Antipsychotic Medications Flashcards
Initial goal of acute treatment
is to bring pt back to baseline
Maintenance treatment aim is to
prevent recurrence and maximize quality of life
As needed, emergency, use of antipsychotics may be needed for acute agitation but it can also….
reduce tolerability,
give the perception that premature dose increases are needed
More likely antipsychotic side effects to consider in young, 1st time psychosis patients,
Greater likelihood of weight gain and adverse metabolic side effects.
Why use lower dosage in 1st time psychosis?
Because it may respond more rapidly to a lose dose.
Recommended starting dose for older adults with concomitant health conditions already receiving multiple medications…
1/4 to 1/2 lower than usual adult starting dose
Typically time taken to show initial response to medication
2-4 weeks
(looking for at lease 20% reduction in symptoms)
Large rapid doses of Clozapine have led to
Cardiovascular collapse and death
(especially in pts taking respiratory depressant medications like Benzodiazepines)
Clozapine:
Starting dose
Therapeutic Dose
Maximum Dosage
Start: 12.5 mg (1x or 2x daily)
Therapeutic: 300-450 mg /day
Maximum: 900 mg/day
Markers for significant and substantial improvement
> 20% improvement is significant
50% improvement is substantial
Reasons for not seeing significant or substantial improvement on medication:
concomitant substance abuse
rapid metabolism
poor absorption
interactions w/ other meds
smoking
Run through the general prescribing course in a patient not responding adequately to treatment
Start low on an antipsychotic and increase to therapeutic dosage. If no significant or substantial improvement, look for cause. If no cause is determined raise dose for a bit (2-4 weeks). If raised dose doesn’t work, try a different antipsychotic (one with different binding profile or side effects). After 2 trials of antipsychotic meds at therapeutic dose are unsuccessful, try Clozapine
Special considerations using Augmentation Therapy
+Antidepressant (Negative Symptoms or Depression)
+Benzodiazepine, like Lorazepam (Catatonia)
Pt concerns over the use of Clozapine
burdens of required blood work
logistical barriers such as access to transportation
side effects, such as weight gain or somnolence
Clinician concerns over the use of Clozapine
limited experience in using clozapine
+worried about paperwork
+think pts wont adhere
+concerned about side effects
- overestimate the likelihood of severe neutropenia
