Pharmacology of Schizophrenia Flashcards
DA Receptor Blockade: Efficacy vs Toxicity
Need >60% D2 blockade for efficacy
>80% = EPS
What is the relationship between FGA potency and prominent side effects?
Low potency = anticholinergic and antihistaminergic effects
High potency = EPS
What drug interactions do you need to keep in mind with FGAs?
CYPs
Which SGAs may attenuate TD sx?
Seroquel and Clozapine
What does the BBW for clozapine say?
Agranulocytosis
Seizures
Cardiac complications
Important side effects with clozapine
Hypotension Bowel Obstruction Sedation Weight gain Metabolic side effects
Clozapine Titration
Slow
If miss 2 doses, must start titration from beginning
Nicotine lowers clozapine levels
12.5-25mg then increase by 25mg daily to target dose between 300mg
Goal WBC and ANC
WBC: >3.5 ANC: >2 Weekly for 6 months Then every 2 weeks for 6 months Then Every 4 weeks forever
Clozapine Registry Guidelines
WBC 2-3/ANC 1-1.5 = interrupt therapy, wait then rechallenge
WBC<1 = d/c and do not rechallenge
Risperidone
Most “typical”
Highest EPS of SGAs
Hypotension
Olanzapine
Highest metabolic side effects and wt gain (w/ clozapine)
Smoking lowers levels
Seroquel
May improve TD
SEDATION and weight gain
Ziprasidone
500 calories of food + BID
Activating at low doses
Affects NE and SR too
Abilify
Partial agonist
Best side effect profile
Akathisia
Paliperidone
Similar to risperidone and similar side effects
ER capsule found in stool
Saphris (asenapine)
Sublingual
Lurasidone
Great side effect profile minus sedation
MUST be taken with food
LAIA
There are several LAIAs to improve compliance
Most every 2-4 weeks
Deltoid or gluteal administration
Risperidone LAIA
Bridge with oral therapy for 3 weeks
Invega
First 2 doses should be deltoid (fear of needles - don’t do)
Zyprexa LAIA BBW
Post injection delirium
Monitor for 3 hours after injection!
Abilify LAIA
Oal overlap for 2 weeks
Akathisia Treatment
Lower dose, but if stable on that dose give propranolol
Screening Tool to Test for TD
AIMS
Abnormal Involuntary Movement Scale
SGAs with worst metabolic side effect profile
Olanzapine and Clozapine
Hyperpolactinemia
FGAs and risperidone are the WORST
Add Abilify or bromocriptine
Drooling
Most common with clozapine
Ipatropium NS and atropine eye drops SL
