RxPrep Schizophrenia & Psychosis

schizophrenia

chronic, severe, and disabling thought disorder that occurs in ~1% of all societies regardless of class, color, religion, or culture; common symptoms include hallucinations, delusions, and disorganized thinking/behavior

c) hallucinations

Sensing something that's not present, such as imaginary voices

a) delusions

b) disorganized thinking/behavior

c) hallucinations

a) delusions

A belief about something real that's not true, such as imagining that your family (which is real) wishes to hurt you

a) delusions

b) disorganized thinking/behavior

c) hallucinations

b) disorganized thinking/behavior

Inability to focus attention and communicate organized thoughts

a) delusions

b) disorganized thinking/behavior

c) hallucinations

treatment adherence

________ for schizophrenia is important and often difficult to obtain, primarily due to lack of insight.

DSM-5

What sets the diagnostic criteria for schizophrenia?

dopamine, glutamine, serotonin

What 3 neurotransmitters are primarily involved in schizophrenia?

extrapyramidal side effects

________ are a group of side effects related to irregular movements.

c. dystonias

Prolonged contraction of muscles during drug initiation, including painful muscle spasms; life-threatening if airway is compromised

a) akathisia

b) dyskinesias

c) dystonias

d) Parkinsonism

e) tardive dyskinesias

younger; males

(Older/Younger) (females/males) are at a higher risk for developing dystonias.

centrally-acting anticholinergic

What drug class can be used for prophylaxis or treatment of dystonias?

benztropine, diphenhydramine

What 2 centrally-acting anticholinergics can be used for prophylaxis or treatment of dystonias?

a) akathisia

Restlessness with anxiety and an inability to remain still

a) akathisia

b) dyskinesias

c) dystonias

d) Parkinsonism

e) tardive dyskinesias

benzodiazepines, propranolol

What 2 drugs/classes are used to treat akathisia?

d) Parkinsonism

Tremors, abnormal gait, and bradykinesia

a) akathisia

b) dyskinesias

c) dystonias

d) Parkinsonism

e) tardive dyskinesias

anticholinergics, propranolol

What 2 drugs/classes are used to treat Parkinsonism when tremor is the main symptom?

e) tardive dyskinesias

Uncontrollable movements in the tongue, face, trunk, and extremities; can interfere with walking, talking, and breathing; can be irreversible

a) akathisia

b) dyskinesias

c) dystonias

d) Parkinsonism

e) tardive dyskinesias

older; females

(Older/Younger) (females/males) are at a higher risk for developing tardive dyskinesias.

stop drug and replace w/ SGA w/ low EPS risk

What is the course of action if a patient develops tardive dyskinesia?

second generation antipsychotic

What does SGA stand for?

extrapyramidal symptoms

What does EPS stand for?

clozapine, quetiapine

What are 2 SGAs with low EPS risk?

b) dyskinesias

Abnormal movements that are more common with dopamine replacement for Parkinson disease

a) akathisia

b) dyskinesias

c) dystonias

d) Parkinsonism

e) tardive dyskinesias

dextromethorphan, dopamine/dopamine agonists, high dose centrally-acting anticholinergics, interferons, stimulants, systemic steroids

What are 6 prescription drugs/classes that can cause psychotic symptoms?

bath salts, cannabis, cocaine, LSD, methamphetamine, PCP

What are 6 illicit/recreational substances that can cause psychotic symptoms?

delusions, disorganized speech, hallucinations

One of what 3 positive sign/symptoms must be present to be diagnosed with schizophrenia?

b) apathy

Lack of emotion

a) alogia

b) apathy

c) avolition

alogia, apathy, avolition, social withdrawal

What are 4 common negative signs/symptoms that are diagnostic criteria for schizophrenia?

c) avolition

Loss of motivation

a) alogia

b) apathy

c) avolition

a) alogia

Lack of speech

a) alogia

b) apathy

c) avolition

dopamine; serotonin

Antipsychotics primarily block ________ receptors. Newer antipsychotics also block ________ and other receptors.

psychosis

Decreasing dopamine activity helps control ________, but negatively affects dopamine pathways involved in focus, attention, and movement.

positive

(Negative/Positive) symptoms are easier to treat.

SGA

What drug class is used first-line for the treatment of schizophrenia?

second

(First/Second) generation antipsychotics have a lower incidence of EPS.

EPS

Dystonias, dyskinesias, tardive dyskinesias, and akathisia are examples of ________.

poor

Adherence to antipsychotics is typically (good/poor).

b

Antipsychotic drug formulation that eliminated the need for daily oral tablets or capsules

a) acute IM injection

b) long-acting injection

c) oral solution/suspension

d) orally disintegrating tablet

d

Antipsychotic drug formulation that is useful with dysphagia and prevents cheeking

a) acute IM injection

b) long-acting injection

c) oral solution/suspension

d) orally disintegrating tablet

cheeking

tablet hidden inside the cheek and spit out later

dysphagia

difficulty swallowing

c

Antipsychotic drug formulation that is useful for children and people with a feeding tube

a) acute IM injection

b) long-acting injection

c) oral solution/suspension

d) orally disintegrating tablet

a

Antipsychotic drug formulation that provides "stat" relief to calm down an agitated, psychotic patient for their own safety and the safety of others

a) acute IM injection

b) long-acting injection

c) oral solution/suspension

d) orally disintegrating tablet

anticholinergics, benzodiazepines

Acute IM antipsychotics are often mixed in "cocktails" with what 2 other drug classes?

benzodiazepines, olanzapine

What 2 drugs/classes should not be given together in an acute IM antipsychotic "cocktail" due to risk of excessive sedation and breathing difficulty?

acute IM injection, long-acting injection, oral solution/suspension, orally disintegrating tablet

What are 4 antipsychotic drug formulations developed to help with adherence in schizophrenia?

true

True or False: Antipsychotics are not indicated for agitation control in elderly patients with dementia-related psychosis.

mortality, stroke

Antipsychotics carry a warning for an increased risk of what 2 things in patients with dementia?

first-generation antipsychotic

drug class that mainly works by blocking dopamine-2 receptors with minimal serotonin receptor blockade

phenothiazine

Many of the FGAs are in the ________ class.

first-generation antipsychotics

What does FGA stand for?

haloperidol

What is the main FGA used in schizophrenia?

Haldol

What is the brand name for haloperidol?

c

Haloperidol is a ________ potency FGA.

a) low

b) mid

c) high

butyrophenone

What drug class is the FGA haloperidol in?

IM; monthly

What is the route of administration and frequency used for haloperidol decanoate?

IM; Q2W

What is the route of administration and frequency used for fluphenazine decanoate?

increased mortality in elderly patients with dementia-related psychosis

What is the main boxed warning associated with all antipsychotics?

QT prolongation

What is the boxed warning associated with thioridazine?

anticholinergic effects, CNS depression, EPS, hyperprolactinemia, NMS, orthostasis/falls, QT prolongation

What are 7 warnings associated with FGAs?

chlorpromazine, haloperidol, thioridazine

What 3 FGAs are most likely to cause QT prolongation?

increases

The incidence of EPS with FGAs (decreases/increases) when administered as an injection.

hyperprolactinemia

increased prolactin levels that can lead to infertility, oligomenorrhea/amenorrhea, galactorrhea, or erectile dysfunction/decreased libido

neuroleptic malignant syndrome

What does NMS stand for?

NMS

highly lethal warning mostly associated with FGAs; indicated by mental status changes, hyperthermia, muscle rigidity, and/or autonomic instability

anticholinergic effects,

dizziness,

EPS,

sedation

What are 4 side effects associated with FGAs?

increased; decreased

Lower potency FGAs have (decreased/increased) sedation and (decreased/increased) EPS.

decreased; increased

Higher potency FGAs have (decreased/increased) sedation and (decreased/increased) EPS.

SGA

drug class that blocks dopamine-2 and serotonin-2A receptors

aripiprazole, cariprazine

What 2 SGAs are dopamine-2 and serotonin-1A partial agonists?

brexpiprazole

What SGA is a dopamine-2/serotonin-1A partial agonist and serotonin-2A antagonist?

FGAs

Chlorpromazine, thioridazine, loxapine, perphenazine, haloperidol, fluphenazine, thiothixene, and trifluoperazine are examples of ________.

SGAs

Aripiprazole, clozapine, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone, asenapine, brexpiprazole, cariprazine, iloperidone, and lumateperone are examples of ________.

Abilify

What is the brand name for aripiprazole?

Abilify Maintena

What aripiprazole brand is a monthly IM suspension?

Aristada

What aripiprazole brand is an IM suspension given every 4-8 weeks?

activation, akathisia

What are 2 side effects of aripiprazole?

Clozaril

What is the brand name for clozapine?

third

Clozapine is very effective and has decreased risk of EPS/tardive dyskinesia but is used no sooner than ________-line due to severe side effect potential.

a

What is the boxed warning associated with clozapine that's the reason it's in a REMS program?

a) agranulocytosis/neutropenia

b) cardiomyopathy/myocarditis

c) seizures

agranulocytosis/neutropenia, cardiomyopathy/myocarditis, seizures

What are 3 boxed warnings associated with clozapine?

12.5

Due to risk of seizure, clozapine dosing should be started at no higher than ________ mg once or twice daily, then titrated slowly using divided doses.

agranulocytosis,

seizures

constipation,

hypersalivation,

increased weight,

What are 5 side effects associated with clozapine?

≥1500

To start clozapine treatment, a patient's baseline ANC must be ________/mm3.

<1000

Clozapine therapy should be stopped if a patient's ANC is ________/mm3.

Latuda

What is the brand name for lurasidone?

EPS,

nausea,

metabolic syndrome,

somnolence

What are 4 side effects of lurasidone?

Zyprexa

What is the brand name for olanzapine?

Zyprexa Relprevv

What olanzapine brand is an injection suspension that lasts 2-4 weeks and has a REMS program associated with it?

3 hours

Zyprexa Relprevv must be administered in a registered healthcare facility where patients should be monitored for ________ post-injection.

delirium and sedation following injection

What is the boxed warning associated with Zyprexa Relprevv?

blood glucose, lipids, triglycerides, weight

Increases in what 4 things is seen with metabolic syndrome?

metabolic syndrome, somnolence

What are 2 side effects associated with olanzapine?

Invega

What is the brand name for paliperidone?

risperidone

Paliperidone is the active metabolite of ________.

Invega Sustenna

What paliperidone brand is a monthly IM injection?

Invega Trinza

What paliperidone brand is an IM injection given every 3 months?

Invega Hafyera

What paliperidone brand is an IM injection given every 6 months?

EPS,

increased prolactin,

metabolic syndrome

What are 3 side effects associated with paliperidone?

Seroquel

What is the brand name for quetiapine?