Schizophrenia

Question 1

Schizophrenia rough Tx guidelines

Answer 1

FGA for positive symptoms.
- High EPS risk.
- Low metabolic syndrome risk.
SGA for positive and negative symptoms.
- Low EPS risk.
- High metabolic syndrome risk.
- Possible increase in cognition.

Question 2

FGA Dosing

Answer 2

Based on Chlorpromazine (CPZ) equivalents:

- 300-1000 mg CPZ equivalents.

Question 3

TMAP Schizo Tx guidelies

Answer 3

First episode psychosis
- SGA
Acute severe psychosis (acute positive symptoms)
- Haldol (FGA)
- Olanzapine (SGA)
Maintenance
- Younger: SGA
- Middle: SGA or FGA
- Treatment resistant: FGA or clozapine
- Pregnant: clozapine or lurasidone (category B)

Question 4

Special Considerations

Answer 4

Ziprasidone and Lurasidone - must be taken with food.
Most common EPS symptom = akathisia (agitation, distress, restlessness).
Avoid Ziprasidone if cardiac concerns.
Risk EPS increased on Risperidone > 6mg.

Question 5

Treatment Resistant patients

Answer 5

Tried FGA or SGA
Tried a different FGA or SGA
Now try Clozapine

Question 6

Clozapine use

Answer 6

Require weekly lab draws
REMs Clozapine Registry
“RPh dispense until next lab draw.”
Avoid smoking

Question 7

Relative risk of Weight Gain

Answer 7

Highest: SGA’s - Olanzapine=Clozapine
Med-High: low potency FGA
Medium: risperidone=paliperidone=quetiapine
Med-low risk: med potency FGA
Low risk: high potency FGA=aripiprazole=ziprasidone

Question 8

Relative risk of Diabetes/Insulin Resistance

Answer 8

High: SGA - Clozapine, Olanzapine
Moderate: SGA - Quetiapine, Risperidone
Lower: Ziprasidone, Aripiprazole, and FGA’s

Check HbAIc and BG quarterly when on SGA’s.

Question 9

Relative risk of Prolactin Elevation

Answer 9

Highest: Risperidone=Paliperidone=Haldol
High: FGA
Medium-high: Olanzapine
Med: Ziprasidone
Med-low: Quetiapine=clozapine
Low: aripiprazole

Question 10

Relative risk of QT Prolongation

Answer 10

Highest: Thioridazine, Pimozide
High: Ziprasidone > Paliperidone
Med-high: Quetiapine=Risperdione=Olanzapine=Haloperidol
Med: Clozapine
Med-low: Aripiprazole=Fluphenazine=Chlorpromazine