2. Pharm: Anti-psychotics

Question 1

Before giving antipsychotics, it is recommended that BL levels of what, are taken from ALL patients?

Answer 1

1. Serum glucose/lipids
2. Weight (BMI)
3. BP
4. If possible: waist circumference, personal and family fx of metabolic and CV disease

Question 2

When giving anti-psychotics, adherence is important.

What 6 drugs can be given in a non-adherent patient? *test Q*

Answer 2

Give Long-Acting Injectable Agents (LAIA’s) q 2-12 weeks, depending on agent, dose and pt

1. Haloperidol decanoate
2. Fluphenazine decanoate
3. ROAP
   
   1. Risperidone + Olanzapine + Aripiprazole + Paliperidone (ROAP)

Question 3

What drugs are given for [acute agitation]?

Answer 3

• Injectable (IR) and ODT or SL versions

Question 4

What drugs are given for [multi-drug resistant disease]?

Answer 4

Clozapine

Question 5

What drugs are given for [psychotic with anti-suicidal thoughts/behaviors]?

Answer 5

Clozapine

Question 6

After a patient increases/switches antipsychotic medications, what is necessary?

Answer 6

Combination anti-psychotic therapy.

Question 7

Name rating scales that can be used to assess SE for antipsychotic therapy

Answer 7

1. GASS (Glawgow antipsychotic SE scale)
2. AIMS (Abnormal involunatry movement scale)
3. BARS (Barnes Akathisia Rating Scale)
4. SAS (Simpson-Angus Scale for EPS)

Question 8

Positive symptoms of schizophrenia and pathway involved

Answer 8

Mesolimbic pathway

1. Hallucinations
2. Delusions
3. Disorganized speech/ thoughts
4. Agitation
5. ABNL motor behavior

Question 9

Negative symptoms of schizophrenia and pathway involved

Answer 9

• Mesocortical pathway
  
  1. Apathy
  2. Avolition
  3. Alogia
  4. Cognitive deficits (working memory)
  5. Social withdrawal

Question 10

Therapeutic choices in which anti-psychotic drug to give begins with:

Answer 10

1. Dosing history: efficacy vs SE
2. Tolerance to known SE (WG, metabolic effects, EPS)

Question 11

How long do anti-psychotics take to kick in?

Answer 11

2-3 weeks: max benefit (remission) can take several months