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PT2 Psyche 1-6 > schizo therapeutics > Flashcards

schizo therapeutics Flashcards

1
Q

first week response of medication use

A
  • medicated cooperation
  • less agitation
  • decreased hallucinations
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2
Q

weeks 2-4 response of medication use

A
  • improved socialization
  • hygiene
  • mood
  • improved hallucinations/delusions
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3
Q

weeks 4-8 response of medication use

A
  • improved thought disorder
  • less hallucination/delusions
  • appropriate conversations
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4
Q

duration of treatment after first episode

A

12 months after remission

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5
Q

duration of treatment after 2nd episode

A

likely life-long

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6
Q

response to treatment is considered

A

20% improvement in symptoms

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7
Q

olanzapine ODT is absorbed where

A

the gut

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8
Q

general antipsychotic dosing

A
  • start Qd to QID
  • titrate to control symptoms
  • taper slowly if switching
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9
Q

withdrawal symptoms of antipsychotics

A

nausea

headache

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10
Q

medication selection

A
  • First episode = 2nd Gen
  • Second choice = 2nd gen or 1st gen
  • Third choice = clozapine
  • Fourth choice = clozapine augment
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11
Q

first generation antipsychotics

A 
chlorpromazine
perphenazine
haloperidol
fluphenazine
loxapine
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12
Q

aripiprazole (abilify) dosing

A
  • 10 to 30 mg/day
  • no renal adjustment
  • adjust in severe hepatic impairment
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13
Q

aripiprazole side effects

A

GI
akathisia
insomnia
*High risk fo extrapyramidal events and somnolence in adolescents

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14
Q

aripiprazole cautions

A

CV disease

HTN

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15
Q

clozapine (clozaril) benefits

A

improves suicidality, violence

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16
Q

clozapine dosing

A
  • 12.5 mg - 900 mg daily, titrate slowly
  • avoid in CKD
  • caution in hepatic failure
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17
Q

clozapine side effects

A
  • high metabolic risk
  • sedation
  • hypotension
  • agranulocytosis
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18
Q

clozapine monitoring

A

CBC with REMS for agranulocytosis weekly for the first 6 months

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19
Q

Olanzapine (zyprexa) dosing

A

5-20 mg daily

no renal dose adjustment

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20
Q

olanzapine contraindications

A

narrow-angle glaucoma

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21
Q

olanzapine side effects

A
  • extreme weight gain

- sedation

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22
Q

paliperidone (invega) dosing

A
  • 3-12mg daily

- adjust for renal impairment

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23
Q

paliperidone side effects

A
  • orthostatic hypotension
  • headache
  • akathisia
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24
Q

quetiapine (seroquel) dosing

A
  • IR and ER
  • 50-800 mg qday
  • start 25 mg for elderly
  • take ER one hour before meal
  • no renal dose adjustment
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25
Q

quetiapine side effects

A
  • sedation
  • orthostatic hypotension
  • weight gain
26
Q

risperidone (risperdal) dosing

A
  • 1-16 mg daily

- adjust for renal and hepatic impairment

27
Q

risperidone side effects

A

highest EPS rate of 2nd gens

28
Q

ziprasidone (geodon) dosing

A
  • 20 - 80 mg BID with food
  • no renal dose adjustment
  • do adjust for hepatic impairment
29
Q

ziprasidone side effects

A
  • risk of QTc prolongation

- low weight gain

30
Q

asenapine (saphris) dosing

A
  • start 5 mg SL BID
  • max is 10 mg BID
  • do not eat or drink for 10 minutes after taking
  • no adjustment for renal impairment
31
Q

asenapine contraindications

A

hepatic impairment

32
Q

asenapine side effects

A
  • general antipsychotic side effects (anticholinergic, orthostatic hypotension)
  • LOW WEIGHT GAIN
33
Q

iloperidone (fanapt) dosing

A
  • initial 1 mg bid, titrate slowly to 12 mg bid

- no renal adjustment

34
Q

iloperidone side effects

A
  • tachycardia
  • hypotension
  • low risk of akathisia and weight gain
35
Q

lurasidone (latuda) dosing

A
  • start 40 mg daily
  • maintenance dose up to 80 mg daily
  • taken with food
  • adjust renally and hepatically
36
Q

lurasidone side effects

A
  • akathisia is common
  • somnolence
  • weight neutral or loss
37
Q

brexpiprazole (rexulti) dosing

A

-1mg daily titrated to max of 4mg daily

38
Q

brexpiprazole side effects

A
  • less akathisia

- favorable metabolic profile

39
Q

cariprazine (vraylar) dosing

A
  • 1.5 mg daily up to max of 6 mg

- avoid in renal and hepatic problems

40
Q

cariprazine side effects

A
  • favorable metabolic profile

- side effects are delayed due to long half life

41
Q

short acting prn injectables max doses

A
  • haloperidol no max
  • olanzapine 30 mg/day
  • ziprasidone 40 mg/day
  • aripiprazole 30 mg/day
42
Q

olanzapine long acting (zyprexa relprevv) monitoring

A

must be kept on site for 3 hours to watch for sedation and delirium

43
Q

paliperidone (invega trinza)

A
  • long acting, 3 month formulation

- must have had 5 doses of invega sustenna before getting trinza

44
Q

how to treat delirium

A
  • nonpharm approach
  • antipsychotics if there is risk of self harm
  • avoid benzos
45
Q

acute agitation nonpharm

A
  • decrease noise and stimulation
  • observe carefully
  • calm communication
  • open ended questions
  • avoid challenging delusions
  • orientation
46
Q

medications for acute agitation

A
  • lorazepam po or im ever 1-2 hours
  • short acting injectables
  • loxapine
47
Q

avoid combining what drugs with olanzapine

A

benzos due to sedation

48
Q

extrapyramidal side effects of antipsychotics

A
  • acute dystonia
  • pseudoparkinsonism
  • akathisia
  • tardive dyskineasia
  • neuroleptic malignant syndrome
49
Q

treatment for acute dystonia

A

benztropine

diphenhydramine

50
Q

treatment for akathisia

A

propranolol

benzos

51
Q

treatment for pseudoparkinsonism

A

anticholinergics (benztropine, diphenydramine)

52
Q

tardive dyskinesia treatment

A

tetrabenzine
reserpine
clozapine if indicated

53
Q

treatment for neuroleptic malignant syndrome

A

dantrolene

54
Q

drugs with highest risk of orthostatic hypotension

A

clozapine

olanzapine

55
Q

drugs with lowest risk of orthostatic hypotension

A

aripiprazole
brexiprazole
cariprazine

56
Q

drugs with highest risk of QTc prolongation

A

thioridazine
ziprasidone
iloperidone
haloperidol

57
Q

drugs with most sedation

A

olanzapine

clozapine

58
Q

drug with least sedation

A

aripiprazole

59
Q

drugs with lower risk of metabolic problems

A

asenapine
iloperidone
aripiprazole

60
Q

monitoring for atypical antipsychotics

A
  • weight every 4 weeks
  • waist circumference annually
  • blood pressure and fasting glucose @ 12 weeks then annually
  • fasting lipids @ 12 weeks then every 6 years

PT2 Psyche 1-6 (6 decks)

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