Antipsychotics Flashcards
SGA - highest metabolic risk
Clozapine, olanzapine, quetiapine
SGA - moderate metabolic risk
Risperidone, paliperidone
SGA - lower metabolic risk
Aripiprazole, ziprasidone, lurasidone, and asenapine
SGA - lowest EPS risk
Quetiapine (recommended in patients with PD who needs antipsychotics)
SGA - highest hematologic effects
Clozapine (agranulocytosis)
SGA - highest QT prolongation risk
Ziprasidone
SGA - highest increased prolactin risk
Risperidone, Paliperidone
SGA - highest seizure risk
Clozapine (dose-dependent)
Antipsychotic MOA
blocks dopamine and serotonin receptors (less with FGA)
BBW for antipsychotics
Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death.
Dystonia
prolonged contraction of muscle during initiation of FGAs, including painful muscle spasm; can be fatal if airway is compromised. higher risk with younger males. May prophylactically treat with diphenhydramine, benztropine.
Akathisia
restlessness with anxiety and an inability to remain still. Treated with diphenhydramine, benztropine, benzodiazepines or propranolol.
Tardive dyskinesia
abnormal facial movement, primarily tongue or mouth. Higher risk with elderly females. Stop the drug and replace with SGA. TD can be irreversible.
Dyskinesia
abnormal movements
Clozapine monitoring
REMS: Baseline ANC must be 1500/mm2 or more to start the treatment. check ANC weekly x 6 months, then Q2W for 6 months, then monthly. Stop if ANC <1,000
Pimavanserin
Drug for psychosis in PD (brand: Nuplazid).
SEs: peripheral edema, confusion.
SGAs with DDI w/ smoking
olanzapine and clozapine. Pts who smoke require a higher dose.
Latuda administration instruction
take with food that contains at least 350 kcal.
SGA taken with food
Latuda and Geodon
SGA taken without food
Seroquel XR (light meal up to 300kcal is okay)
Best time to take olanzapine
at night because it’s long-acting and sedating.
Two treatments for TD
Valbenazine (Ingrezza) and Deutetrabenazine (Austedo)
SEs: somnolence, QT prolongation.
Neuroleptic Malignant Syndrome
rare but lethal that could be caused by FGAs (much less risk with SGAs and other dopamine antagonists such as metoclopramide).
S/Sx: hyperthermia, extreme muscle rigidity, mental status change, tachycardia, tachypnea, BP changes, increased in CPK and WBC.
Treatment: taper off quickly. supportive care. cool patient down with cooling bed, antipyretics, cooled IV fluids. Muscle relaxation with benzo or dantrolene.
SGAs that can be used for resistant depression
aripiprazole, olanzapine/fluoxetiene (brand: symbyax), quetiapine, brexipiprazole