pharmacotherapy exam 3 schizo

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pharmacotherapy exam 3 schizo
2010-11-21 15:32:40
schizophrenia pharmacotherapy exam

pharmacotherapy exam three schizophrenia
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  1. current DSM IV criteria for schizo
    • 2 + symptoms more than one month-delusions (fixed false beliefs) hallucinations(see hear things) disorganized speech, grosslydisorganized or catatonic behavior
    • social occulational dysfunction
    • duration (<6 months)
    • exclusion of sxhizoaffectie mood disorder, substance abuse disorders, general medical condition
  2. age of onset
    males 10-24 for males, females 20-30
  3. there is a genetic relation... but there are more than 600 genes that code related to schizo
  4. the dopamine hypothesis
    • da overactivity caused schizo , anti da agents treat psychosis
    • d amphetamine induced psychosis occurs via releaes of da and inhibiting its reuptake
    • current opinion holds that da activity varies with different brain sites, decreased da in prefrontal cortex and increased da in emsolimibic area
  5. serotonin hypothesis
    • lsd, mescaline, psilocybin and nallucinogens
    • alterations in 5ht receptors in schizo
    • alterations in 5ht metabolism, negative correlation between csf 5ht and ventricular enlargeent
    • alteratinos in serotonergic neurendocrine challenge studies decreased in 5ht mediated responses in unmedicated patients
    • clozapine and risperdal-atypical antispychoitcs ocupy 5ht2a receptros in vivo
    • nuermous atyica agents show high affinity for various 5ht receptors--clozzapine and 5ht2a
  6. glutamate hypothesis
    • induction of psychosis via hypofunciton or block of hte nmda receptor
    • pcp causes psychosis
    • nmda antagonism by ketamine cuses injury and dysfunction of glutamaterigc neruons in posterior cingulate and retrosplenial coretx
    • no fda approved agents in market
  7. where do hallucinations reside, negative symptoms and disorganization
    • hallucinations--increased flow in left temporal lobe and decreased flow in posterior cingulate
    • negative symptoms--correlate with bilateral frontal andleft parietal hypoperfusion and increased flow with caudate
    • disorganized --correltes with increased flow in right anterior cingulate and decresd flow in right anterior prefrontal
  8. what are signs and symptoms of schizo--no one is diagnositic
    • appearnace--unusual clothing, poor self care, suscpicious ness, detachemnt, bizarre psoture, grimacing, athetosis, mutism, catonia, waxy flexibility
    • affect--internal stae of mood--not congruent with state of mind of mood, blunted, flat, pseudoparkinsonian, akathisia
    • mood--abnormal expression of mood, variable mood
    • speech--aprosdoia, lack of emotional tone, incomprehensible
    • thought form/content-- loose ilogical, bizarre, circumstatnial tangential, clang associates, neologisms, perservration, proverty of content, echolatia, thought blocking
    • perception-halucinations, auditory, visual olfactory, tactile cenesthesic, delusions--persectuion, grandiosity, outside control, ideas of reference, thought withdrawalor insertion, thought broadcast, somatic
    • behavior-- stereotypic, echopraxic, negativistic, catatonic, cataleptic
    • cognition-- clear sensorium, deficits in attention, memory, language, executive and motor functions, impariemnts in fortnal lobe functions, concept formation, planning, sequencing, cognitivie shifting, and maintenance of respones to environmental issues
  9. what is tardive dyskinesia--
    • involuntary choreiform, athetoid or rhythmic movmeents of the tongue, jaw or extremities
    • risk factors are long term treatment with typical neuroleptics incerased age, female, mood disorder, cognitivie disorder, rapid decreasewithdrawal or neurolepctis
    • etiology unkonwn possible dopaminergic
    • treatment slow taper of neuroleptic chae to clozapine vit e buspar
  10. what are factors affecting treatment responses
    • gender, early responders, brain insult, medical history
    • diet
    • exercise--stimulates relaease of neurotransmitters
    • sleep
    • alcohol
    • caffeine--anxiety, insomnia, dizziness, headache, nausea, inreased heart rate, withdrawal reactions--SMOKING INCRASES LIVER ENZYMES AND LOWERS BLOOD LEVELS
    • cocaine, amphetamines
    • cannibus, hallucinogents PCP
  11. what are top ten side effects with antipsychotics
    • movement disorders--EPS, dystonia, pseudoparkinsons akathisia, tardive dyskinesia
    • metabolic disturbances--risks for metabolic syndrom--weight gain hyperlipidemia,d iabetes
    • sedation, anticholinergic SE--hypotension/tachycardia
    • headaches NVD
    • hyperprolactinemia
    • cardia arrhythmias
    • neuroleptic malignant syndrom
    • seizures
    • hypersensitivity to sunlight
    • stroke risks in geriatric patietns
  12. EPS dystonias--
    • distickt like parkinsons--occurs early in tx
    • most commin within the first week, men>women
    • high potency agents>low potency agents
    • painful muscle spasms 9eyes neck back)
    • treatment with antiparkinsons agents--cogentin
  13. EPS pseudoparkinsonism
    • onset 5-90 days after initiation
    • women>men
    • high potency agents>low potency agents
    • tolerance develops after 2-3 months
    • slowed movements rigidity, tremor
    • treatment with antiparkinson agents
  14. EPS--akathisia
    • onset 6-60 days
    • younger>elderly
    • high potency>low potency
    • restlessness cant sit still, pacing, rocking, standing up and sitting down
    • TX--beta blocker--propranlolol 10mgtid
    • benzo
    • anticholinergic agents
  15. EPS tardive dyskinesia
    • typical antipsychotics >1 year
    • women>men, elderly
    • potentially irreversible and untreatable
    • inovlentary movements of any muscle groups, eyes, tongue, arms, hands feet
    • TX-- clozapine, olanzapine, quetiapine, vit e 1200iu q day prophylaxis,
  16. SE of antipsychotic agents
    • antiholinergic side effects-- tolerance afer 1-2 motnhs, dry mouth, blurred vision, constipatio, urinary retention, nasal congestion, tachycaria, ejactulation inhibition
    • METABOLIC SIDE EFFECTS-- ab obestiy, triglycerides, bdl, bp fasting glucose
    • NERUOLEPTIC MALIGNANT SYNDRO--fatal if not reconized and treated early00dc antispychotics, hydrate benzos dantrolene
  17. what are low potency agents typical antipsychotics
    • mellaril, thorazine, serentil thioridazine, chlorpromazine mesoridazein
    • LOW EPS
  18. what are high potency typical antipyschotic agents
    • haldol, fluphenzazine thiothixene trifluoperazine, perphenazine
    • HIGH EPS
  19. what are advantages of haldol and prolixin
    • 2 week to monthly dosing, disadvantage tardive dyskinesia risk
    • logn acting IM injection HIGH EPS low sedation, hypotension and anticholinergic
  20. what are low potency 2nd generation antipsychotic agents
    • clozaril, zyprexa seroquel clozapine olanzapine quetiapine
    • LOW EPS
  21. whats special about clozapine
    • significantly decreasd incident of tarrdive dyskinedia, dystonias, pseudopharinsons neurleptic malignant syndrom hyperprolatinemia suicide LOW POTENCY 2ND GENERATION
    • DISADVANTAGES-- agranulocytosis, weekly blood monitoring for first 6 months then every 2 weeks there after SEIZURES
    • sedation constipation, hypersalivation, orthostatic hpotension tachyardia,myothathy, weight gain, diabetes, hyperlipidemia
  22. whats special about olanzapine
    • +-improvement of negative symptoms/cognition, decresaed incident of movement disorder--tardive dyskinesia, less comparative prolactin elevation
    • disadvantage--side effect profile--low potencty agent NO EPS HIGH SEDATION hypotenion, anticholinergic, weight gain, diabetes, hyperlipdiemia, neuroleptic malignant syndrome
  23. what do you watch out for for IM ZYPREXA injection
    psot injection delirium sedation syndrome sever sedation coma and or deliurm after each injection must be observed for atleast 3 hours
  24. whats special about quetiapine
    • treatemetn of depressive episodes in bipolar disorder acute manic episodes in bpI disorder as either monotherapy or adjunct therapy to lithium or divalpreox maintenance treatment of bipolar i disorder as adjunct therapy to lithium or divalproex and schizo
    • advantages-- decreased incident of ;movement disorder--tardive dyskinesia
    • less comparative prolactic elevation
  25. what are disadvanatages to quetiapine
    • low potency agent--sedation, anticholinergic, orthostatic hypotension
    • wegith gain, diabetes, hyperlipidemia
    • neuroleptic malignant syndrom--
  26. what are atypical high potency antipsychotics
    • risperidone
    • paliperidone
    • ziprasidone
    • airpiprazole
    • hoperidone
    • asenapine
    • lurasidone
  27. what are special things about risperidone
    • tx schizophrenia in adults and adolexents--alone or in combo wiht lithium or valproate for short term treamtent of acute manic ormixed episodes associated with bipolar i disorder
    • trea irritability associated with autistic disorder in kids
    • ADVANATGES iprovemnt of negative symptoms and cognition, decreased incident of moement EPS, side efect profile similar to high potency agents
    • DISADVANATGES- activation, akathisia, insomnia, headaches, NVD, dystonias, pseudoparkinsons tardive dyskinesia, hyperproactinemia, neurolepic malignant syndrom
  28. what is unique of paliperidone
    • acute and maintenance treatment of schizo acute treatment of schozoaffective disorder as monotherapy, acute treatment of schozoaffective disorder
    • renal elimination
  29. what drugs have once monthly injections
    • invega--once montly--
    • risperdal
  30. whats unique about iloperidone
    • ACUTE treatment for schizo
    • atypical high potency
    • QTC prolongation--drug interaction wiht cyp2d6 and 3a4
  31. whats unique about ziprasidone
    • QTC prolongation
    • + decreased incident of moevement disorder tardive dyskinesia--
    • HIGH POTENCY lower sedation anticholinergic carddiovascualr weight gain
    • -- activation, akathisisa, insomnia, headaches, NVD, QT porlongation neuroleptic malignant syndrom
  32. whats unique abotu lurasidone
    • atyical high potency
    • TAKE WITH FOOD cype 3a4 inhibiotors
  33. whats unique about asenapine
    • high affinity for 5ht3, high potensy
    • sublingual
  34. whats unigue about aripiprazole
    • partial agonist at d2 and 5ht3
    • treatment of schozo, treatment of manic or mixed episodes bp i
    • less prolactin elevation