Schizophrenia Flashcards by hannibal britton

Which drugs in schizophrenia are used for RAPID acute tranquilization

RAPID IM:

1) Haloperidol
2) Aripiprazole
3) ziprasidone
4) zyprexa

HAZZ*

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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)

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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

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Thorazine

Chlorpromazine

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Mellaril

Thioridazine

TYPICAL

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Serentil

Mesorridazine

TYPICAL AP

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Loxitane

Loxapene

**Adasuve for ACUTE aggitation assoc w/ schizo

** ORAL INHALATION by HCP

caution: bronchoconstriction

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Moban

Molindone

TYPICAL AP

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Trilafon

Perphenazine

TYPICAL

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Stelazine

Trifluoperazine

TYPICAL

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Navane

Thiothixene

Typical

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Prolixin

FluPhenazine

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Haldol

QT prolongation

Torsades de pointes

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Orap

Pimozide

Used for TOURETTES ONLY

QT PROLONGATION

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Ingrezza

Valbenacine

Treats: Tartive dyskinesia

Reduces dopamine release into synaptic cleft

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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)

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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 &amp; sweating
       Seizures > 600mg/d
       ^ glycemia/ lipids/ weight gain
       ** SEDAtion**

PART OF REMS PROGRAM

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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

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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)