Pharmacotherapy of Schizophrenia Flashcards
what are the two main groups of symptoms in schizophrenia?
positive symptoms and negative symptoms
what are positive symptoms of schizo
delusions
hallucinations
disorganized thoughts and behaviors
abnormal motor behavior
what are negative symptoms of schizo
social withdrawal
poor self care
depression
how is smoking related to antipsychotics
associated with induction of 1A2 due to hydrocarbons inhaled which can decrease serum concentrations of 1A2 substrate antipsychotics
what are typical antipsychotics and what is the efficacy
older agents and mostly D2 receptor antagonists
good efficacy for positive symptoms but can worsen negative symptoms
what are the typical antipsychotics
haloperidol
chlopromazine
fluphenazine
perphenazine
loxapine
thioridazine
what is the main side effect of typical antipsychotics
EPS
what is the MOA of atypical antipsychotics
D2 antagonists and 5HT2a antagonists
what are the side effects of atypical antipsychotics
less EPS but more metabolic side effects
what are the 3 types of atypical antipsychotics
Pines
Dones
Partial Agonists
what is the MOA of partial agonists
stabilize dopamine (not too much or too little)
what are the side effects of partial agonists
more akathisia
black box warning for suicidal thoughts/behaviors
what are the 3 partial agonists
aripiprazole
brexpiprazole
cariprazine
what are the warnings for ALL antipsychotics
-Boxed warning for increased risk of death in elderly patients
-metabolic adverse effects
-EPS
-risk for insomnia, hypotension, and increased risk of falls/fractures
Asenapine (dosage, P450, side effect)
-sublingual and patch
-1A2 substrate
-QTc prolongation
what is clozapines p450
1A2 substrate (educate smokers)
what is the boxed warning for clozapine
neutropenia
orthostasis
bradycardia/syncope
seizures
CV issues
what are the side effects of clozapine
lots of weight gain
QTc prolongation
sedation
dry mouth
GI motility
what is the REMS protocol for clozapine
monitor weekly x 6 months
biweekly x 6 months
every 4 weeks indefinitely
Olanzapine p450
1A2 substrate
olanzapine side effects and warnings
significant weight gain and sedation
metabolic syndrome
DRESS warning
what is lybalvi
olanzapine + samidorphan
how does lybalvi work
opioid antagonist w/ preferential activity at the mu opioid receptor. helps decrease the weight gain associated with olanzapine
quetiapine p450
3A4 substrate
quetiapine side effects and warnings
QTc prolongation
weight gain and sedation
boxed warning for suicide
Iloperidone p450
2D6 substrate
Iloperidone side effects
QTc prolongation
high risk for orthostasis and syncope (creates dosing issue)
Lurasidone p450
3A4 substrate
Lurasidone side effects
akathisia
suicide
what should always be taken with lurasidone
350 calories of food to increase bioavailability
ziprasidone p450
3A4 substrate
what is an absolute CI of Ziprasidone
QTc prolongation
what are side effects/counseling of ziprasidone
DRESS warning
take w/ food
risperidone p450
2D6 substrate
risperidone side effects
EPS
hyperprolactinemia
weight gain
sedation
orthostasis
what atypical antipsychotic is good for mood symptoms
risperidone
how is paliperidone eliminated
renally (may need adjustments)
what are side effects of paliperidone
EPS
hyperprolactinemia
weight gain
sedation
QTc prolongation
orthostasis
Lumateperone p450
3A4 substrate
lumateperone side effects
low weight gain/metabolic risk
low risk for EPS or akathisisa
pimavanserin p450
3A4 substrate
what is pimavanserin used for
treatment of hallucinations or delusions in patient with Parkinson’s
what is pimavanserin MOA
inverse agonist and antagonist at serotonin receptor
haloperidol injection dose, frequency, efficacy
load 20x oral dose
maintenance 10x oral dose
use z-track
very effective
every 4 weeks
what is the supplementation with risperdal consta
must supplement w/ oral risperidone for 3-4 weeks
perseris injection counseling points
abdominal sub q injection
avoid beltline
must rotate within quadrant on stomach
what is the supplementation for perseris
no oral overlap
what is the frequency and oraloverlap of rykindo
every 2 week IM injection
7 days of oral overlap
where to inject and how often for uzedy
abdominal or upper arm subq inj
given once monthly or every 2 months
what is the injection schedule of Invega Sustenna
loading dose then booster then every 5 weeks after loading dose
where to inject invega sustenna
deltoid
how long to oral overlap invega sustenna
if started correctly theres no need for oral overlap
when to adjust dose in invega sustenna
moderate to severe renal impairment
how to start invega trinza
can start if stable on sustenna for at least 4 doses
where to give invega trinza
deltoid
when do you not give invega trinza
CrCl < 50 mL/min
how to start invega hafyera
can start after 4 doses of sustenna or 1 dose of trinza
where to inject invega hafyera
gluteal injection only
when to not give invega hafyera
CrCl < 90
what is required for zyprexa relprevv
REMS
what is a major side effect of zyprexa relprevv
PDSS (post dose delirium sedation syndrome)
overlap requirements for abilify maintena
must overlap with oral aripiprazole for at least 14 days
where to inject abilify maintena
deltoid or gluteal injections
when to adjust the dose adjustments for abilify maintena
if taking 2D6 or 3A4 inhibitors or inducers for more than 14 days as concomitant therapy
what is the overlap for abilify asimtufii
continue oral aripiprazole for 2 weeks after 1st injection
asimtufii frequency and where to inject
every 2 month dosing
gluteal injections only
overlap for aristada
oral overlap with aripiprazole for 3 weeks
overlap for initio
no need for 3 week overlap
when to avoid use of initio
patients who are poor 2D6 metabolizers or 2D6 inhibitors
what are the IR/emergency injections
haloperidol, chlorpromazine, fluphenazine
