IDT - Schizophrenia, Bipolar Aebi Flashcards
SGA
Second Generation Antipsychotic (newer, atypical)
FGA
First Generation Antipsychotics (older, typical)
Treatment Goals for Schizophrenia
Decrease Symptoms Increase Quality of Life - minimize AE Encourage Adherence Decrease Hospitalization/cost
First Generation Antipsychotics
Reduce Positive symptoms
No effect on negative symptoms
Increase EPS
Less risk for Metabolic Syndrome
Second Generation Antipsychotics
Reduce Positive symptoms
Moderate efficacy at reducing negative symptoms
Possible effect on increased cognition
Less EPS
What Considerations should be taken with FGA dosing?
Potency
- related to D2 occupancy/affinity
- Higher D2 affinity associated with ‘stronger’ potency
- Dosed on CPZ equivalents
What considerations should be taken with SGA dosing?
Consider side effects and dose to them
- Initial dose, start low and titrate up slowly
- maintenance dose, watch for long term side effects (metabolic, QT, Prolactin, EPS)
What is Stage 1 dosing in the Schizophrenia Algorithm?
First Episode Schizophrenia: Trial of a single SGA
Aripiprazole, Olanzapine, Quetiapine, Risperidone, Ziprasidone
What is stage 2 in the Schizophrenia Algorithm and when should it be started?
Started after partial or non-response from stage 1
Trial of a single SGA (different than one used in Stage one) or an FGA
After how many failed trials should Clozapine be used?
At least 2 failed trials.
When might Clozapine be tried earlier than stage 3?
Patient history of recurrent suicidality, violence or substance abuse.
Persistent positive symptoms greater than 2 years
Required if greater than 5 years
What must be done if a patient is taking Clozapine?
Much slower titration, needs weekly lab draws for WBC and ANC, coordinated Dosing, REMS in Clozapine Registry.
What is there a high risk of with Clozapine?
Neutropenia, Leukopenia or agranulocytosis
What other Antipsychotics have a risk of Neutropenia
All FGA and SGA
Haloperidol, Olanzapine, Quetiapine and risperidone usually seen from 4wks-4months
What APs have a high risk of weight gain?
SGA’s (Olanzapine, Clozapine)
Which FGA’s have a medium high risk for weight gain?
Low potency FGAs
What AP’s have the lowest risk for weight gain?
High Potency FGAs, Aripiprazole and Ziprasidone
Which APs are more high risk in patients with Diabetes or Insulin Resistance
SGAs = higher risk, Clozapine and Olanzapine most
FGA’s = lower risk
Ziprasidone, aripiprazole
If a patient suffered from Gynecomastia, weight gain and heart paliptations, which medication should be chosen?
Aripiprazole
Which Antipsychotic Drugs have the highest risk of Prolactin Elevation?
Risperidone, Palieridone, Haldol (First Generation Antipsychotics)
Which Antipsychotic drugs have a lower risk of Prolactin Elevation
Quetiapine, Clozapine
Aripiprazole (lowest)
Which Antipsychotic Drugs have the highest risk for QT prolongation?
Thioridazine, Pimozide > Ziprasidone > Palieridone
Which Antipsychotic drugs have the Lowest risk for QT prolongation?
Clozapine (highest of rest) Aripiprazole, Fluphenazine, Chlorpromazine (equal)
Why might serum levels of Clozapine be reduced in a patient who smokes tobacco?
Clozapine Metabolized by same enzyme induced by Cyp 1A2, which breaks down and excretes drug faster.
