Schizophrenia Flashcards
Which drugs in schizophrenia are used for RAPID acute tranquilization
RAPID IM:
1) Haloperidol
2) Aripiprazole
3) ziprasidone
4) zyprexa
HAZZ*
Deconate formulations for typicals/Atypicals
Haldol : monthly
Fluphenazine: 2-4 weeks
Risperdal Consta: IM Q 2W
Paliperidone Palmitate: Invega sustenn, Invega Trinza
Aripiprazole: Abilify Maintena
Aripiprazole lauroxil (Aristada) IM Q4-6 wks
Olanzapine(zyprexa Relprevv)
Which agents increase prolactin the most?
Galaxtorrhea, amenorrhea, gynecomastia, and impotence
From 2nd Gen:
1) Risperidone
2) Paliperidone
**Aripiprazole has NOT been shown to elevate prolactin levels
Thorazine
Chlorpromazine
Mellaril
Thioridazine
TYPICAL
Serentil
Mesorridazine
TYPICAL AP
Loxitane
Loxapene
**Adasuve for ACUTE aggitation assoc w/ schizo
** ORAL INHALATION by HCP
caution: bronchoconstriction
Moban
Molindone
TYPICAL AP
Trilafon
Perphenazine
TYPICAL
Stelazine
Trifluoperazine
TYPICAL
Navane
Thiothixene
Typical
Prolixin
FluPhenazine
Haldol
QT prolongation
Torsades de pointes
Orap
Pimozide
Used for TOURETTES ONLY
QT PROLONGATION
Ingrezza
Valbenacine
Treats: Tartive dyskinesia
Reduces dopamine release into synaptic cleft
What is treatment for NMS ??!
1) D/C AP
2) IV FLUID, COOLING, decrease BP
3) ^ DA with DA agonist (BROMOCRIPTINE)
4) Dantrolene - muscle relaxant treatment of malignant hyperthermia
( Dantrium- PO caps, Revonto- IV, Ryanodex-IV)
Clozaril, FazaCLO, versaCLOZ,
ClozaPINE (ATYPICAL)
MOA: blocks D4, 5HT2, alpha, H1
Treats: schizo thats treatment resist.
Forms: oral tabs
FazaCLOZ - ODT
VERSACLOZ - oral yello SUSP
DI: substrate of CYP1A2, caution w/ fluvoxamine and CIPROFLOXACIN
Benefit: DOES NOT CAUSE EPS OR TD or PROLACTIN
SE: agranulocytosis: > 1500 prior to starting
Myocarditis: BBW W/ Heart Disease
Thromboembolic eventS: PE
ORTHOSTASIS** ( BBW)
Hypersalivation & sweating
Seizures > 600mg/d
^ glycemia/ lipids/ weight gain
** SEDAtion**
PART OF REMS PROGRAM
Risperdal
Risperidone
Treats: schizophrenia, Bipolar mania, autism
Forms: oral tabs
ODT
oral SOLN
IM depot (CONSTA) - Q2 Wks. Tabs for 3 wks comb
Se: ^EPS, mod weight gain, slight ^ prolactin
Zyprexa/ Zydis
Olanzapine
Treats: schizo, bipolar disorder, depress assoc w/ bipolar, Depression thats TREATMENT RESISTANT.
Forms: oral tabs
ODT - Zydis
IM- Zyprexa RelPREV
IM- RAPID
SE: WEIGHT GAIN + DIABETES more common
Hyperglycemia, hyperlipidemi,
Monitor: weight, Glucose, Lipids, DRESS( rash, fever s/s), IM - Orthostasis,
Zyprexa RELPREVV program ( LIKE REMS)
Combo: symbyax(olazapine + fluoxetine)
Seroquel/ seroquel XR
Quetiapine
Treats: schizo
Bipolar
Major depp disorder(MDD)
Forms: oral tabs only
XR: Empty stomache or light meal
SE: hepatic dsfx & HYPOTENSION
GeoDON
Ziprasidone
Forms: oral tabs
IM
Treats: schizo & Bipolar disorder
W/ food increases ABSORPTION (20mg BID)
MAX: 80mg/d
**Acute agitaion: 10-20mg IM (RAPID)
Advantages: **low WT GAIN, NO diabetes
SE: QT PROLONGATION(BBW), bradycardia, decrease electrolytes)
**WARNING: ziprasidone is assoc w/ rare but serious SKIN rxs. If your patient has fever w a RASH and or swollen lymph glands they must seek URGENT MEDICAL ATTENTION
Abilify, Aristada-IM
Aripiprazole
MOA: partial agonist of D2 and 5-HT1a, and as an antagonist at the 5-HT2a receptor
Forms: (tabs, ODT, oral sln, IM-DEPOT & RAPID)
Maintena- once MONTHLY
Aristada- IM 4-6 WEEKS
Indication: schizophrenia
Bipolar
Depression
Autism
Dose: 10-15mg QD. Max 30mg/d
Substrate of CYP3A4 & 2D6, WATCH FOR DRUG INTERACTIONS
Advantages: LONG T1/2
No weight GAIN,
NO CARDIAC, LOW
RISK OF EPS,
Abilify Maintena: 400mg IM Monthly
Aristada: q4-6 weeks (3wks of ORAL)
- ## Strong 2D6 or 3A4 inhibitors (300mg)
InvegA
Paliperidone
Indication: schizophrenia
MOA: Blocks D2, S2, alpha 2
Forms: 1.5mg, 3mg, 6mg, 9mg tabs
Deconate IM FORM
Dose: ER tabs; 3-12QD
Delivers smooth plasma levels over 24 hrs. (OROS)
Dosing: INDIVIDUALIZED specifically to pts RENAL FUNCTION
Max: 3mg for mod-severe RENAL impairment
Max: 6mg for mild RENAL
Caution: Can PROLONG QT interval
Invega Sustenna
Paliperidone XR IM
Deconate formulation
117mg IM MONTHLY
- DOES NOT need PO overlap
Administered in: DELTA OR GLUTEAL
Invega TRINZA
Paliperidone DEC
- 3 MONTH IM
: used only after they have been on MONTHLY IM paliperidone (Invega sustenna) for at least 4 months
: DELTOID OR GLUTEAL
Fanapt
iLoperidone
Treats: schizo
Forms: tabs ONLY
- TITRATE SLOWLY TO AVOID ORTHOSTASIS
- Not recommended in HEPATIC impairment
- QT prolongation**
- DI: Reduce dose by 1/2 when w/ CYP2D6 & CYP3A4
Which Antiphsychotics have the most ORTHOSTASIS?
Clozaril (clozapine)
iLoperidone (Fanapt)
Saphris
Asenapine
Treats: schizo/ Bipolar
MOA: serotonin, adrenergic, alpha,D, H1
Forms: SUBLINGUAL ONLY!!!
Administration: DONT EAT OR DRINK FOR 10 minutes!!!!
Warnings: SERIOUS ALLERGIC RXNS
Latuda
Lurasidone
Treats: schizophrenia
DEPRESSIVE episodes assoc w/ Bipolar
Forms: 40/80mg tabs
Dose: w/ FOOD**
Drug INTERACTIONS: It is contraindicated w/ strong **CYP3A4 inhibitors and inducers. **
May cause NEUTROPENIA/LEUKOPENIA
NO QT PROLONGATION
REXulti
MOA: partial D2 agonist/ antagonist of 5-HT2a
Indications: Major Depressive Disorder
SchiOphrenia: 1-4mg QD
Dosage forms: tabs
DI:
- Strong CYP2D6 (fluoxetine/paroxetine) & CYP3A4 inhibitors DECREASE THE DOSE
- STRONG inducers : double the DOSE
Vyraylar
Cariprazine
PARTIAL AGONIST OF D2
treats: Bipolar & SchizophreniA
Form: CAPSULES
Dose: DAILY ONLY !! LONG HALF LIFE
SE: RESTLESSNESS and INSOMNIA
DI: Vraylar is CYP3A4 substrate
BBW: Dont give in DEMENTIA related psychosis
Which AP has the best efficacy for schizophrenia?
Clozapine
- save for RESISTANT because of SEVERE AGRANULOCYTOSIS
Which AP has the most weight gain, DM, dyslipidemia, and antichinergic!!
Clozapine
Olanzapine
Which AP have lowest to NO weight GAIN?
Ziprasidone
Lurasidone
Aripiprazole
Note: iLoperidone has a moderate wt gain and low DIABETES & dyslipidemia
Which AP do I recommend if I’m worried about QT prolongation?
ABILIFY (aripiprazole)
LaTUDA (lurasidone)
RexuLTi (brexpiprazole)
Vraylar (caripazine)
Which AP can I recommend for RESISTANT DEPRESSION?
1) Abilify
2) Seroquel XR
3) Symbyax
4) Brexpiprazole (Rexulti)
Which AP can I recommend for Bipolar?
1) Risperidone
2) Geodon (zuprasidone)
3) Abilify
4) Seroquel
5) Saphris
6) Latuda
7) Zyprexa
8) vraylar
Which AP are ODT?
Clozapine
Olanzapine
Abilify
risperidone
(ROCA)
Which AP MUST be taken w/ FOOD?
LATUDA (Lurasidone)
GEODON (Ziprasidone)
Which AP must be taken on an EMPTY STOMACHE?
Quetiapine XR
Treatment for akathesia?
Propanolol
Lorazepam
Parkinsonism
Benztropine
Amantadinr
Treatment of dystonia?
Benztropine
Diphenhydramine
How to treat NMS?
Bromocriptine - D2 agonist
Dantrolene - muscle relaxant
Cooling blankets - lower TEMP
Which AP is available as a sublingual tablet?
Asenapine
Which AP are available as an ORAL SOLUTION?
Aripiprazole
Clozapine
Risperidone
Which AP is available as an oral INHALATION?
Loxapine (ADASUVE)
