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| some clinical presentations of schiz-4 |
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cant live depedntly
cant miantain emplyment
substance abuse
imparied functioning btwn episodes |
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late in life schiz ppl feel -
this mean acute are _ but residual symtpoms_ |
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| most social deterioration for schiz occurs duing how many years? |
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| for a schiz pt, when the acute psychotic episodes remits, what happens to the residual features? |
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| what is the most common ADEs of 1st generation antipsychotics-2 |
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| 1st generation anipsychotics treat what schiz symtpoms? |
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How mnay symtpoms must you ahve to diagnose as schiz?
for how long |
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| what are the 5 symtpoms of schiz, and which ones do you at least have to ahve one of to be diagnosed with schiz? |
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delusions
halluciniations
disorganized speech
disorganized ot catatonic
negative symtpoms
1,2,3 |
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| what 2 disorders must be exlcuded before cna diagnose as schiz |
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mood disorder
schizoaffective |
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| if a devolpement disorder is present in the pt what symtpom must be present and for how long to be diagnosed as schiz |
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hallucinations/delusions
1 months` |
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| The schiz disorder can't be diagnosed if thought the symtpms are due to? -2 |
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| what are the frst gneeration antipsychotics-3 |
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perphenazine
fluphenazine
haloperidol |
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| what receptors are affected by the first generation antipsychotics |
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| what are the 4 side effects of the 1st geneeration antipsychoitcs-4 |
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anti cholinergic
sedation/wt gain
Low BP
EP/increase prolactin |
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| whcih 1st generation antipsychotics have the highest EPS/prolacitn |
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| which 1st genreaiton has the lowest BP effect |
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| which 1st generration antipsychoitc has the most wt gain/sedation |
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| which 1st generation antipsychotic causes the lest anti-cholinergic |
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what are the half life of:
haloperidol
fluphenaizine
perrphenazine |
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what is the P450 metab for:
haloperidol
fluphenazine
perphenazine |
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| what are the 4 phases of EPS |
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parkinsonism
dystonia
akathesia
tardive dyskenisa |
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symtpoms for parkinsonism-2
how long afterr antipsychotic treatment does this occur? |
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Definition
bradykinesia
tremor
1-2 weeks |
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| what emdicaiotn works well for parkinsonism |
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Definition
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what is the symtpoms fo dystonia
how long afte treatment do they occur? |
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Definition
tonic contractions
1-4 days |
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| what med is good for dystonia |
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symtpoms of akathisia-2
how do you treat-2 |
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inner restless, pacing
change med/dose or use propanolol |
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when does tardive dyskneisa appea after antipsychotic treatment?
it usually affects what muscles |
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| what are some risk factors for tardive dyskensia-4 |
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| older age, acute EPS, diabetes, female |
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how do you treat tardive dyskneis?
when do you see resolvement of symptoms if everr? |
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decrease dose and the disct
months to years |
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how can you assess tardive dyskenisa
how often do you do this test? |
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AIMS
base line then quarterly |
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| 2nd gen antipsychotics are good for what symtpoms |
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Definition
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| can secodn gen antipsychotcs cause tardive dyskenesia |
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Definition
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| look on pg 6 for all the 2nd gen antipsychotics |
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| clozapine is the 2nd gen that causes the most-4 |
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| BP, metabolic, sedation, anticholinergic |
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| what med causes the least of all 5 2nd gen side affects-2 |
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Definition
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| what med comes closest to clonzapine for potent in a lot of side effects |
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Definition
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| what 2nd gen antipsychotics do the most EPS/prolactin affects |
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| what 2nd gen is only as a capsule |
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| which 2nd generrations cna be avaialbe as injection too-3 |
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Definition
olanzipine
ziprasidone
aripirprazole |
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| what 2nd gen have oral disentegraitng available |
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Definition
clozapine
olanzipine
risperridone |
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| which 2nd gen has no P450 interactions |
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Definition
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| which 3 2nd gen have a smoking interaction |
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Definition
clozapine
olanzipine
asenapine |
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| go look quickly at the P450s for the 2nd gen antipsychotics before test |
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| if the patient has severe suicide intentions or history of violence/abuse what med shoudl be given? |
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| due to risk of _ clozapine is given a t low dose and titrated |
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| what is the stating dose of clozapine, then evry 3 days cna increase by- |
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| need to obtain clozapine concentrations if using dose > |
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| how is the tapering of WBC monitoring done for clozapine |
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every wk x 6 months
normal: every 2 wks for 6 motnhs
normal- everyr 4 weeks |
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when do you hold clozapine (WBC and ANC)
when do you dsict |
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WBC btwn 2000-3000; ANC btwn 1000-1500
WBC<2000 or ANC <1000 |
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which 2nd generation drugs have more effect on 5 HT 2C and H1?-2
what does this mean? |
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Definition
olanzapine
clozapine
-higher metabolic effects |
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which 2nd gen gen antipsychotics have more effect on D2 and 5HT 1A?-3
what does this mean? |
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ziprasidone
aipirazole
lurasidone
-less metabolic effects |
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| what 2nd gen are not either more or less for cetain receptors |
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Definition
quetapine
risperiodne
ilopeiodone
asenapine |
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Monitoring for :
Weight (3) |
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baseline
Q month x 3 mo
q 3 months |
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Monitoring for :
waist circumference (2) |
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| baseline-> 12 weeks-> annually |
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Monitoring for :
fasting glucose |
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| base line->12 mo-> annual |
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Monitoring for :
fasting lipids
(3) |
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| baseline-> 12 wks-> annually -5 yrs |
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| what med has a lot of agranulocytosis |
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| what meds have a lot fo seizures-2 |
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| what meds have a lof of neuronal maliganncy? |
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| highpotency> low pot>2nd gen |
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| what meds cause QT elongations |
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| meds that increase what cause most sexual dysfunction |
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| risk factros for neuoleptic malgnancy-3 |
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1st gen antipsych
dehydraiton
catatonia |
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| when does neuronal malignancy appear after antipsychoptic treaemtn |
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depot formulations (long acting) are given how often for:
haloperidal |
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depot formulations (long acting) are given how often for:
fluphenazine |
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depot formulations (long acting) are given how often for:
risperidone |
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depot formulations (long acting) are given how often for:
paliperidone |
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depot formulations (long acting) are given how often for:
olanzapine |
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| either stabilize pt on oral meds or use for _ days to see if they toelrate it |
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| oral drug/depot overalp for risperidone reccomended for |
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| what drugs do you adminster depot form into gluteus?-4 |
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Definition
risperidone
aripiprazole
paliperidol
olanzipine |
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| what drugs do you admin depot form into Z tract IM method-2 |
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Definition
fluphenazine (prloxin D)
Haloperidol (Haldol D) |
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| IM dose of fluphenazine is _ x the oral? |
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Definition
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| titration for depot dose of fluphenazine |
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| weekly dose for 4 weeks then every 2 weeks |
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| overalp haloperridol depot for how long with oral? |
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Definition
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| how much increase is the IM dose of haloperidol |
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Definition
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| which depot does not need overalp with oral med |
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Definition
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which depot drug has a restrcited distribution?
why? |
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Definition
olanzipine
coma and deliium is common |
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| look at the assessments prio to teatment on pg 12 |
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Definition
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| write treatment sheet like the one at bottom of pg 12 |
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Definition
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| in frist 7 days of trearment should see reduced-3 |
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| aggression, anxiety, agitation |
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| when should sleep and appetite imrpove after treatment? |
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Definition
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| if you suspect pt to be cheeking (not actally taking tablet) what do you do |
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ativan should not be combined wiht what IM?
why?-2 |
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Definition
zyprexa
respiratory depresison/CNS deresison |
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| to become stable, treatment needed for at least |
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Definition
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| in first 2-3 weeks of stable treatment, what is improved |
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Definition
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| if no imrpovement is seen within _ weeks fo the therrapeutic dose, then need to change alogrothim |
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| when is lifetime antipsychotic treatment used? |
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