PNN - Schizophrenia Review Questions
What is dystonia? - ✔️✔️muscle spasm/rigidity. Can be potentially fatal if respiratory
muscles are affected. Treatment: IV/IM diphenhydramine, or benztropine. (this occurs
because antipsychotics BLOCK dopamine loss of balance of DA and ACh. Give
anticholinergic to restore this balance)
What is akathisia? - ✔️✔️Restlessness, irritability. Treat by decreasing antipsychotic
dose, or give propranolol, lorazepam, or diphenhydramine.
What is pseudoparkinsonism? - ✔️✔️if patient has been on antipsychotics for a long
time (weeks-months of DA blockade) parkinson's. resting tremor, shuffling gait,
cogwheel rigidity, etc. Treat with anticholinergic: benztropine, diphenhydramine,
trihexylphenidyl, or amantadine.
What is tardive dyskinesia? - ✔️✔️hyperkinetic movement disorder - tongue, lip, jaw,
face and extremity movement. Can be irreversible. Management: use a lower dose, or
change to clozapine.
What is NMS? - ✔️✔️neuroleptic malignant syndrome. Severe depletion of dopamine
leads to muscle rigidity. Symptoms: rigidity, fever, diaphoresis, altered consciousness,
BP increase, HR increase. May cause increase in CPK (muscle breakdown). This is a
medical emergency! D/c antipsychotic. Cool the patient - IV fluids, cooling blankets.
Increase DA with dopamine agonist (Bromocriptine). Dantrolene - is a muscle relaxant.
What are the symptoms associated with hyerprolactinemia? - ✔️✔️galactorrhea,
amenorrhea, gynecomastia, and impotence.
Which agents causes the greatest prolactinemia? - ✔️✔️Risperidone and Iloperidone.
Which agent causes the least hyerprolactinemia? - ✔️✔️Aripiprazole.
Which typical antipsychotic comes as an inhaled formulation? - ✔️✔️Loxapine
(Loxitane). Never give this to a patient with asthma/COPD, can cause
bronchoconstriction. Used for acute agitation.
Compare typical vs. atypical antipsychotics? - ✔️✔️typicals block D2 only, and only
affect (+) symptoms. Atypicals 5HT and D2 that affect both positive and negative
symptoms.
What are the side effects associated with all antipsychotics? - ✔️✔️extrapyramidal
effects (dystonia, akathisia, pseudoparkinsons, tardive dyskinesias, NMS). Sedation,
anticholinergic effects, orthostasis, hyperprolactinemia, and metabolic effects.
, "WASHMEN" - weight gain, anticholinergic, sedation, hypotension, movement
disorders, EPSE, NMS.
Which antipsychotics have the highest risk for EPSE? - ✔️✔️typicals and risperidone.
Which antipsychotics have the lowest risk of EPSE? - ✔️✔️clozapine, iloperidone,
quetiapine.
Which antipsychotics are available as oral inhalation? - ✔️✔️Loxapine (Loxitane)
Which typical antipsychotic is used for tourette's? - ✔️✔️Pimozide (Orap)
Which antipsychotics have a long-acting IM decanoate formulation available? -
✔️✔️Haldol (monthly), Fluphenazine (2-4 wks), Risperdal Consta (2wks), Invega
Sustenna (monthly), Invega Trinza (3 months), Abilify maintena (4wks), Abilify Aristrada
(4-6 weeks, Zyprexa Relprevv (2-4 weeks)
How do we transition patients form oral risperidone to Risperdal consta? - ✔️✔️Must
give PO for 3 weeks after first injection to transition the patient. May d/c oral after 3
weeks.
How do we transition patients from oral paliperidone to Invega sustena? Invega trinza? -
✔️✔️Oral continuation of therapy is not necessary since paliperidone has a very long
half life. But to transition from Sustenna (monthly) to Trinza (3 months), patient must be
on Sustenna for at least 4 months.
How do we transition oral aripiprazole to Abilify Maintena? Aristada? - ✔️✔️To start a
patient on Maintena (4wks), patient must be on oral abilify for 2 weeks. To give Aristada
(4-6 weeks), patient must be on oral abilify for 3 weeks.
What is the generic name for Rexulti? - ✔️✔️Brexpiprazole
What is the generic name for Vraylar? - ✔️✔️Cariprazine
What is the MOA for aripiprazole, brexpiprazole, and cariprazine? Implication -
✔️✔️partial DA and 5HT agonist, but also 5HT antagonist. Because of this, these
drugs should be avoided in patients with impulse control problems - may result in
gambling, promiscuous sexual activity, excessive spending, etc.
What is Clozapine indicated for? - ✔️✔️Refractory/resistant schizophrenia.
What is dystonia? - ✔️✔️muscle spasm/rigidity. Can be potentially fatal if respiratory
muscles are affected. Treatment: IV/IM diphenhydramine, or benztropine. (this occurs
because antipsychotics BLOCK dopamine loss of balance of DA and ACh. Give
anticholinergic to restore this balance)
What is akathisia? - ✔️✔️Restlessness, irritability. Treat by decreasing antipsychotic
dose, or give propranolol, lorazepam, or diphenhydramine.
What is pseudoparkinsonism? - ✔️✔️if patient has been on antipsychotics for a long
time (weeks-months of DA blockade) parkinson's. resting tremor, shuffling gait,
cogwheel rigidity, etc. Treat with anticholinergic: benztropine, diphenhydramine,
trihexylphenidyl, or amantadine.
What is tardive dyskinesia? - ✔️✔️hyperkinetic movement disorder - tongue, lip, jaw,
face and extremity movement. Can be irreversible. Management: use a lower dose, or
change to clozapine.
What is NMS? - ✔️✔️neuroleptic malignant syndrome. Severe depletion of dopamine
leads to muscle rigidity. Symptoms: rigidity, fever, diaphoresis, altered consciousness,
BP increase, HR increase. May cause increase in CPK (muscle breakdown). This is a
medical emergency! D/c antipsychotic. Cool the patient - IV fluids, cooling blankets.
Increase DA with dopamine agonist (Bromocriptine). Dantrolene - is a muscle relaxant.
What are the symptoms associated with hyerprolactinemia? - ✔️✔️galactorrhea,
amenorrhea, gynecomastia, and impotence.
Which agents causes the greatest prolactinemia? - ✔️✔️Risperidone and Iloperidone.
Which agent causes the least hyerprolactinemia? - ✔️✔️Aripiprazole.
Which typical antipsychotic comes as an inhaled formulation? - ✔️✔️Loxapine
(Loxitane). Never give this to a patient with asthma/COPD, can cause
bronchoconstriction. Used for acute agitation.
Compare typical vs. atypical antipsychotics? - ✔️✔️typicals block D2 only, and only
affect (+) symptoms. Atypicals 5HT and D2 that affect both positive and negative
symptoms.
What are the side effects associated with all antipsychotics? - ✔️✔️extrapyramidal
effects (dystonia, akathisia, pseudoparkinsons, tardive dyskinesias, NMS). Sedation,
anticholinergic effects, orthostasis, hyperprolactinemia, and metabolic effects.
, "WASHMEN" - weight gain, anticholinergic, sedation, hypotension, movement
disorders, EPSE, NMS.
Which antipsychotics have the highest risk for EPSE? - ✔️✔️typicals and risperidone.
Which antipsychotics have the lowest risk of EPSE? - ✔️✔️clozapine, iloperidone,
quetiapine.
Which antipsychotics are available as oral inhalation? - ✔️✔️Loxapine (Loxitane)
Which typical antipsychotic is used for tourette's? - ✔️✔️Pimozide (Orap)
Which antipsychotics have a long-acting IM decanoate formulation available? -
✔️✔️Haldol (monthly), Fluphenazine (2-4 wks), Risperdal Consta (2wks), Invega
Sustenna (monthly), Invega Trinza (3 months), Abilify maintena (4wks), Abilify Aristrada
(4-6 weeks, Zyprexa Relprevv (2-4 weeks)
How do we transition patients form oral risperidone to Risperdal consta? - ✔️✔️Must
give PO for 3 weeks after first injection to transition the patient. May d/c oral after 3
weeks.
How do we transition patients from oral paliperidone to Invega sustena? Invega trinza? -
✔️✔️Oral continuation of therapy is not necessary since paliperidone has a very long
half life. But to transition from Sustenna (monthly) to Trinza (3 months), patient must be
on Sustenna for at least 4 months.
How do we transition oral aripiprazole to Abilify Maintena? Aristada? - ✔️✔️To start a
patient on Maintena (4wks), patient must be on oral abilify for 2 weeks. To give Aristada
(4-6 weeks), patient must be on oral abilify for 3 weeks.
What is the generic name for Rexulti? - ✔️✔️Brexpiprazole
What is the generic name for Vraylar? - ✔️✔️Cariprazine
What is the MOA for aripiprazole, brexpiprazole, and cariprazine? Implication -
✔️✔️partial DA and 5HT agonist, but also 5HT antagonist. Because of this, these
drugs should be avoided in patients with impulse control problems - may result in
gambling, promiscuous sexual activity, excessive spending, etc.
What is Clozapine indicated for? - ✔️✔️Refractory/resistant schizophrenia.
