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.
What are some advantages of long acting AP injectables over oral dosage?
Improvement of adherence
Pharmacies/Medical administration
What are some disadvantages of Long acting AP injectables over oral dosage?
Expensive
Cant be retrieved out of body
For an individual with schizophrenia who wants to reintegrate into society and work what APs would be best?
Risperidone
If a person is pacing constantly and cant seem to sit still what Extrapyramidal side effect might they be experiencing?
Akathesia
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.
What are some advantages of long acting AP injectables over oral dosage?
Improvement of adherence
Pharmacies/Medical administration
What are some disadvantages of Long acting AP injectables over oral dosage?
Expensive
Cant be retrieved out of body
For an individual with schizophrenia who wants to reintegrate into society and work what APs would be best?
Risperidone
If a person is pacing constantly and cant seem to sit still what Extrapyramidal side effect might they be experiencing?
Akathesia
What Is often a compliance issue with Asenapine oral tablets?
Taste Awful
Why might treatment with antipsychotics lead to more psychotic, agitations and delusions over time?
Dopamine affect from D2 antagonism
What Antipsychotics are FDA approved for Bipolar disorder?
Aripiprazole Quetiapine Risperidone Olanzapine Olanzapine/Fluoxetine Ziprasidone
What drugs can elicit mania in bipolar patients?
Alcohol, Bronchodilators, Caffeine, Cocaine, Stimulants, Steroids, TCAs, Hallucinogens, Dopamine Agonists, Pseudophed, Interferon
Bipolar I vs Bipolar II
Bipolar I - both manic and depressive episodes that vary in length
Bipolar II - less severe manic episodes but frequent depressive episodes
What is Cyclothymia?
A chronic but milder form of bipolar disorder characterized by episdoes of hypomania and depression that last for at least two years
What is mixed episode Bipolar Disorder?
Where an individual experiences both Mania and depression simultaneously
How many times must an individual experience mania or depression to have Rapid-cycling bipolar disorder?
4 or more episodes within one year
What length of time defines a Manic Episode?
at least 7 days of an abnormal or persistently elevated or irritable mood.
What test may be given to screen for Manic behavior
DSM-5
How does the DSM-5 define a Hypomanic Episode?
similar to a manic phase, but less intense, only required to persist for 4 days, should be observable by others that the person is noticeably different from a regular non-depressed mood.
What Mood stabilization medications are FDA approved for Bipolar Disorder?
Vaplroate
Carbamazepine
Lamotrigine
Lithium
What Antipsychotics are FDA approved for Bipolar disorder?
Aripiprazole Quetiapine Risperidone Olanzapine Olanzapine/Fluoxetine Ziprasidone
What Medications are best used to treat euphoric hypomania or psychotic mania?
Lithium, Valproate, Aripiprazole, Quetiapine, Risperidone or Ziprasidone
