Schizophrenia Flashcards
first generation aka typical antipsychotics have an increased risk of which side effects?
High potency have more extrapyramidal symptoms (uncontrollable tremors and jerking), akathesia (restlessness), tardive dyskinesia (abnormal facial movements), hyperprolactinemia, neuroleptic malignant syndrome.
Low potency have more sedation, ortho hypo, anticholinergic s/e, weight gain, lower seizure threshold.
Mid potency have less incidence of s/e
list some high potency FGA
haloperidol, pimozide, flupentixol, fluphenazine, trifluoperazine
list some low potency FGA
chlorpromazine, methotrimeprazine
list some mid potency FGA
loxapine, zuclopenthixol, perphenazine
what makes second generation aka atypical antipsychotics different from first?
less EPS and more other side effects due to binding affinity to other neurotransmitters
when initiating antipsychotics, titrate gradually over ___. An adequate trial is ____. If stable, continue therapy for ____ and up to ____ in certain patients.
when initiating antipsychotics, titrate gradually over 1-2 weeks. An adequate trial is 4-6 weeks. If stable, continue therapy for 1-2 years and up to 5 years in certain patients.
when discontinuing antipsychotics, decrease dose by ___ every ___ over _________.
when discontinuing antipsychotics, decrease dose by 20% every 2-4 weeks over 6-12 months for 1st episode, 6-24 months for >=2episodes.
how to switch antipsychotics
crossover technique over 2wk-3mths
treatment resistant schizophrenia is defined as
failure to respond (less than 20% improvement in symptoms) to 2 or more adequate trials (4-6 wks)
what is used for treatment resistant schizophrenia? why is it reserved for this purpose in terms of efficacy and safety?
clozapine (SGA)
effective in reducing aggression, suicidality, mortality
risk of agranulocytosis requires registering into a brand specific registry which conducts regular lab monitoring
what must you consider and check before dispensing clozapine
Clozapine brands are not interchangeable, patients must enroll into a brand specific registry, must call registry to confirm that the patient’s labwork is done and clears them to take clozapine. Must also contact physician for retitration if patient misses dose for over 48 hours.
what are other side effects to monitor for clozapine?
sedation, dizziness, hypersalivation, tachycardia (may indicate myocarditis), and constipation (take osmotic laxatives, not fibre). also monitor for weight gain and metabolic disturbances
what are signs of agranulocytosis?
flu-like symptoms (fever, chills, sore throat), mouth sores, weakness or lethargy.
which SGAs are most sedating?
clozapine, olanzapine, quetiapine
which SGAs cause the most insomnia?
aripiprazole, paliperidone
which SGAs cause the most EPS?
risperidone, paliperidone
which SGAs cause the most weight gain?
clozapine, olanzapine, quetiapine
which SGAs cause the most metabolic disturbances?
clozapine, olanzapine (glucose and lipids)
which SGAs cause the most hyperprolactinemia?
risperidone, paliperidone
which SGAs have the most CV effects?
clozapine, ziprasidone (ortho hypo and QT)
which antipsychotics are also available IM? what are the benefits of IM
Aripiprazole*, olanzapine, paliperidone, risperidone
increased adherence, remission, reduced hospitalization, relapse
*must tolerate PO x14d before starting IM
Administration counselling points for SGA?
take Lurasidone and ziprasidone w food for absorption
take aripirazole QAM due to insomnia
Combination antipsychotics may be used when?
May combine oral first line antipsychotics (aripiprazole, risperidone, ziprasidone) with LAIs if inadequate response to monotherapy (according to Dipiro)
