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therapeutics 2 > Pharmacotherapy of Schizophrenia > Flashcards

Pharmacotherapy of Schizophrenia Flashcards

1
Q

what are the two main groups of symptoms in schizophrenia?

A

positive symptoms and negative symptoms

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2
Q

what are positive symptoms of schizo

A

delusions
hallucinations
disorganized thoughts and behaviors
abnormal motor behavior

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3
Q

what are negative symptoms of schizo

A

social withdrawal
poor self care
depression

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4
Q

how is smoking related to antipsychotics

A

associated with induction of 1A2 due to hydrocarbons inhaled which can decrease serum concentrations of 1A2 substrate antipsychotics

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5
Q

what are typical antipsychotics and what is the efficacy

A

older agents and mostly D2 receptor antagonists
good efficacy for positive symptoms but can worsen negative symptoms

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6
Q

what are the typical antipsychotics

A

haloperidol
chlopromazine
fluphenazine
perphenazine
loxapine
thioridazine

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7
Q

what is the main side effect of typical antipsychotics

A

EPS

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8
Q

what is the MOA of atypical antipsychotics

A

D2 antagonists and 5HT2a antagonists

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9
Q

what are the side effects of atypical antipsychotics

A

less EPS but more metabolic side effects

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10
Q

what are the 3 types of atypical antipsychotics

A

Pines
Dones
Partial Agonists

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11
Q

what is the MOA of partial agonists

A

stabilize dopamine (not too much or too little)

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12
Q

what are the side effects of partial agonists

A

more akathisia
black box warning for suicidal thoughts/behaviors

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13
Q

what are the 3 partial agonists

A

aripiprazole
brexpiprazole
cariprazine

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14
Q

what are the warnings for ALL antipsychotics

A

-Boxed warning for increased risk of death in elderly patients
-metabolic adverse effects
-EPS
-risk for insomnia, hypotension, and increased risk of falls/fractures

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15
Q

Asenapine (dosage, P450, side effect)

A

-sublingual and patch
-1A2 substrate
-QTc prolongation

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16
Q

what is clozapines p450

A

1A2 substrate (educate smokers)

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17
Q

what is the boxed warning for clozapine

A

neutropenia
orthostasis
bradycardia/syncope
seizures
CV issues

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18
Q

what are the side effects of clozapine

A

lots of weight gain
QTc prolongation
sedation
dry mouth
GI motility

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19
Q

what is the REMS protocol for clozapine

A

monitor weekly x 6 months
biweekly x 6 months
every 4 weeks indefinitely

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20
Q

Olanzapine p450

A

1A2 substrate

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21
Q

olanzapine side effects and warnings

A

significant weight gain and sedation
metabolic syndrome
DRESS warning

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22
Q

what is lybalvi

A

olanzapine + samidorphan

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23
Q

how does lybalvi work

A

opioid antagonist w/ preferential activity at the mu opioid receptor. helps decrease the weight gain associated with olanzapine

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24
Q

quetiapine p450

A

3A4 substrate

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25
Q

quetiapine side effects and warnings

A

QTc prolongation
weight gain and sedation
boxed warning for suicide

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26
Q

Iloperidone p450

A

2D6 substrate

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27
Q

Iloperidone side effects

A

QTc prolongation
high risk for orthostasis and syncope (creates dosing issue)

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28
Q

Lurasidone p450

A

3A4 substrate

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29
Q

Lurasidone side effects

A

akathisia
suicide

30
Q

what should always be taken with lurasidone

A

350 calories of food to increase bioavailability

31
Q

ziprasidone p450

A

3A4 substrate

32
Q

what is an absolute CI of Ziprasidone

A

QTc prolongation

33
Q

what are side effects/counseling of ziprasidone

A

DRESS warning
take w/ food

34
Q

risperidone p450

A

2D6 substrate

35
Q

risperidone side effects

A

EPS
hyperprolactinemia
weight gain
sedation
orthostasis

36
Q

what atypical antipsychotic is good for mood symptoms

A

risperidone

37
Q

how is paliperidone eliminated

A

renally (may need adjustments)

38
Q

what are side effects of paliperidone

A

EPS
hyperprolactinemia
weight gain
sedation
QTc prolongation
orthostasis

39
Q

Lumateperone p450

A

3A4 substrate

40
Q

lumateperone side effects

A

low weight gain/metabolic risk
low risk for EPS or akathisisa

41
Q

pimavanserin p450

A

3A4 substrate

42
Q

what is pimavanserin used for

A

treatment of hallucinations or delusions in patient with Parkinson’s

43
Q

what is pimavanserin MOA

A

inverse agonist and antagonist at serotonin receptor

44
Q

haloperidol injection dose, frequency, efficacy

A

load 20x oral dose
maintenance 10x oral dose
use z-track
very effective
every 4 weeks

45
Q

what is the supplementation with risperdal consta

A

must supplement w/ oral risperidone for 3-4 weeks

46
Q

perseris injection counseling points

A

abdominal sub q injection
avoid beltline
must rotate within quadrant on stomach

47
Q

what is the supplementation for perseris

A

no oral overlap

48
Q

what is the frequency and oraloverlap of rykindo

A

every 2 week IM injection
7 days of oral overlap

49
Q

where to inject and how often for uzedy

A

abdominal or upper arm subq inj
given once monthly or every 2 months

50
Q

what is the injection schedule of Invega Sustenna

A

loading dose then booster then every 5 weeks after loading dose

51
Q

where to inject invega sustenna

A

deltoid

52
Q

how long to oral overlap invega sustenna

A

if started correctly theres no need for oral overlap

53
Q

when to adjust dose in invega sustenna

A

moderate to severe renal impairment

54
Q

how to start invega trinza

A

can start if stable on sustenna for at least 4 doses

55
Q

where to give invega trinza

A

deltoid

56
Q

when do you not give invega trinza

A

CrCl < 50 mL/min

57
Q

how to start invega hafyera

A

can start after 4 doses of sustenna or 1 dose of trinza

58
Q

where to inject invega hafyera

A

gluteal injection only

59
Q

when to not give invega hafyera

A

CrCl < 90

60
Q

what is required for zyprexa relprevv

A

REMS

61
Q

what is a major side effect of zyprexa relprevv

A

PDSS (post dose delirium sedation syndrome)

62
Q

overlap requirements for abilify maintena

A

must overlap with oral aripiprazole for at least 14 days

63
Q

where to inject abilify maintena

A

deltoid or gluteal injections

64
Q

when to adjust the dose adjustments for abilify maintena

A

if taking 2D6 or 3A4 inhibitors or inducers for more than 14 days as concomitant therapy

65
Q

what is the overlap for abilify asimtufii

A

continue oral aripiprazole for 2 weeks after 1st injection

66
Q

asimtufii frequency and where to inject

A

every 2 month dosing
gluteal injections only

67
Q

overlap for aristada

A

oral overlap with aripiprazole for 3 weeks

68
Q

overlap for initio

A

no need for 3 week overlap

69
Q

when to avoid use of initio

A

patients who are poor 2D6 metabolizers or 2D6 inhibitors

70
Q

what are the IR/emergency injections

A

haloperidol, chlorpromazine, fluphenazine

therapeutics 2 (24 decks)

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