starting risperidone should take caution if they are currently taking what class of drugs
olanzapine (Zyprexa), quetiapine (SEROQUEL), ziprasidone (GEODON)
This atypical has excessive sedation causing bedtime dosing
(ZYPREXA) dizziness, hypotension, weight gain, increasing triglycerides, blood glucose levels
What are the common ADRs of olanzapine?
dizziness, sedation, postural hypotension, dry mouth, dyspepsia
What are the common ADRs of Seroquel?
sedation EPSE, respiratory disorder (absorption increased with food)
What are the common adverse effects of GEODON (ziprasidone)
very mild compared to other atyipicals (headache, asthenia, nausea, vomiting, constipation, anxiety, insomnia, lightheadedness, mild sedation, akathesia and rash)
Most common ADRs with abilify (aripiprizole)
ABILIFY and GEODON (except GEODON/ziprasidone still has QTc prolongation)
Which atypical antipsychotics have the least side effects?
ziprasidone, aripiprazole, quetiapine, olanzapine, risperidone, clozapine (clozapine is worst, olanzapine is 2nd worst, aripiprazole is best)
What are the Atypical antipsychotics?
FALSE (there is no use for 2 antipsychotics to treat schizophrenia - need to justify more than 1 - usually treating an offlabel disease like sleep)
TRUE/FALSE - antipsychotics have few indications to be used together in schizophrenia treatment
antihistamine (sedation and weight gain), anticholinergic (dries up), hypotension, dizziness, arrhythmias, endocrine, EPSE, NMS (potentially fatal), seizures
Main ADRs of older antipsychotics
FALSE (older drugs have higher - ABILIFY might actually lower prolactin levels)
TRUE/FALSE - Newer (atypical antipsychotics) have a higher incidence of hyperprolactinemia
Neuroleptic Malignant Syndrome, Akathesia
Which ADRs require removal of antipsychotic therapy?
Tardive Dyskinesia, Pseudoparkinsonism (don't completely remove - can make symptoms worse in TD)
Which ADRs require decreasing the dose of antipsychotic therapy?
Dystonia (anticholinergic), Agranulocytosis (clozapine)
Which ADRs do not require a change to the antipsychotic therapy (might add other agents to treat symptoms