L54-57 Pharmtx of Schizo Ott Flashcards
5 key features that define psychotic disorders
-delusions
-hallucinations
-disorganized thinking and speech
-disorganized or abnormal motor behavior
- negative sxs
T or F: Hallucinations in schizo are typically visual but can also be auditory, tactile, or olfactory
False, usually auditory
T or F: Onset of schizophrenia is early childhood to adolescence
False, adolescence to early adulthood
onset of schizo late teens, early 20s
A. Men
B. Women
A. Men
T or F: Smoking is associated with induction of 3A4, which decreases serum conc of 3A4 substrate antipsychotics *
False, 1A2
T or F: All antipsychotic drugs are considered to be equally effective in clinical trials with no exceptions
False, the exception is that clozapine is goated and the most effective
oral antipsychotic drug tx is generally considered first-line unless what
pt presents w/ reason to consider IM depot drug tx first
T or F: the efficacy of typical antipsychotics for positive sxs is similar atypical antipsychotics
True
which of the following is a 1st gen typical antipsychotic but displays atypical antipsychotic properties?
A. Haloperidol
B. Loxapine
C. Fluphenazine
D. Thioridazine
B. Loxapine
Most commonly used typical antipsychotic - routine and prn
A. Haloperidol
B. Loxapine
C. Fluphenazine
D. Thioridazine
A. Haloperidol
T or F: Higher potency typicals lead to more EPS
True
T or F: typical antipsychotics are effective for treating positive sxs, and may have negative sxs benefits
False, they make negative sxs worse
What effect do partial agonists have on dopamine transmission?
Stabilize it
T or F: Partial agonists are associated with less akathisia than other antipsychotics
False, more akathisia
Which of the following is approved for adjunct treatment in depression?
A. Haloperidol
B. Loxapine
C. Aripiprazole
D. Sugammadex
C. Aripiprazole -> partial agonists are typicaly adjunct
2D6 and 3A4 substrate
A. Aripiprazole
B. Brexpiprazole
C. Cariprazine
A and B
Moderate akathisia
A. Aripiprazole
B. Brexpiprazole
C. Cariprazine
all of them, they’re partial agonists
3A4 substrate only
A. Aripiprazole
B. Brexpiprazole
C. Cariprazine
C
Low weight gain
A. Aripiprazole
B. Brexpiprazole
C. Cariprazine
A
Low-moderate weight gain
A. Aripiprazole
B. Brexpiprazole
C. Cariprazine
B and C
Atypical antipsychotics ending what what suffix have higher weight gain than other agents?
-pine
sublingual and patch formulations
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine
A. Asenapine
1A2 substrate
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine
A B and C
3A4 substrate
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine
D
Boxed warning of neutropenia, orthostasis, bradycardia, syncope, seizures, myocarditis, cardiomyopathy
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine
B. Clozapine
QTc prolongation
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine
A B D (all but olanzapine)
DRESS warning
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine
C. Olanzapine
High risk metabolic syndrome
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine
C. Olanzapine
Boxed warning for suicidal ideation
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine
D. Quetiapine
Weight gain and sedation
A. Asenapine
B. Clozapine
C. Olanzapine
D. Quetiapine
B C and D
(asenapine has weight gain but not sedation)
How often do you apply an asenapine transdermal patch?
every 24 hours
T or F: Asenapine transdermal patches have a warning for QTc prolongation
True
When is it appropriate to reduce the dose of an asenapine transdermal patch?
If given with a UGT or strong 1A2 inhibitor (Fluvoxamine**)
what are the timelines for monitoring clozapine REMS
weekly x 6 months, biweekly x 6 months, then every 4 weeks.
what drug is added to olanzapine to mitigate weight gain and metabolic syndrome potential?
Samidorphan
what the fuck is samidorphan? **
opioid antagonist with preferential activity at the mu opioid receptor (is the mu important?)
Less D2 antagonism, more 5HT2a antagonist - less EPS
A. The. “-pines”
B. The “-dones”
A. The “-pines”
Higher weight gain than other agents
A. The. “-pines”
B. The “-dones”
A. The “-pines”
Even D2 and 5HT2A antagonists
A. The. “-pines”
B. The “-dones”
B. The “-dones”
High risk for orthostasis and syncope
A. Iloperidone
B. Lurasidone
C. Ziprasidone
A. Iloperidone
QTc prolongation
A. Iloperidone
B. Lurasidone
C. Ziprasidone
A and C
2D6 substrate
A. Iloperidone
B. Lurasidone
C. Ziprasidone
A. Iloperidone
Higher risk for akathisia
A. Iloperidone
B. Lurasidone
C. Ziprasidone
B. Lurasidone
Warning for suicidal thoughts - adjunct for bipolar depression
A. Iloperidone
B. Lurasidone
C. Ziprasidone
B. Lurasidone
Take with 350 calories (thanks Cora)
A. Iloperidone
B. Lurasidone
C. Ziprasidone
B. Lurasidone
DRESS warning
A. Iloperidone
B. Lurasidone
C. Ziprasidone
C. Ziprasidone
3A4 substrate (1/3) and aldehyde oxidase (2/3) (less worry for P450 interactions
A. Iloperidone
B. Lurasidone
C. Ziprasidone
C. Ziprasidone
Highest D2 blockade for atypical antipsychotics
A. The. “-pines”
B. The “-dones”
B. The “-dones”
High risk EPS, moderate metabolic side effects
A. The. “-pines”
B. The “-dones”
B. The. “-dones”
2D6 substrate (minor 3A4)
A. Risperidone
B. Paliperidone
A. Risperidone
EPS, hyperprolactinemia, weight gain, sedation,orthostasis (this one is weird because the other side of the table says similar side effects to the other drug so maybe just both?)
A. Risperidone
B. Paliperidone
A. Risperidone
Renally eliminated-dose adjustment in impairment
A. Risperidone
B. Paliperidone
B. Paliperidone
QTc prolongation
A. Risperidone
B. Paliperidone
B. Paliperidone
Lumateperone:
- (high/low) risk for weight gain or metabolic side effects
- (high/low) risk for EPS or akathisia
- ___ substrate
Low, Low, 3A4
FDA approved for tx of hallucinations or delusions in a pt with PD ***
A. Risperidone
B. Lumateperone
C. Clozapine
D. Pimavanserin
D. Pimavanserin
Inverse agonist and antagonist at the 5HT2A receptor
A. Risperidone
B. Lumateperone
C. Clozapine
D. Pimavanserin
D. Pimavanserin
Pimavanserin is a ___. substrate
3A4
Haloperidol decanoate (IM Inj) dosing that was bold
- Given every ___ weeks
- Load: __ times oral dose
- Maintenance: __ times oral dose
- __ based - Z-track (wtf does this mean)
4 weeks
20 times oral dose
10 times oral dose
oil based
What must you do with initiation of Risperdal tx (this is IM risperidone)
supplement with oral risperidone (or another antipsychotic) for the first few weeks of treatment - “i tell providers until 3rd injection” **
what is the subq abdominal injection of risperidone called
Perseris
If on 3 mg oral risperidone, what dose should be initiated if transitioning to perseris (abdominal subq version)? what about 4 mg?
3 oral -> 90mg
4 oral -> 120 mg
If you are starting Perseris, what should be considered if taking a 3A4 inducer?
avoid completely or give a higher dose of injection -> could also use oral supplementation whatever that means
Rykindo (IM inj of risperidone)
- Every __ week injection
- oral dose overlap is (longer/shorter) than Risperdal Consta
every 2 weeks
oral dose overlap is short (7 vs 21 days)
Abdominal OR upper arm subq injection:
A. Uzedy
B. Risperdal Consta
C. Rykindo
D. Perseris
A. Uzedy
Given once monthly or every 2 months
A. Uzedy
B. Risperdal Consta
C. Rykindo
D. Perseris
A. Uzedy
Loading dose, then booster, then every 4 weeks (starting 5 weeks after loading dose)
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera
A. Invega Sustenna
Initial loading and booster doses must be given in deltoid to improve absorption consistency
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera
A. Invega Sustenna
May require dose adjustment in moderate to severe renal impairment.
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera
A. Invega Sustenna
May be initiated in a pt who has been stable after at least 4 invega sustenna doses
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera
B. Invega Trinza
Recommended to be given deltoid; gluteal admin results in a lower Cmax
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera
B. Invega Trinza
Not recommended if CrCl < 50 mL/min **
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera
B. Invega Trinza
May be initiated after stable Invega Sustenna for 4 months or stable Invega Trinza after one 3- month dose
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera
C duh but i just put this in here so i could read it again
Gluteal only
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera
C. Invega hayfera
Can cause PDSS (Post-dose delirium sedation syndrome)
A. Invega Sustenna
B. Invega Trinza
C. Invega Hafyera
D. Zyprexa Relprevv
D. Zyprexa Relprevv
How long do you need to overlap Abilify Maintena with oral aripiprazole?
at least 14 days after first injection
what are the two methods of injection for abilify maintena?
deltoid or gluteal
okay memorize the stupid ass table on slide 34 i guess
fuck me right
Gluteal only
A. Abilify Maintena
B. Abilify Asimtufii
C. Aristada (arip lauroxil)
D. Aristada Initio
B. Abilify Asimtufii
Every 2 month dosing - 720mg, 960 mg
A. Abilify Maintena
B. Abilify Asimtufii
C. Aristada (arip lauroxil)
D. Aristada Initio
B. Abilify Asimtufii
continue oral aripiprazole for 2 weeks after first injection
A. Abilify Maintena
B. Abilify Asimtufii
C. Aristada (arip lauroxil)
D. Aristada Initio
A and B
Overlap with oral aripiprazole for 3 weeks after first injection
A. Abilify Maintena
B. Abilify Asimtufii
C. Aristada (arip lauroxil)
D. Aristada Initio
C. Aristada (arip lauroxil)
is a prodrug
A. Abilify Maintena
B. Abilify Asimtufii
C. Aristada (arip lauroxil)
D. Aristada Initio
Aristada
developed to avoid need for 21 day oral overlap of antipsychotic
A. Abilify Maintena
B. Abilify Asimtufii
C. Aristada (arip lauroxil)
D. Aristada Initio
D. Aristada Initio
Avoid in pts who are 2D6 poor metabolizers or with strong 3A4 or 2D6 inhibitors
A. Abilify Maintena
B. Abilify Asimtufii
C. Aristada (arip lauroxil)
D. Aristada Initio
D. Aristada Initio
what are three most common antipsychotic injections used in psychiatric emergencies?
Haloperidol, chlorpromazine, fluphenazine - halo is most common tho
Which of the following CANNOT be given at the same time as a benzo bc of a box warning of respiratory depression
A. Haloperidol
B. Chlorpromazine
C. Fluphenazine
D. Olanzapine
D. Olanzapine
what drug and dosage form exists for immediate tx of psychiatric emergencies but is not commonly used
loxapine for inhalation (Adasuve)
Clinical tx strategies for EPS:
Tx for acute dystonia
IM anticholinergic NOW dose (benztropine 2 mg, diphenhydramine 50 mg)
Clinical tx strategies for EPS:
tx for Drug-induced parkinson’s
Oral anticholinergic (benztropine, trihexyphenidyl, diphenhydramine)
Clinical tx strategies for EPS:
tx for akathisia
Propranolol is 1st line but a benzo (usually lorazepam) can also be used
Clinical tx strategies for EPS:
Tx for tardive dyskinesia
VMAT2 Inhibitors **
2D6/3A4 substrate
A. Tetrabenazine
B. Valbenazine
C. Deutetrabenazine
B. Valbenazine
QTc prolongation
A. Tetrabenazine
B. Valbenazine
C. Deutetrabenazine
B and C
(just) 2D6 substrate
A. Tetrabenazine
B. Valbenazine
C. Deutetrabenazine
C. Deutetrabenazine
T or F: Neuroleptic Malignant Syndrome does not classify as a medical emergency
False, it is a medical emergency
sxs of neuroleptic malignant syndrome (5 or so)
hyperpyrexia
tachycardia
labile BP
Muscle rigidity - elevated CK(?) myoglobinuria
Neuroleptic Malignant Syndrome:
Treatment is __________ -> d/c antipsychotics, consider DA’s
supportive
T or F: You should not initiate other antipsychotics after neuroleptic malignant syndrome occurs
False, its actually not contraindicated to have future antipsychotic use
3 metabolic adverse effects from atypical antipsychotics
