Schizophrenia: Ott Flashcards
What are the key features that define a psychotic disorder?
- Delusions: false beliefs
- Hallucinations: perceptions without stimulus
- Disorganized thinking and speech
- Disorganized or abnormal motor behavior
- Negative Symptoms: DONT repsond to meds
What are some of the Halluciantions people may experience?
- Usually auditory
- Can be visual, tactile, or olfactory
What is the disease course in Schizophrenia?
- 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
What is the way that developing Schizophrenia is related to substance abuse?
- 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
How does illicit drugs affect the development of Schizophrenia?
- Marijuana, Cocaine, and Amphetamine use can hasten the onset of Schizophrenia, EXACERBATE symptoms, and REDUCE time to relapse
When thinking about antipsychotic drug therapy overview, what are something that we need to consider during Schizophrenia?
- 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?]
What are the clinical pearls for the typical antipsychotics in Schiziophernia?
- 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
What are the atypical antipsychotics used in Schizophrenia [GAME CHANGERS]?
- Aripiprazole, Asenapine, Brexpiprazole, Carprazine, Clozapine, Iloperidone, Lumateperone, Lurasidone, Olanzapine, Paliperidone, Quetiapine, Risperidone, Ziprasidone
What is the specific clinical consideration for Aripiprazole?
- 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
What is the specific clinical considerations for Asenapine?
- Sublingual or Transdermal; Poor oral bioavailability if swallowed
- Moderate Weight Gains; metabolic syndrome
- P450 1A2 Substrate
What is the specific clinical considerations for Brexpiprazole?
- Partial Agonist
- Akathisia
- P450 2D6 & 3A4 substrate
What is the specific clinical considerations for Cariprazine?
- Partial Agonist
- HIGH risk of akathisia
- P450 3A4 Substrate
What is the specific clinical considerations for Clozapine?
- 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
What is the specific clinical considerations for Iloperidone?
- BOXED WARNING: QTc prolongation & Orthostatic Hypertension
- P450 2D6 & 3A4 Substrate
What is the specific clinical considerations for Lumateperone?
- Partial Agonist
- Take with food to enhance absorption
- UGT & 3A4 Substrate
- D1/D2 partial agonist
What is the specific clinical considerations for Lurasidone?
- MUST take with food to imporve bioavailability
- SE: akathisia, Low risk of weight gain/metabolic syndrome
- P450 3A4 substrate
What is the specigic clinical considerations for Olanzapine?
- HIGH risk of sedation, significant weight gain, hyperglycemia, hyperlipidemia, metabolic syndrome risk, anticholinergic at HIGH DOSE
- LAI: Zyprexa relprevv - REMS
What is the specific clinical considerations for Paliperidone?
- ER dosage form - ghost tablet
- Renal elimination - dose adjustment
- HIGH EPS risk, hyperprolactinemia, moderate weight gain/metabolic syndrome
What is the specific clinical considerations for Quetiapine?
- Significant SEDATION
- BOXED WARNING: QTc prolongation
- Moderate risk for weight gain/metabolic syndrome
- P450 3A4 substrate
What is the specific clinical considerations for Risperidone?
- HIGH risk of EPS & Hyperprolactinemia
- Moderate risk of weight risk/metabolic syndrome
- P450 2D6 Substrate [Produces Paliperidone]
What is the specific clinical considerations for Ziprasidone?
- MUST be taken with food to improve bioavailabiility
- Lower risk of weight gain/metabolic syndrome
- Low akathisia
- NO P450
What is the purpose for Pimavanserin within Schizophernia?
- 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
What is the purpose of the Olanzapine/Samidorphan combination product for Schizophrenia?
- 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
For Clozapine, what is the REMS monitoring systems with Schizophrenia?
- Weekly x 6 months, biweekly x 6 months, then every 4 weeks
What is the way that Haloperidol & Fluphenazine should be injected within Schizophrenia?
- 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
What is important to know about Risperdal Consta [Risperidone] in Schizophrenia?
- MUST supplement with oral risperidone [or other antipsychotic] for the first few weeks of treatment
- After 3rd injection you can stop the oral med
What is important to know about Perseris in Schizophrenia?
- Abdominal SubQ injection used to treat Schizo
- 3A4 Inducer - Use 120 mg dose or may need oral supplementation
What is important to know about Invega Sustenna [Paliperidone] in Schizophrenia?
- Loading dose, then booster, then every 4 weeks
- Deltoid or gluteal muscle
- If loading strategy followed, NO need for oral overlap
What is important to know about Invega Trinza [Paliperidone 3mo] in Schizophrenia?
- 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
What is important to know about Invega Hafyera [Paliperidone 6mo] in Schizophrenia?
- May be intitiated after stable Invega Sustenna for 4 Months or Stable Invega Trinza after one 3 month dose
- ONLY BUTT INJECTION
What is important to know about Zyprexa Relprevv [Olanzapine] in Schizophrenia?
- REMS
- PDSS: Post Dose Delirium Sedation Syndrome
What is important important to know about Abilify Maintena [Aripiprazole] in Schizophrenia?
- 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
What is important to know about Aristade [Aripiprazole Lauroxil] in Schizophrenia?
- Overlap with oral aripiprazole for 3 weeks after first injection
What are the 1A2 Inducers that get reduced do to smoking in Schizophrenia?
- Olanzapine, Asenapine, Clozapine, Loxapine
What are the Immediate Release Antipsychotics that are used in Schizophernia?
- Haloperidol [Most common], Chlorpromazine, Fluphenazine, Olanzapine
- Loxapine for inhalation: Adasuve
What is important to know about Olanzapine IR IM Injection within Schizophrenia?
- CANNOT be given at the same time as Benzodiazepines IR Injection: BOXED WARNING for respiratory depression
What is the clinical Treatment Strategies for EPS in Schizophernia?
- 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
What is the function of the VMAT inhibitors in Schizophrenia
- MOA: Inhibit the vesicular monoamine transporter to decrease storage/increase release of dopamine, serotonin, norepinephinr
What are the VMAT inhibitors that are used in Schizophernia?
- Tetrabenazine
- Valbenazine: 2D6/3A4 Substrate [SE: QTc Prolongation]
- Deutetrabenazine: 2D6 Substrate [SE: Qtc Prolongation]
What is Neruoleptic Malignant Syndrome in Schizophrenia?
- 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
What are the metabolic side effects in Schizophrenia?
- Hyperglycemia, Hyperlipidemia, Hypertension
- Clozapine = Olanzapine>
- QUetiapine = Risperidone = Paliperidone = Asenapine = Iloperidone = Cariprazine = Brexpiprazole >
- Ziprasidone = Lurasidone = Aripiprazole
