Refractory Schizophrenia

1. True or False Re: Clozapine
  1. Many of the side effects of clozapine are dose independent
  2. Many of the side effects of clozapine are dependent of the speed of titration
  3. Adverse effects are more common at the beginning of therapy
  4. If pt misses drugs for more than 2 days – need to restart titration
2. True or False Re: Clozapine
  1. Target dose for a male smoker is 550 mg/day
  2. The metabolite of clozapine is norclozapine
  3. Target dose is mostly dependent on patient tolerability
  4. Result of clozapine augmentation is often disappointing
  5. If not effective clozapine augmentation needs to be given up in 3-6 months
3. The following drugs are useful in augmentation of clozapine
  1. Haloperidol
  2. Risperidone
  3. Aripiprazole
  4. Amisulpride
  5. Lamotrigine
  6. Omega 3 FA
4. The following are alternatives to clozapine resistant schizophrenia
  1. CBT
  2. ECT
  3.  Omega 3 fatty acids
  4. Gingko biloba
  5. Allopurinol
  6. COX2 inhibitors
5. True or False Re: Clozapine side effects
  1. Sedation improves with time
  2. Hyper salivation is troublesome at night
  3. Hyper salivation sometimes persists
  4. Pirenzepine can be used as treatment for hyper salivation
  5. Constipation is only short lived
6. True or False Re: Clozapine side effects
  1. Hypotension as well as hypertension occur in Tx with clozapine
  2. Hypertension is a permanent problem
  3. Atenolol is used to treat the hypertension caused by clozapine therapy
7. If a person on clozapine develops fever
  1. It could be normal transient phenomenon – T, Clozapine induced CRP and IL-6, causing fever, transient phenominon
  2. It could be due to myocarditis – T, but ECG changes, +ve cardiac enzymes, tachycardia at rest and when afebrile is suggestive
  3. It could be due to opportunistic infection 2ry to neuropenia – T
  4. It could be to NMS – T
8. True or False Re: Clozapine and Seizures
  1. Seizures occur only in the first year
  2. EEG changes are common in patients with clozapine
  3. Sodium Valproate may be given prophylactically if the plasma levels are high or dose is high (>500μg/L)
  4. If fits occur stop clozapine for 1 week
  5. Restart at 50% of original dose
9. True or False Re: Clozapine side effects
  1. Nausea is common symptom in the early part of the Tx with clozapine
  2. Treatment of nausea is with maxalon
  3. Nocturnal enuresis is seen only in the first 18 weeks
  4.  Desmopressin is useful in Nocturnal enuresis

Answers                                                                                                         

1. True or False Re: Clozapine

  1. Many of the side effects of clozapine are dose independent – F, dose dependent, thus in order to get rid of a S/E reduce dose
  2. Many of the side effects of clozapine are dependent of the speed of titration – T, thus to reduce S/E slow down titration
  3. Adverse effects are more common at the beginning of therapy – T
    Target therapeutic plasma level is 450 μg/L – F, it is 350 μg/L, Target doses (Female non smoker – 250mg/d, Male non smoker – 350mg/d, Female smoker – 450mg/d, Male smoker – 550mg/d
  4. If pt misses drugs for more than 2 days – need to restart titration - T
2. True or False Re: Clozapine
  1. Target dose for a male smoker is 550 mg/day - T
  2. The metabolite of clozapine is norclozapine – T, important in the monitoring of plasma levels
  3. Target dose is mostly dependent on patient tolerability - T
  4. Result of clozapine augmentation is often disappointing – T
  5. If not effective clozapine augmentation needs to be given up in 3-6 months – T
3. The following drugs are useful in augmentation of clozapine
  1. Haloperidol - T
  2. Risperidone - T
  3. Aripiprazole - T
  4. Amisulpride - T
  5. Lamotrigine - T
  6. Omega 3 FA - T
4. The following are alternatives to clozapine resistant schizophrenia
  1. CBT - T
  2. ECT - T
  3.  Omega 3 fatty acids - T
  4. Gingko biloba - T
  5. Allopurinol - T
  6. COX2 inhibitors - T
5. True or False Re: Clozapine side effects
  1. Sedation improves with time - T
  2. Hyper salivation is troublesome at night – T
  3. Hyper salivation sometimes persists -T
  4. Pirenzepine can be used as treatment for hyper salivation – T Anticholinergics are used – atropine drops, hyocine (Buscopan lozenges)
  5. Constipation is only short lived - F, usually persists
6. True or False Re: Clozapine side effects
  1. Hypotension as well as hypertension occur in Tx with clozapine – T, first 3 weeks
  2. Hypertension is a permanent problem - F, transient
  3. Atenolol is used to treat the hypertension caused by clozapine therapy – T, it is also used to treat the transient tachycardia
7. If a person on clozapine develops fever
  1. It could be normal transient phenomenon – T, Clozapine induced CRP and IL-6, causing fever, transient phenomenon
  2. It could be due to myocarditis – T, but ECG changes, +ve cardiac enzymes, tachycardia at rest and when afebrile is suggestive
  3. It could be due to opportunistic infection 2ry to neuropenia - T
  4. It could be to NMS – T
8. True or False Re: Clozapine and Seizures
  1. Seizures occur only in the first year – F, can develop any time
  2. EEG changes are common in patients with clozapine – T, therefore an abnormal EEG does not mean epilepsy
  3. Sodium Valproate may be given prophylactically if the plasma levels are high or dose is high (>500μg/L) – T
  4. If fits occur stop clozapine for 1 week – F, stop drug for ONE day
  5. Restart at 50% of original dose - F, reduction of dose is enough
9. True or False Re: Clozapine side effects
  1. Nausea is common symptom in the early part of the Tx with clozapine - T, usually resolves
  2. Treatment of nausea is with maxalon – F, avoid maxalon and stematil as it can cause EPSE
  3. Nocturnal enuresis is seen only in the first 18 weeks - F, can persists for months to years
  4.  Desmopressin is useful in Nocturnal enuresis – T, but hyponatraemia can occur

Source                                                                                                         

Maudsley Prescribing Guidelines – 10th edition – page 53-63

About these ads

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s