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RxPrep

Schizophrenia/Psychosis

QuestionAnswer
First-line drug class for schizophrenia? Second-generation antipsychotics (SGAs)
Why are SGAs preferred over 1st gen? Lower EPS risk
Which symptoms respond best to antipsychotics? Positive symptoms (hallucinations, delusions)
Which symptoms are harder to treat? Negative symptoms (like anhedonia, social withdrawel, lack of speech)
When use clozapine? Treatment-resistant schizophrenia (failure of ≥2 antipsychotics)
What causes neuroleptic malignant syndrome? D2 blockade (more D2 blocking in FGAs)
Classic NMS signs? Hyperthermia, rigidity, mental status changes, autonomic instability
Labs in NMS? ↑ CPK, ↑ WBC
Treatment of NMS? Stop antipsychotic + supportive care ± dantrolene or bromocriptine
Akathisia (physical restlessness and movements) onset timing? days to weeks after starting treatment
Dystonia (involuntary spasms/twitching) timing? 1-4 days after starting tx
Tardive dyskinesia timing? Months–years after tx initiation
Treatment for dystonia? Diphenhydramine or benztropine (anticholinergics)
Treatment for akathisia? Propranolol or benzodiazepine
Highest QT risk drugs? Ziprasidone, haloperidol, thioridazine, chlorpromazine (aka Ziprasidone + 1st gen drugs)
All antipsychotics effect on QT? All can prolong QT, but to varying degrees
Which FGA has boxed warning for QT? Thioridazine
Which drugs have the lowest risk of QT prolongation? Aripiprozole, quetiapine, lurasidone (latuda)
Which SGAs cause metabolic syndrome? Clozapine, olanzapine, risperidone, quetiapine (most 2nd gens can cause it)
Which drug has highest metabolic risk? Clozapine and olanzapine
Lower metabolic risk drugs? Aripiprazole, ziprasidone, lurasidone
Which drugs increase prolactin most? Risperidone mainly, paliperidone can too though
Paliperidone brand name? Invega
Prolactin elevation can have what effects? Galactorrhea, sexual dysfunction, amenorrhea
Highest EPS risk? FGAs all have a high risk (due to greater D2 blocking)
SGAs with higher EPS risk? Risperidone, paliperidone (high dose)
Low EPS options? Quetiapine, clozapine
Preferred drug in Parkinson psychosis? Quetiapine
Drowsiness is a common side effect of which drug(s)? Literally all of the antipsychotics
Clozapine box warning? Agranulocytosis/neutropenia
Required ANC to start and stop clozapine? To start: ≥1500/mm³ Stop if: ANC <1000
Major ADRs with clozapine Seizures, myocarditis, hypotension and neutropenia
Which antipsychotic(s) can cause drooling (sialorrhea)? Clozapine (unique ADR)
Smoking significantly lowers levels of which drugs? Clozapine and Olanzapine
Olanzapine major ADR? Metabolic syndrome
Risperidone major ADR? Increased prolactin
Major ADRs with quetiapine? Well tolerated, sedation and metabolic syndrome
Major risk of ziprasidone? QT prolongation
Which antipsychotic needs to be taken with food? Lurasidone (>350 calories) and Ziprasidone
Lurasidone major ADR? Dystonia
Which SGA is given sublingually? Asenapine (no food/drinks 10 after using)
Box warning for all antipscyhotics? ↑ mortality in elderly with dementia psychosis Strokes and falls
Which drug is a substrate of 2D6, causing multiple DDIs? Risperdone, increases when used with fluoxetine and paroxetine)
Which antipsychotic(s) require renal dosing? Paliperidone (CrCl > 10 required)
Which drug can cause tongue numbness? Asenapine (due to SL dosing)
What drugs should we avoid in patients with a concern for movement disorders? FGAs, risperidone, paliperidone
Drug treatment for tardive dyskinesia (TD)? Valbenazine, deutetrabenazine
Created by: cdaughtry
 

 



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