Pharmacotherapy of Schizophrenia

Question 1

5 key features that define psychotic disorders

Answer 1

1. Delusions
2. Hallucinations (usually auditory, but also visual, tactile, or olfactory)
   3 Disorganized thinking/speech
3. Disorganized or abnormal motor behavior
4. Negative symptoms

Question 2

When is the typical onset of schizophrenia? For men and women?

Answer 2

Late adolescence to early adulthood
Men: late teens, early 20s
Women: late 20s, early 30s

Question 3

Smoking is associated with the induction of _____ because of hydrocarbons produced and inhaled, which ______ the serum concentration of ____ substrate antipsychotics (olanzapine, asenapine, clozapine, loxapine)

Answer 3

1A2
1A2
decreases

Question 4

Three substances that can hasten the onset of schizophrenia, exacerbate symptoms, and reduce time to relapse

Answer 4

Marijuana
Cocaine
Amphetamine

Question 5

Should substance use treatment and mental health treatment be undertaken at the same time in schizophrenia patients?

Answer 5

Yes

Question 6

What should be considered when choosing an antipsychotic for a patient?

Answer 6

1. Doses per day
2. Side effects
3. Previous drug therapy
4. Cost
5. Concomitant drug therapy
6. Need for monitoring

Question 7

Older antipsychotic agents are primarily antagonists of which receptor?

Answer 7

D2

Question 8

The efficacy of typical antipsychotics for positive symptoms is _________ to that of atypical antipsychotics

Answer 8

similar

Question 9

Which typical antipsychotic is most commonly used?

Answer 9

Haloperidol - routine and PRN

Question 10

Which antipsychotics are associated with more EPS?

Answer 10

Higher potency typicals
Atypical: risperidone + paliperidone

Question 11

Typical antipsychotics are very effective for treating ________ symptoms but are likely to worsen _______ and ________ symptoms

Answer 11

Positive
Negative, cognitive

Question 12

Atypical antipsychotics are usually antagonists of which receptors?

Answer 12

D2
5HT2A

Question 13

Which atypical antipsychotics are partial agonists?

Answer 13

Aripiprazole
Brexipiprazole
Cariprazine

Question 14

Partial agonists are associated with more _________ other antipsychotics

Answer 14

Akathisia

Question 15

Aripiprazole and brexpiprazole are both ______ + _______ substrates, while cariprazine is only a _____ substrate

Answer 15

2D6 + 3A4
3A4

Question 16

Partial agonists are approved for adjunct treatment in ________, so all have a boxed warning for __________ ___________

Answer 16

depression
suicidal thoughts/behavior

Question 17

Which of the “pines” have sublingual and patch formulations?

Answer 17

Asenapine

Question 18

Asenapine, clozapine, and olanzapine are all substrates of which CYP?

Answer 18

1A2

Question 19

Quetiapine is a substrate of which CYP?

Answer 19

3A4

Question 20

Which “pines” have a risk for QTc prolongation?

Answer 20

Asenapine
Clozapine
Quetiapine

Question 21

Olanzapine has a high risk for __________ ___________ and warning for ________

Answer 21

high risk - metabolic syndrome
warning - DRESS

Question 22

The “pines” have a higher incidence of which side effects compared to other antipsychotics?

Answer 22

Weight gain
Sedation

Question 23

Quetiapine has a boxed warning for what?

Answer 23

suicidal ideation

Question 24

Boxed warnings for clozapine (7)

Answer 24

1. Neutropenia
2. Orthostasis
3. Bradycardia
4. Syncope
5. Seizures
6. Myocarditis
7. Cardiomyopathy

Question 25

Side effects of clozapine (6)

Answer 25

1. Sedation 2. Weight gain 3. Constipation 4. Hypersalivation 5. Dry mouth 6. GI hypomotility with obstruction risk

Question 26

Asenapine patch instructions

Answer 26

Apply one patch every 24 hours, rotate patch site to minimize application site reactions

Question 27

If taken with a 1A2 inhibitor, how should you adjust the dose of asenapine?

Answer 27

Reduce the dose because it's a 1A2 (and UGT) substrate

Question 28

Monitoring timeline for Clozapine REMS

Answer 28

Weekly x 6 months Biweekly x 6 months Then every 4 weeks

Question 29

Mechanism of action of Samidorphan

Answer 29

opioid antagonist with preferential activity at the mu opioid receptor

Question 30

Asenapine has a warning for what?

Answer 30

QTc prolongation

Question 31

Which of the "dones" have a warning for QTc prolongation?

Answer 31

Iloperidone Ziprasidone Paliperidone

Question 32

Which "dones" are substrates of 2D6?

Answer 32

Iloperidone Risperidone (minor 3A4)

Question 33

Lurasidone is a substrate of CYP _____

Answer 33

3A4

Question 34

Ziprasidone is a substrate of CYP ______ (1/3) and aldehyde oxidase (2/3)

Answer 34

3A4 less worry for CYP interactions!

Question 35

Which "dones" should be taken with food?

Answer 35

Lurasidone Ziprasidone

Question 36

Which "dones" have the highest D2 blockade of all the atypical antipsychotics?

Answer 36

Risperidone Paliperidone

Question 37

Side effects of risperidone and paliperidone (5)

Answer 37

1. EPS 2. Hyperprolactinemia 3. Weight gain 4. Sedation 5. Orthostasis

Question 38

Lumateperone (Caplyta) is a substrate of CYP _____

Answer 38

3A4

Question 39

Overlap with oral aripiprazole for ___ weeks when starting Abilify Maintena and ___ weeks for Aristada

Answer 39

Maintena - 2 weeks Aristada - 3 weeks