Schizophrenia

Question 1

Aripiprazole

Answer 1

SE: akathisia/anxiety
CYP: 2D6 and 3A4 substrate
LAI must have 2 or 3 week overlap with oral therapy

Question 2

Asenapine

Answer 2

SL only
SE: moderate weight gain, metabolic syndrome, QT prolongation
CYP: 1A2 substrate
Smoking decreases bioavailability

Question 3

Brexpiprazole

Answer 3

SE: moderate risk of weight gain (more than abilify), less risk of akathisia than abilify
CYP: 2D6 and 3A4 (dose adjustments when used with inhibitors or inducers of those)

Question 4

Cariprazine

Answer 4

SE: moderate risk of weight gain, high risk of akathisia
CYP: 3A4
Not recommended in hepatic or renal dysfunction

Question 5

Clozapine

Answer 5

MOST EFFECTIVE
SE: significant, requires dose titration, agranulocytosis (REMS), cardiomyopathy, hypersalivation, hypotension, metabolic syndrome, dose-related seizures, QT prolongation, constipation, sedation
CYP: 1A2
REMS: must monitor ANC weeklyx6 months then biweeklyx 6 months, then every 4 weeks

Question 6

Iloperidone

Answer 6

BOXED WARNING FOR QT PROLONGATION
SE: orthostatic hypotension (so slow dose titration), moderate weight gain, metabolic syndrome
CYP: 2D6 and 3A4
BID dosing
Do not use under 18 years old

Question 7

Lurasidone

Answer 7

1st line
Must take with FOOD
SE: akathisia, low risk of weight gain/metabolic syndrome
CYP 3A4

Question 8

Olanzapine

Answer 8

Give at bedtime
SE: sedation, weight gain, hyperglycemia, hyperlipidemia, metabolic syndrome risk
CYP: 1A2
LAI: Zyprexa Relprevv, REMS requires pts to consent ton treatment and monitoring after dose. every 2-4 weeks

Question 9

Paliperidone

Answer 9

Osmotic release
metabolite of risperidone
GHOST TABS
SE: EPS, hyperprolactinemia, moderate weight gain/metobolic syndrome, QT prolongation
LAI: Invega sustenna- q4 weeks
Invega Trinza- q12 weeks

Question 10

Quetiapine

Answer 10

BOXED WARNING FOR QT PROLONGATION
SE: sedation, weight gain
Abuse potential b/c similar to benzos
CYP: 3A4

Question 11

Risperidone

Answer 11

1st line treatment
SE: higher risk of EPS (especially in younger black males), hyperprolactinemia, weight gain
CYP: 2D6
LAI: Risperdal Consta- q2weeks: take with oral for 3 weeks

Question 12

Ziprasidone

Answer 12

BID, can be giving qd
MUST TAKE WITH FOOD
SE: lower risk of weight gain/metabolic syndrome, lower risk of akathisia, QT prolongation
DRESS warning

Question 13

Chlorpromazine

Answer 13

1st antipsychotic

antihistamine side effects

Question 14

promethazine

Answer 14

antihistamine, antiemetic

Question 15

thioridazine

Answer 15

many SE’s: anticholinergic, sedation, sexual dysfunction, cardiovascular

Question 16

Fluephenazine

Answer 16

EPS

Available as IM Depot (must z track)- no need to overlap oral dosing

Question 17

Prochlorperazine

Answer 17

Antiemetic

Question 18

perphenazine

Answer 18

CATIE studies: combination with anticholinergic is beneficial

Question 19

Thiothixene

Answer 19

Modest EPS

Question 20

Haloperidol

Answer 20

EPS

Available as IM Haloperidol-Decanoate- every 4 weeks, must z-track

Question 21

Molindone

Answer 21

Moderate EPS

Question 22

Pimozide

Answer 22

Tourette’s disease, suppress motor and vocal tics