Antipsychotics Ott Flashcards
onset of schizophrenia in males and females
males - late teens early 20s
women - late 20s early 30s
smoking is associated with induction of ____ because of ____
1A2, hydrocarbons
what to do if pt smokes and takes a 1A2 substrate
increase the dose
most commonly used typical antipsychotic
haloperidol, can be used PRN
which antipsychotics are partial agonists
aripipraozole
bexiprazole
cariprazine
partial agonists are associated with increased what
akathasia, low weight gain
partial agonists are approved for ajunct treatment in what?
depression, box warning suicide
aripiprazole is a ____ substrate
2D6 and 3A4
bexiprazole is a ____ substrate
2D6 and 3A4
cariprazine is a ____ substrate
3A4
which drug has a patch and sublingual formulation?
asenapine
asenapine is a substrate of ___
1A2
asenapine has ____
QTC prolongation
clozapine is a _____substrate
1A2
boxed warnings for clozapine
neutropenia, orthostasis, bradycardia, syncope, seizures, myocarditis, cardiomyopathy
clozapine side effects
sedation, constipation, weight gain, hypersalivation, dry mouth, GI hypomotility,
drugs with QTC prolongation
asenapine, clozapine, quetiapine, iloperidone, ziprasidone, paliperidone
olanzapine is a ____ substrate
1A2
olanzapine side effects
weight gain and sedation
DRESS warning
quetiapine is a _____substrate
3A4
quetiapine side effects
weight gain and sedation
suicide ideation
asenapine patch should be applied every
24 hours, rotate sites
clozapine REMS
absolute neutrophil count
monitoring weekly x 6 months
biweekly x 6 months
then every 4 weeks
what drug is the combo opioid antagonist
olanzapine/samidorphan
mu opioid activity
iloperidone risks
orthostasis and syncope
iloperidone is a _____ substrate
2D6
lurasidone is a ____ substrate
3A4
lurasidone risks
akathasia, suicidal
which should be taken with food
lurasidone and ziprasidone
ziprasidone is a _____ substrate
3A4 and aldehyde oxidase
risperidone is a ______ substrate
2D6 (3a4 minor)
risperidone side effects
EPS, hyperprolactinemia, weight gain, sedation, orthostatis
paliperidone side effects
similar to risperidone
which drug renally eliminated
paliperidone
lumateperone (Capylta) is a ____ substrate
3A4
lumateperone side effects
low risk for weight gain, akathesia, EPS
pimavanserin use
hallucinations in Parkinsons disease
inverse agonist and antagonist and serotoni 5HT2A
pimavanserin is a ____ substrate
3A4
which drug must be Z tracked, is long acting for 4 weeks
haloperiodol
Risperdal consta requirements
must supplement with oral risperidone for first 4 weeks of treatment
what is Perseris and where does it go
risperidone injection
abdominal subq injection
what is Rykindo and dosing
risperidone injection
every 2 week injection
oral dose overlap is only 7 days
what is Uzedy and dosing
risperidone injection
abdominal or upper arm subq
given once every month or 2 months
what is Invega Sustenna and dosing
given in _____
paliperidone
loading then booster then every 4 weeks
loading and booster given in deltoid
does Invega need oral overlap
no, if we have loading
Invega sustenna has ____ elimination
renal
Invega Trinza can be given when
if at least 4 stable invega sustenna doses
Invega Trinza given in ____
deltoid
Invega Trinza not recomended in _____
CrCl < 50 mL/min
what is Invega Trinza
paliperidone q3 months
what is Invega Hafyera
paliperidone q6 months
when can we give Invega Hafyera
sustenna - 4 months OR
trinza - one 3 month dose
Invega Hafyera is a ____ injection
gluteal
Zyprexa Relprevv risk
PDSS - post dose delirium sedation syndrome
Zyprexa Relprevv is what drug
olanzapine
abilify maintena and asimtufii requirement
overlap with oral aripiprazole for 14 days after first injection
where to administer abilify maintena
deltoid, gluteal
when do we need to adjust dose for Abilify Maintena?
if we are taking 2D6 or 3A4 inhibitors or 3A4 inducers for more than 14 days with it
Abilify Asimtufii dosing and site
every 2 months, gluteal
Aristada requirement
prodrug so overlap with 3 weeks of oral
Aristada initio does not need what
overlap of oral for 3 weeks
when to avoid Aristada Initio
poor 2D6 metabolizers or with strong 3A4 or 2D6 inhibitors
immediate release antipsychotic injections
haloperidol, chlorpromazine, fluphenazine
Lozapine for inhalation
what can we not give together with olanzapine IM immediate release
benzodiazepines IR, respiratory depression
treatment for acute dystonia
anticholinergics IM (benztropine, diphenhydramine)
treatment for Parkinsons induced symptoms
anticholinergics PO (benztropine, diphenhydramine, trihexphyenidyl)
treatment for akathisia
beta blocker - propranolol
benzodiazepine - lorazepam
treatment for tardive dyskinesias
VMAT inhibitors
VMAT inhibitors
valbenazine
deutetrabenazine
VMAT inhibitors cause
QTC prolongation
valbenazine is a substrate for ___
2D6/3A4
deutetrabenazine is a substrate for ___
2D6
neuroleptic malignant syndrome is what
life threatening
symptoms of NMS
hyperpyrezia, tachycardia, labile bP
muscle rigidity, elevated CK
is future antipsychotic use contraindicated in NMS
no
drugs with highest risk of metabolic issues
clozapine, olanzapine
metabolic issues
HTN, hyperglycemia, hyperlipidemia
what should we monitor with metabolic
family hx
BMI
waist
BP
glucose / a1c
lipids fasting
