Schizo Flashcards
Positive symptoms
Hallucinations, delusions, ideas of influence from external forces, disorganized speech/disconnected thoughts
-dopamine antagonism
Negative symptoms
Flat affect (no emotion), alogia (inability to carry convo), anhedonia (no pleasure in anything), avolition (lack of drive/motivation)
-SGA/atypical agents
FGA APS
-chlorpromazine (low potency)
-fluphenazine (high potency)
-haloperidol (high potency)
-perphenazine (med potency)
-thioridazine (mod/high potency)
-thiothixene (mod/high potency)
FGA SE
EPS, QTc prolongation, prolactin elevation, photosensitivity, blue gray skin, orthostatic hypotension, altered thermoregulation
SGA APS
Aripiprazole, Asenapine, Brexpiprazole, Cariprazine, Clozapine, Iloperidone, Lurasidone, Lumateperone, Olanzapine, Paliperidone, Pimavanserin, Quetiapine, Risperidone, Ziprasidone
SGA SE
Metabolic syndrome, QTc prolongation, blood dyscrasia/neutropenia’s, seizure threshold, anticholinergic effects, sedation, prolactin elevation, ophthalmic effects
Short acting injectables
Chlorpromazine, Haloperidol, Fluphenazine, Olanzapine, Ziprasidone
Long acting injectables
Fluphenazine, Haloperidol, Aripiprazole, Olanzapine, Risperidone, Paliperidone
Aripiprazole clinical pearls
-May be activating and less sedating than other AEDs
-Insomnia, AKATHISIA, restlessness
-LAI
-Can cause IMPULSIVITY bc of dopamine agonism
-ODT contains phenylalanine (allergy)
-Can be used in peds
Asenapine clinical pearls
-little weight gain, least sedating and anticholinergic
-do not eat or drink 10 mins after taking SL tab
-High risk QTc, topical patch can cause skin irritation, anaphylaxis can occur
Asenapine CI
severe hepatic diseases
Brexpiprazole (Rexulti) clinical pearls
-Impulsivity
-Akathisia (dose related), long half life (91 hrs), fewer metabolic changes
Cariprazine clinical pearls
-Akathisia (dose related), long half life (2-4 days)
Paliperidone (Invega)
-EPS, Prolactin
-LAI
-Can be used in PEDs
-No PO overlap required
-Food inc bioavailability
-Tab can be in stool
-Acts like FGA
-Must be on Sustenna for 4 months before put on trinza
Clozapine clinical pearls
-Blood dyscrasia, metabolic risk, REMs program
-For refractory illness (suicidality), QTc, seizures, myocarditis, constipation, hypersialorrhea, worst for metabolic conditions (cholesterol/BP meds can help)
-Seizure risk inc with dose so might need a AED (mood stabilizer)
-If interrupted >48 hours, need to restart at lowest dose
-REMs: first 6 months: weekly draws, next 6 months: biweekly draws, 1 year: draws every month
-Should avoid benzos (lorazepam)
-orthostasis
-sedation
Iloperidone clinical pearls
-most likely to cause orthostatic hypotension (slow titration), QTc, less sedating, need 50% dose reduction if given w/ CYP inhibitors
-Not recommended in severe hepatic impairment
-cardio AE
Lurasidone (Latuda) clinical pearls
-avoid strong CYP3A4 inhibitors/inducers
-less sedation and orthostasis
-Renal/hepatic dosing needed
-Depression associated with BPD as mono therapy or adjunct to lithium or VPA
-Can be used in PEDs
Lumateperone clinical pearls
-no significant changes in metabolic parameters, not associated with inc in EPS
-Not recommended in breastfeeding
-Monitor w/ MRI for signs of multifocal lucoencepalophy
-May impair fertility, & during 3rd trimester can have EPS withdrawal, feeding disorder may occur
Olanzapine clinical pearls
-Metabolic risks, DRESS
-Post injection delirium/sedation syndrome, REMs for LAI (3 hr observation), monitor ANC
-Should avoid if on lorazepam
-Lybalvi: olanzapine + samidorphan: less weight gain, need to be off opioids for 7-14 days before initiating
-Can be used in PEDs
Pimavanserin clinical pearls
-Avoid CYP3A4s or reduce dose
-No dopamine receptor activity
-Used for treatment in hallucinations & delusions with parkinson’s disease (dopamine deficiency)
-Not recommended for renal compromise < 30 ml/min
Quetiapine (Seroquel) clinical pearls
-Sedation, metabolic issues
-Can be misused
-Often prescribed for sleep
-Can cause cataracts
-Weight gain
-Can be used in PEDs
Risperidone clinical pearls
-EPS, prolactin elevation
-Can be used in PEDs
-LAI
-Refrigeration
-There is a SQ injection that can not be touched after injected and needs to be carefully injected and pumped 50 times
-Acts like FGA
Ziprasidone
-Give with food
-DRESS
-Used for manic crisis
-CI: no use in those at risk for QTc
-Cardo AE
Acute dystonias
jaw locked up, trouble speaking
High risk APS for Acute dystonias
High potency or high dose FGA, younger men
Treatment for Acute dystonias
Anticholinergics, IM benzos, dec or d/c dose
Pseudoparkinsonism
tremor, postural abnormalities, difficulty turning
High risk APS for Pseudoparkinsonism
High potency or high dose FGA, older females
Treatment for Pseudoparkinsonism
Anticholinergics, dec or d/c agent
Akathisia
restlessness, pacing, shuffling, compulsion to stay in motion, distress
High risk APS for Akathisia
High potency FGA, aripiprazole, risperidone
Treatment for Akathisia
Beta-blockers, dec or d/c agent (propranolol, nadolol, metoprolol
Tardive dyskinesia
limb twisting, rocking, tongue thrusting
High risk APS for Tardive dyskinesia
High potency or high dose FGA, older female, AA
Treatment for Tardive dyskinesia
Prevention, d/c agent, switch APS (clozapine), use Ingrezza
NMS
Rare but lethal
high potency drugs cause but possible all APS
Risk: dehydration, organic mental disorder
treatment: d/c APS
increasedWBC,CPK,LFT
Benazines (ingrezza)
CI: MAOis
Interactions: CYP3A4 inducers/inhibitors
May prolong QTc
Metabloc syndrome
need 3 criteria: obesity, abnormal lipid panels, high BP, high BG
