Schizophrenia

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Author:
jcu1
ID:
259102
Filename:
Schizophrenia
Updated:
2014-01-29 16:04:09
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Description:
Neuro
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  1. characteristic symptoms of schizo
    • delusions
    • hallucinations
    • disorganized speech
    • grossly disorganized or catatonic behavior
    • negative symtpoms
  2. general timeline of response to antipsychotics
    • 1. agitation and aggression respond first
    • 2. hallucinations, disorganized speech, and behavior in days to weeks (positive sx's)
    • 3. negative sx's and delusions take longer and may never respond
  3. Nigrostriatal pathway
    • substantia nigra to basal ganglia/caudate-putamen)
    • controls voluntary movement
    • blockade = EPS
  4. Mesolimbic pathway
    • ventral tegmentum to limbic structures (amygdala, nucleus accumbens, hippocampus)
    • arousal, memory, motivation
    • hyperDA = positive sxs
    • blockade of DA = relieves psychosis
  5. Mesocortical pathway
    • ventral tegmentum to cerebral cortex
    • cognition, communication, social functioning, stress
    • hypoDA = negative sx's
  6. tuberoinfundibular pathway
    • hypothalamus to pituitary
    • blockade = hyperprolactinemia
  7. amt of DA blockade needed to get antipsychotic effect and where
    > 60% blockade in mesolimbic pathway
  8. amt of DA blockade that increases risk of EPS and where
    > 80% blockade in the nigrostriatal pathway
  9. list of FGAs to know
    • Haloperidol
    • fluphenazine
    • Perphenazine
    • Chlorpromazine
  10. list of SGAs to know
    • clozapine
    • risperidone
    • olanzapine
    • quetiapine
    • ziprasidone
    • aripiprazole
    • paliperidone
    • asenapine
    • iloperidone
    • lurasidone
  11. side effects most associated with first gens vs. second gens
    • FGA: EPPS
    • SGA: Metabolic
  12. clinical effect of D2 antagonism
    • antipsychotic effect (relief of + sx's)
    • induction of EPS
    • increased prolactin levels
  13. clinical effect of 5HT-2A antagonism
    • improvement of negative sx's
    • improvement of cognitive impairment
    • attenuation of EPS
  14. clinical effect of alpha-1 antagonism
    sedation, hypotension, tachycardia
  15. clinical effect of H1 antagonism
    sedation, weight gain
  16. clinical effect of M1 antagonsim
    • Anticholinergic effects
    • attenuation of EPS
  17. Haloperidol potency, usual dose, CYP pathway
    • high potency
    • 2-20 mg
    • 1A2, 2D6, 3A4
  18. Fluphenazine potency, usual dose, CYP
    • high potency
    • 2-20 mg
    • 2D6
  19. perphenazine potency, usual dose, CYP
    • Mid potency
    • 10-64 mg
    • 2D6
  20. chlorpromazine potency, usual dose, CYP
    • low potency
    • 100 - 800 mg
    • 3A4
  21. clozapine and EPS (why)
    • very little amt
    • bc of low potency at D2
  22. Which antipsychotics may improve TD sx's
    • clozapine
    • quetiapine
  23. receptors blocked by clozapine and the clinical effect
    • alpha-1
    • alpha-2
    • H1
    • M1
    • hypotention, sedation, metabolic effects, bowel obstruction, enuresis, sialorrhea
  24. clozapine black box warnings
    • agranulocytosis
    • seizures
    • myocarditis
    • CV/resp rxns
    • death (in elderly pts with dementia)
  25. clozapine dosing
    • begin 12.5 - 25 mg qd
    • increase by 25 mg qd or 50 mg qod
    • target dose around 300 - 600 mg
    • max dose 900 mg
  26. missed clozapine doses
    if > 2 days missed, have to restart titration
  27. clozapine and smoking
    smoking decreases levels
  28. clozapine monitoring
    • WBC and ANC
    • every wk for 6 mo
    • every 2 wks for months 6-12
    • every 4 wks from 1 yr to infinity

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