Schizophrenia Flashcards
schizophrenia patho
dec brain size and asymmetry, inc ventricle size, dec grey matter
DA deficit
dx of schizo
delusions
hallucinations
disorganized speech
grossly disorganized or catatonic behavior
negative sx
2 or more of these present for significant portion of time in 1 month period that affects work, relationships, school etc.
what is considered tx resistant
pt trialed on 2+ APs for at least 8 weeks on optimized dose
mixing FGA and SGA can mitigate bennies of
SGA
FGAs includes
haloperidol
chlorpromazine
periphenazine
fluphenazine
thioridazine
thiothixene
FGAs AE and BBW
EPS (tardive dyskinesias, akesthesias,
QTc p
inc prolactin level
derm
photosnes
blue-grey skin
orthostatic hypotension
altered thermoregulation
BBW: dementia related psychosis;inc mortality in elderly patients w dementia-related psychosis
SGAs includes
aripiprazole
quetiapine
clozapine
olanzapine
ziprasidone
risperidone
lurasidone
blexiprazole
paliperidone
cariprazine
Iloperidone
SGAs AE and BBW
QTc p
anticholinergic
inc prolactin (palperidone, risperidone)
dec seizure threshold
blood dyscarias
sedation
ophthalmic (quetiapine)
BBW: dementia related psychosis; inc mortality in elderly patients w dementia-related psychosis
tx options if pt is AP naive
risperidone, aripiprazole, ziprasidone (any AP except clozapine)
high potency FGA and AE trend
hapoperidol
fluphenazine
thiothixine
trifluoperazine
perphenazine
higher EPS, less anticholinergic risk
APs that have the most inc prolactin
FGA:
thioridazine
thiothixene
chlorpromazine
fluphenazine
haloperidol
SGA:
risperidone
paliperidone (P!)
FGAs w anticholinergic AE
thioridazine
chlorpromazine
loxapine
molindone
Aripiprazole
weight gain?
sedation?
key AE?
dosage forms
less weight gain
less sedation
can cause IMPULSIVITY, insomnia, akathisia, restlessness,
LAI (maintena, aristada)
new products: mycite and aristada initio
asenapine
bennies
AE
pearl
new topical patch available!
change patch daily on upper arm, back, abdomen, hip
little weight gain, least sedating and anticholinergic AE
CI in severe heaptic disease
high risk of QTc prolongation
topical patch may cause skin irritation
anaphylaxis at a single dose
impulsivity AE
aripiprazole
brexipiprazole
brexipiprazole
AE
pearls
IMPULSIVITY
akasthisia (DOSE RELATED)
t1/2 = 91 hours
less metabolic changes than others
po only!
caripiprazole (vraylar)
pearls
akasthisia (dose related)
long t1/2 2-4d
clozapine
blood dyscrasia
QTc prolongation
constipation–> NEED bowel regimen
seizure
myocarditis
METABOLIC CONDITIONS
monitoring? see notes
Iloperidone
ORTHOSTATIC HYPOTENSION–> titrate slowly
less sedating and no prolactin increase
po only!
if on CYP-is –> dec dose 50%
which APs are PO only
brexipiprazole
Iloperidone
lurasidone
lumateperone
pimavanserin
Lumateperone
no metabolic, EPS, ECG changes
po only!
well-tolerated
Olanzapine
forms
AE
REMS?
uses
REMS for post-injection delirium and sedation syndrome
metabolic, ANC, QTc, sedation issues
DRESS!!!
sedation, metabolic issues, QTc, ANC
used in sz w acute BPD monotherapy
which APs have REMS and what is the REMS for?
Clozapine - blood acrasias
Olanzapine - post-injection delirium and sedation syndrome
Quetiapine
misused, do not use as sleep aid
QTc, sedation, metabolic issues
metab by 3A4
risperidone
LAI (IM and SQ), po, ODT, po suspension
INC PROLACTIN\
SQ uncomfy; cant touch area
ziprasidone
po cap TAKE W FOOD, SAI IM
DRESS!
CI in patients at high risk QTc p
pregnancy may need higher/lower doses and of what medications
higher; clozapine, olanzapine
APs FDA approved in pediatrics
aripiprazole
lurasidone
olanzapine
quetiapine
palperidone
risperidone
short acting injectables
chlorpromazine
haloperidol
fluphenazine
olanzapine
ziprasidone
LAI
fluphenazine
heloperidol
aripiprazole
olanzapine
risperidone
paliperidone
injectables with no po overlap recommended/required
risperidone (LAI)
olanzapine
newer injectables (SGAs) are better bc…
water based, less discomfort and better tolerated
APs with the most sedation
chlorpromazine
thioridazine
clozapine
quetiapine
APs with the most EPS
chlorpromazine
haloperidol
fluphenazine
perphenazine
thioridazine
thiothixene
risperidone
palperidone
APs with most anticholinergic AE
chlorpromazine
thioridazine
clozapine - bowel regimen
APs w most orthostasis AE
chlorpromazine
thioridazine
clozapine
Iloperidone
APs with most weight gain
Chlorpromazine
clozapine
olanzapine
Aps with most CV AE
haloperidol
chlorpromazine
clozapine
Iloperidone
Ziprasidone
acute dystonias tx
anticholinergics or benzos IM
pseudoparkinsonism tx
anticholinergics
tardive dyskinesias tx
prevention is key, switch AP, use Ingrenna
caution: anticholinergics MASK sx
anticholinergic AE tx
bowel preps
akathisia AE tx
dec dose, BBs (propranolol, nadolol, metoprolol)
new tx Lybalvi is ___ + ___
olanzapine +samidorphan
need 7d opiate free period or 14d LA-opiate free period
positive sz sx
hallucinations
delusions
ideas of influence
disorganized speech
discontinued thoughts
negative sx sz
AAAA
flat Affect
Alogia - not speaking
Anhedonia
Avolition
A patient starts an AP for sz and calls saying they see a capsule in their stool and is concerned. Which AP is this
Paliperidone
pt has parkinsons psychosis and has associated delusions and hallucinations
what is the best tx option
Pimvanserin
APs metabolized by CYP3A4
Aripiprazole
Brexipiprazole
Cariprazine
Clozapine
Iloperidone
Lurasidone
Lumateperone
Paliperidone
Pimaavanserin
Quetiapine
Ziprasidone
(All except risperidone, olanzapine, asenapine)
patient is experiencing significant impulsivity on their new AP
which APs cause this
aripiprazole
brexipiprazole
pt receiving a LAI SQ and is instructed not to touch the area or let clothing touch the area. patient also later develops significant gynecomastia. which LAI is this
Risperidone LAI
which APs are ODT
risperidone
clozapine
olanzapine
patient is informed that a new AP was released that is a patch. which AP is this
asenapine
which APs have dose-related akasthinia
brexipiprazole
cariprazine
patients should avoid smoking in which APs and why
clozapine and olanzapine
induced 1A2 which decreased Cp of AP
if smoking, need increased dose. if quits smoking, decrease dose
which APs have long t1/2s and what are the half-lifes
brexipiprazole 91h
cariprazine 2-4d
REMS program for clozapine - how frequently do draws need to be done
qwk x6mo then BIW x6mo then qmo
pt takes AP po for the first time and is experiencing significant orthostatic hypotension.
which AP is this and how could it be prevented
Iloperidone
slow titration needed!
avoid ______ if taking strong CYP3A4 inhibitors or inducers
Lurasidone
which AP now approved for 10-17 yo w BPD type I in addition to MDD w BPD I
Lurasidone
patients need bowel regimen when on
clozapine
paliperidone
pt wants to switch from LAI Invega Sustena to LAI Trinza. how long does pt need to be on Sustena before they can try Trinza
4 months of qmo injections
which APs have BBW for use in patients with dementia-related psychosis
all APs
Ziprasidone CI with
high risk QTc p
