Schizophrenia Flashcards
A normal extrapyrimidal system requires a balance of ___ and ___ concentration.
And what is Schiz vs PD
Dopamine and ACh
Schiz = too much DA
PD = too much ACh
What is the diagnostic criteria for schiz
2/5 >1 month
- hallucination
- delusions
- disogranized speech
- Disorganized behavior
- Negative symptoms
1-4 are positive symptoms
What is the difference between typicals and atypicals?
Typicals - block DA2 and affect positive symptoms
Atypicals - block Da2 and 5HT2 and affect positive and negative symptoms
Major ADE of schiz drugs
Tardive dyskinesia
Neuroleptic malignant syndrome
Sedation
anticholinergic effect
Orthostasis
Hyperprolactinemia
Weight gain
What are four EPS side effects? What are they and how long do they last?
What are the treatments?
Dystonia - painful muscle spasm - hours to days - treat with IM/IV benedryl or benztropine
Akathisia - restlessness - days to weeks - treat with lorazepam or propranolol
Psudeoparkinsonism - Resting tremor - weeks to months - treat with anticholinergic
Tardive dyskinesia - Hyperkinetic movement - treat with Valbenazine (ingrezza)
Describe cause, symptoms, labs, and treatment of neuroleptic malignsnt syndrome
Caused by too little dopamine
S/Sx: rigidity, fever, diaphoresis, increased BP/HR
Kabs - increased CPK and WBC
Tx: D/C antipsychotic, fluids, bromocriptine (DA agonist), then dantrolene (muscle relaxant)
What are three rapid IM atypicals/typicals for rapid tranquilization?
Haloperidol
Arpiprazole
Ziprasidone
Zyprexa
Clozapine
Brand
Class
Forumulations
Benefits?
ADE
Clozaril
Atypical
Tabs
ODT (FazaClo)
Suspension (Versacloz)
Doesn’t cause EPS or TD and no effect on prolactin
Agranulocytosis (baseline ANC must be >1500)
Myocarditis, OH
Seizure
Risperidone
Brand
Class
Indications
Formulations
ADE
Risperdal
Atypical
FDA approved for schiz, BPD, and autism
Tabs, ODT, solution, IM
Most EPS riskO
Olanzapine
Brand
Indications
Formulation
ADE
Zyprexa , Zydis
Schiz, BPD, depression with fluoxetine
Tabs, ODT, Sublingual (Zydis)
most risk of weight gain and diabetes
How do you take seroquel?
XR on empty stomach
Ziprasidone
Brand
Indication
Frequency and max
Advantages
ADE
Geodon
Schiz and BPD
BID with food MAX 80mg/day
No weight gain or risk of diabetes
QT prolongation
Arpiprazole
Brand
MOA
Indication
Frequency and max
Formulation
Abilify
Partial agonist of D2 and antagonist of 5HT
Schiz, BPD, depression, autism
Daily , max 30mg/day
Tabs, ODT, solution, IM
How to start Abilify Maintena and Aristada
Must overlap with oral for 2 weeks
With Aristada, must overlap for 3 weeks
Paliperidone
Brand
Indication
Frequency
Active metabolite of…
Renal adjustment
ADE
Invega
Schiz
Daily
Risperidone
Max 3mg/day if renal impairment or elderly
QT prolongation
Invega Sustenna
Frequency, route, Initiation
IM monthly that does NOT need PO overlap
Invega Trinza
Frequency, route, initiation
Every 3 months IM only after they’ve been on invega sustenna for 4 months
Iloperidone
Brand
Indication
ADE
Fanapt
Schiz
OH (because of alphha-adrenergic blocking properties),
QT prolongation
Asenapine
Brand
Indication
ROA / frequency
Saphris, Secuado
Schiz, BOD
Saphris - sublingual BID
Secuado- patch QD
Lurasidone
Brand
Indication
Frequency and max
Contraindication
Advantage
Latuda
Schiz, BPD
QD with food max with 160mg/QD
3A4 inhibitors and inducers
Does not cause QT prolongation
Brexpiprazole
Brand
MOA
Indication
Frequency
Rexulti
Partial DA agonist and 5HT antagonist
Schiz, MDD
Daily
Cariprazine
Brand
MOA
Indication
Frequency
BBW
Vraylar
Partial DA agonist and 5HT antagonist
Schiz, BPD
Daily (ultra long half-life)
Increase risk of death in elderly patients with dementia-related psychosis
Lumateperone
Brand
MOA
Indication
Dose and frequency
BBW
Advantage
Caplyta
5HT and DA antagonist
Schiz
42mg daily with food (only one strength)
Increase risk of death in elderly patients with dementia-related psychosis
Less weight gain, DM risk, EPS, and QT prolongation
What is the only antipsychotic that does not require hepatic impairment adjustment?
Paliperidone (invega)
What four AP’s come in ODT?
Olanzapine, clozapine, arpiprazole, risperidone
What AP’s do you take with food vs empty?
Food - lurasidone and ziprasidone
Empty - Seroquel XR
Which 2 AP’s have highest risk of weight gain, DLD, DM, and anticholinergic effects?
Clozapine and olanzapine
