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PHRM 845: Therapeutics III > Schizophrenia: Ott > Flashcards

Schizophrenia: Ott Flashcards

1
Q

What are the key features that define a psychotic disorder?

A
  • Delusions: false beliefs
  • Hallucinations: perceptions without stimulus
  • Disorganized thinking and speech
  • Disorganized or abnormal motor behavior
  • Negative Symptoms: DONT repsond to meds
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2
Q

What are some of the Halluciantions people may experience?

A
  • Usually auditory
  • Can be visual, tactile, or olfactory
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3
Q

What is the disease course in Schizophrenia?

A
  • Occurs in late adolescence to early adulthood
  • MEN: late teens to early 20s
  • WOMEN: late 20s to early 30s
  • Very episodic and can clear up over time
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4
Q

What is the way that developing Schizophrenia is related to substance abuse?

A
  • Smoking is associated with inductions of 1A2 because of the hydrocarbons produced and inhaled, decreasing the concentration of 1A2 substrate antipsychotics [NOT BECAUSE OF NICOTINE]
  • Olanzapine, Clozapine, Asenapine, Loxapine
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5
Q

How does illicit drugs affect the development of Schizophrenia?

A
  • Marijuana, Cocaine, and Amphetamine use can hasten the onset of Schizophrenia, EXACERBATE symptoms, and REDUCE time to relapse
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6
Q

When thinking about antipsychotic drug therapy overview, what are something that we need to consider during Schizophrenia?

A
  • Dose per day
  • Side Effects [Tolerance? Other Risk Factors?]
  • Previous Drug Therapy [Good or Bad? Family History]
  • Cost [How to pay? Oral or IM?]
  • Concomitant Drug Therapy
  • Monitoring [Labs? Weight? ECG?]
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7
Q

What are the clinical pearls for the typical antipsychotics in Schiziophernia?

A
  • Haloperidol is the MOST COMMON due to routine and PRN [Prolongs QT & Only blocks Dopamine]
  • More EPS with HIGHER potency
  • Effective for POSITIVE symptoms but can worsen NEGATIVE and COGNITIVE symptoms
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8
Q

What are the atypical antipsychotics used in Schizophrenia [GAME CHANGERS]?

A
  • Aripiprazole, Asenapine, Brexpiprazole, Carprazine, Clozapine, Iloperidone, Lumateperone, Lurasidone, Olanzapine, Paliperidone, Quetiapine, Risperidone, Ziprasidone
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9
Q

What is the specific clinical consideration for Aripiprazole?

A
  • Partial Agonist
  • Can cause Akathsia, low risk of weight gain or metabolic syndrome
  • P450 2D6 and 3A4 sustrate
  • LAI must have 2 week or 3 week oral overalap
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10
Q

What is the specific clinical considerations for Asenapine?

A
  • Sublingual or Transdermal; Poor oral bioavailability if swallowed
  • Moderate Weight Gains; metabolic syndrome
  • P450 1A2 Substrate
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11
Q

What is the specific clinical considerations for Brexpiprazole?

A
  • Partial Agonist
  • Akathisia
  • P450 2D6 & 3A4 substrate
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12
Q

What is the specific clinical considerations for Cariprazine?

A
  • Partial Agonist
  • HIGH risk of akathisia
  • P450 3A4 Substrate
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13
Q

What is the specific clinical considerations for Clozapine?

A
  • MOST EFFECTIVE
  • SE: Agranulocytosis, Cardiomyopathy, Hypersalivation, Hypotension, Metabolic Syndrome, Dose Related Seizures
  • P450 1A2 Substrate
  • REM – Must monitor ANC weekly x 6 months, Biweekly x6 months, then every 4 weeks
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14
Q

What is the specific clinical considerations for Iloperidone?

A
  • BOXED WARNING: QTc prolongation & Orthostatic Hypertension
  • P450 2D6 & 3A4 Substrate
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15
Q

What is the specific clinical considerations for Lumateperone?

A
  • Partial Agonist
  • Take with food to enhance absorption
  • UGT & 3A4 Substrate
  • D1/D2 partial agonist
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16
Q

What is the specific clinical considerations for Lurasidone?

A
  • MUST take with food to imporve bioavailability
  • SE: akathisia, Low risk of weight gain/metabolic syndrome
  • P450 3A4 substrate
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17
Q

What is the specigic clinical considerations for Olanzapine?

A
  • HIGH risk of sedation, significant weight gain, hyperglycemia, hyperlipidemia, metabolic syndrome risk, anticholinergic at HIGH DOSE
  • LAI: Zyprexa relprevv - REMS
18
Q

What is the specific clinical considerations for Paliperidone?

A
  • ER dosage form - ghost tablet
  • Renal elimination - dose adjustment
  • HIGH EPS risk, hyperprolactinemia, moderate weight gain/metabolic syndrome
19
Q

What is the specific clinical considerations for Quetiapine?

A
  • Significant SEDATION
  • BOXED WARNING: QTc prolongation
  • Moderate risk for weight gain/metabolic syndrome
  • P450 3A4 substrate
20
Q

What is the specific clinical considerations for Risperidone?

A
  • HIGH risk of EPS & Hyperprolactinemia
  • Moderate risk of weight risk/metabolic syndrome
  • P450 2D6 Substrate [Produces Paliperidone]
21
Q

What is the specific clinical considerations for Ziprasidone?

A
  • MUST be taken with food to improve bioavailabiility
  • Lower risk of weight gain/metabolic syndrome
  • Low akathisia
  • NO P450
22
Q

What is the purpose for Pimavanserin within Schizophernia?

A
  • MOA: Inverse agonist and antagonist of 5HT2A
  • Treatment of Hallucinations of Delusions in a patient with Parkinsons Disease
  • 3A4 Substrate
  • SE: Qtc Prolongation, Peripheral Edema, Confusion, Nausea, Angioedema
23
Q

What is the purpose of the Olanzapine/Samidorphan combination product for Schizophrenia?

A
  • Samidorphan is added to mitigate weight gain and metabolic syndrome of olazapine
  • Samidorphan is an opioid antagonist with preferential activity at the MU opioid receptor
24
Q

For Clozapine, what is the REMS monitoring systems with Schizophrenia?

A
  • Weekly x 6 months, biweekly x 6 months, then every 4 weeks
25
Q

What is the way that Haloperidol & Fluphenazine should be injected within Schizophrenia?

A
  • Old Based Z Track: Zigzag pattern that makes it to where nothing will leak out
  • Haloperidol given every 4 weeks and Fluphenazine given every 2 weeks
26
Q

What is important to know about Risperdal Consta [Risperidone] in Schizophrenia?

A
  • MUST supplement with oral risperidone [or other antipsychotic] for the first few weeks of treatment
  • After 3rd injection you can stop the oral med
27
Q

What is important to know about Perseris in Schizophrenia?

A
  • Abdominal SubQ injection used to treat Schizo
  • 3A4 Inducer - Use 120 mg dose or may need oral supplementation
28
Q

What is important to know about Invega Sustenna [Paliperidone] in Schizophrenia?

A
  • Loading dose, then booster, then every 4 weeks
  • Deltoid or gluteal muscle
  • If loading strategy followed, NO need for oral overlap
29
Q

What is important to know about Invega Trinza [Paliperidone 3mo] in Schizophrenia?

A
  • May be started if patient has been on a stable monthly IM Injection of Invega Sustenna, at least FOUR stable Invega Sustenna doses
  • Given in the DELTOID. as butt decreases Cmax
  • NOT RECOMMENDED for CrCl < 50mL/min
30
Q

What is important to know about Invega Hafyera [Paliperidone 6mo] in Schizophrenia?

A
  • May be intitiated after stable Invega Sustenna for 4 Months or Stable Invega Trinza after one 3 month dose
  • ONLY BUTT INJECTION
31
Q

What is important to know about Zyprexa Relprevv [Olanzapine] in Schizophrenia?

A
  • REMS
  • PDSS: Post Dose Delirium Sedation Syndrome
32
Q

What is important important to know about Abilify Maintena [Aripiprazole] in Schizophrenia?

A
  • MUST overlap with oral aripiprazole [or another oral antipsychotic] for at leat 14 days after first injection
  • DELTOID or BUTT Injection
  • Taking 2D6 or 3A4 inhibitors or 3A4 Inducersa for more than 14 days as concomitant therapy
33
Q

What is important to know about Aristade [Aripiprazole Lauroxil] in Schizophrenia?

A
  • Overlap with oral aripiprazole for 3 weeks after first injection
34
Q

What are the 1A2 Inducers that get reduced do to smoking in Schizophrenia?

A
  • Olanzapine, Asenapine, Clozapine, Loxapine
35
Q

What are the Immediate Release Antipsychotics that are used in Schizophernia?

A
  • Haloperidol [Most common], Chlorpromazine, Fluphenazine, Olanzapine
  • Loxapine for inhalation: Adasuve
36
Q

What is important to know about Olanzapine IR IM Injection within Schizophrenia?

A
  • CANNOT be given at the same time as Benzodiazepines IR Injection: BOXED WARNING for respiratory depression
37
Q

What is the clinical Treatment Strategies for EPS in Schizophernia?

A
  • Acute Dystonia: IM anticholinergic NOW dose [Benztropine 2mg, Benadryl 50mg]
  • Drug Induced Parkinsons: Oral anticholinergics [Benztropine, Trihexyphenidyl, Diphenhydramine]
  • Akathisia: Beta Blocker [Propranolol 1st line] or Benzodiazepine [Lorazepam]
  • Tardive Dyskinesia: VMAT inhibitors
38
Q

What is the function of the VMAT inhibitors in Schizophrenia

A
  • MOA: Inhibit the vesicular monoamine transporter to decrease storage/increase release of dopamine, serotonin, norepinephinr
39
Q

What are the VMAT inhibitors that are used in Schizophernia?

A
  • Tetrabenazine
  • Valbenazine: 2D6/3A4 Substrate [SE: QTc Prolongation]
  • Deutetrabenazine: 2D6 Substrate [SE: Qtc Prolongation]
40
Q

What is Neruoleptic Malignant Syndrome in Schizophrenia?

A
  • LIFE THREATENING caused by dopamine blockage
  • SE: Hyperpyrexia, Tachycardia, Labile Blood Pressure, Muscle RIgidity
  • Supportive Treatment - D/C Antipsychotics and start Dopamine Agonist
  • Can still use antipsychotic meds in FUTURE
41
Q

What are the metabolic side effects in Schizophrenia?

A
  • Hyperglycemia, Hyperlipidemia, Hypertension
  • Clozapine = Olanzapine>
  • QUetiapine = Risperidone = Paliperidone = Asenapine = Iloperidone = Cariprazine = Brexpiprazole >
  • Ziprasidone = Lurasidone = Aripiprazole

PHRM 845: Therapeutics III (25 decks)

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