schizophrenia antipsychotics

Question 1

best efficacy for schizophrenia

Answer 1

clozapine

save it for resistant cases d/t agranulocytosis

Question 2

highest weight gain (thus, also concerned about DM, dyslipidemia and anticholinergic)

Answer 2

clozapine and olanzapine

Question 3

lowest to NO wt gain (thus less concern for DM and hyperlipidemia)

Answer 3

ziprasidone, lurasidone*, aripiprazole

iloperidone (Fanapt) has moderate weight gain and low DM and dyslipidemia

Question 4

use these if worried about QT prolongation

Answer 4

abilify, latuda, rexulti, vraylar

Question 5

for resistant depression recommend

Answer 5

abilify, seroquel XR, symbyax, brexipiprazole (rexulti)

Question 6

for bipolar disorder recommend

Answer 6

risperidone, geodon, abilify, seroquel, saphris, latuda, zyprexa, vraylar

Question 7

only sublingual

Answer 7

asenapine (saphris) = rapidly absorbed

Question 8

what comes in ODT

Answer 8

clozapine, olanzapine, aripiprazole, and risperidone

Question 9

use with food

Answer 9

lurasidone and ziprasidone

Question 10

take on an empty stomach

Answer 10

quetiapine XR

Question 11

most antipsychotic drugs are metabolized via the cytochrome P450 system if the liver

what is the exception

Answer 11

paliperidone (80% is excreted unchanged via the kidneys, only 10% inactivated by hepatic enzymes)

paliperidone is the only medication of this class for which no dose adjustment is recommended in pts with impaired liver function

Question 12

concern regarding CYPs 2D6 and 3A4

Answer 12

aripiprazole and brexipiprazole

Question 13

concern regarding CYP3A4 only

Answer 13

quetiapine, ziprasidone, lurasidone, cariprazine

Question 14

concern regarding CYP2D6 only

Answer 14

iloperidone and risperidone

Question 15

concern regarding CYP1A2 only

Answer 15

clozapine, olanzapine, asenapimne

Question 16

most orthostatic HTN

Answer 16

clozapine and iloperidone

Question 17

concerned on negative impact on impulse control d/t partial dopamine agonist effect

Answer 17

aripiprazole

brexipiprazole (rexulti)

cariprazine (vraylar)

Question 18

olanzapine KEY POINTS

Answer 18

dosage forms: tabs, ODT, suspension

must have pt, pharmacy and MD enrolled in REMs program

1a2 substrate (decrease dose by 1/3 w/ strong inhibitors e.g., fluvoxamine, cipro)

does not cause EPS

MOST anticholinergic, wt gain (concern about increased blood sugars and hyperlipidemia), sedation

no effect on prolactin

CONCERN W/ AGRANULOCYTOSIS thus want ANC (monitored at pharmacy) to be >/= 1500/microliters –> IF SIGNS OF INFECTION OR NEUTROPENIA GO TO MD

BOXED WARNING for orthostatic HTN

ALSO HAS CHOLINERGIC PROPERTIES –> can cause hypersalivation and sweating

Question 19

Solutions

[mnemonic for antipsychotic drug formulations]

Answer 19

H-CAR

clozapine
aripiprazole
risperidone

Question 20

ODT

[mnemonic for antipsychotic drug formulations]

Answer 20

O-CAR

olanzapine
clozapine
aripiprazole
risperidone

Question 21

Long-acting Injectable

[mnemonic for antipsychotic drug formulations]

Answer 21

O-PAR-HF

olanzapine
paliperidone
aripiprazole
risperidone
haloperidol
fluphenazine

Question 22

NMS definition + what to monitor to determine possible NMS

[from PNN schizophrenia chapter]

Answer 22

NMS = life-threatening; d/t the depletion of DA in the CNS: disruption of muscle contraction & disruption of thermostat system

LABS:
-increase CPK (muscle breakdown)
-LFT
-increase in WBC (CBC)
-metabolic acidosis