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Therapeutics II (Spring) > Schizophrenia Treatment > Flashcards

Schizophrenia Treatment Flashcards

1
Q

key features that define psychotic disorders

A

-delusions: false beliefs
-hallucinations
-disorganized thinking and speech
-abnormal motor behavior
-negative symptoms

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2
Q

Disease course in SCZ

A

-onset late adolecence to early adulthood
-men: late teens, early 20s
-women: 20-30s

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3
Q

SCZ link to substance use

A

-smoking induces 1A2 bc inhaled hdrocarbons = dec 1A2 antipsychotics (-olanzapine, asenapine, clozapine, LOXAPINE)
-weed, coke, meth can hasten onset of scz, exacerbate sx, reduce time to relapse
-tx substance use in scz

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4
Q

dopamine pathways?

A
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5
Q

Typical antipsychotics

A

-older agents
-D2 antagonists
-efficacy for postive sx is similar
-haloperidol more commonly used (routine and PRN)
-more EPS risk
-may worsen negative and cog sx

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6
Q

Typical antipsychotics drugs (might not need to know)

A

-haloperidol
-chlopromazine
-phenazines
-loxapine
-thioridazine

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7
Q

Partial agonists

A

-stabilize DA transmission (keep at normal range)
-higher akathisia risk
-adj tx in depression
-box warning for suicide
-3A4 substrate
-mod akathisia
-low weight gain

-Aripiprazole (also 2D6)
-Brexpiprazole (also 2D6)
-Cariprazine

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8
Q

Partial agonist drugs

A

-Aripiprazole
-Brexpiprazole
-Cariprazine

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9
Q

Asenapine

A

-sublingual and patch forms
-1A2
-QTc prolongation

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10
Q

Clozapine

A

-1A2
-box warnings: neutropenia, orthostasis, bradycardia, syncope, sz, myocarditis, cardiomyopathy
-SE: sedation, wt gain, constipation, hypersalivation, dry mouth, GI hypomobility w obstruction risk
-QTc prolongation

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11
Q

Olanzapine

A

-1A2
-significant wt gain and sedation
-high risk metabolic syndrome
-DRESS warning

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12
Q

Quetiapine

A

-3A4
-QTc prolongation
-wt gain
-sedation
-suicide

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13
Q

Asenapine patch

A

-apply one patch q24h, rotate
-QTc prolongation
-UGT and 1A2 substrate = reduce dose of patch if given w strong 1A2 inhibitor (fluvoxamine)

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14
Q

Clozapine REMS

A

-monitoring timelines weekly x 6 months, biweekly x 6months, then q4weeks

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15
Q

Olanzapine/Samidorphan

A

-samidorphan added to mitigate wt gain and metabolic syndrome potential of olanzapine
-samidorphan is opiod antagonist w activity at mu opioid receptor

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16
Q

-done drugs

A

-Iloperidone
-Lurasidone
-Ziprasidone
-Risperidone
-Paliperidone

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17
Q

Iloperidone

A

-high orthostasis and syncope risk
-QTc prolongation
-2D6 substrate

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18
Q

Lurasidone

A

-3A4
-akathisia risk
-suicide (adj for bipolar)
-take w food (350cal) to inc bioavailability

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19
Q

Ziprasidone

A

-QTc prolongation (contraindication)
-DRESS risk
-take w food
-3A4 (1/3) and aldehyde oxidase (2/3) = less P450 interactions

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20
Q

Lumateperone

A

-low risk for wt gain or metabolic side effects
-low risk for EPS or akathisia
-3A4

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20
Q

Risperidone

A

-2D6 (minor 3A4)
-EPS
-hyperprolactinemia
-wt gain
-sedation
-orthostasis

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20
Q

Paliperidone

A

-renal elimination
-similar side effects to risperidone
-QTc

-EPS, hyperprolactinemia, wt gain, sedation, orthostasis

21
Q

Pimavanserin

A

-tx hallucinations or delusions in pt w PD
-inverse agonist and antagonist at 5HT2A
-3A4

22
Q

Xanomeline

A

-M1/M4
-2D6
-baseline and continue monitoring LFTs, HR

23
Warning for all antipsychotics (except xanomeline and trospium)
-box: inc risk of death in elderly treated w them for dementia -metabolic adverse effects -EPS -risk of somnolence, hypotension, motor instability = fall risk -assess fall risk
24
Haloperidol Decanoate
-give q4 weeks -loading dose is 20x oral -maintenance is 10x oral dose -if only using maintenance, may need oral overlap -oil-based-Ztrack
25
Risperdal consta
-MUST supplement w oral risperidone (or another oral antipsychotic) for first few weeks of treatment -- tell providers until 3rd injection (week 4)
26
Perseris (risperidone)
-abdominal subQ injection -3A4 inducers: use 120mg dose or may need oral supplementation
27
Rykindo (risperidone)
-every 2 week IM injection -oral dose overlap shorter than Risperidal Consta (7 vs 21 days)
28
Uzedy (risperidone)
-ab or upper arm SQ injection -qmonth or q2months
29
Invega Sustenna (paliperidone)
-loading dose, then booster, then q4weeks (starting 5 weeks after loading injection) -initial loading and booster doses must be given in deltoid to improve absorption consistency -if loading strategy followed, no need for oral overlap -may require dose adj in mod-severe renal impairment
30
Invega Trinza (paliperidone q3 months)
-may be initiated for a patient who has been on a stable monthly (q4weeks) IM of invega sustenna doses -give deltoid, gluteal admin results in lower Cmax -not recommended if CrCl < 50 mL/min
31
Invega Hafyera (paliperidone q6month)
-may initiate after stable invega sustenna for 4 months ot trinza after one 3 month dose -GLUTEAL only
32
Zyprexa Relprevv (olanzapine)
-REMKS -PDSS (post-dose delirium sedation syndrome)
33
Post-dose delirium syndrome (PDSS)
-significant sedation right after dose -obtain consent and PIN number -dose must be done by staff not pt -pt must stay in clinic 3h and get ride home
34
Zyprexa Relprevv Dosing
-oral: 10,15, 20mg -IM depot: 210, 300mg q2weeks or 405mg q4weeks
35
Abilify Maintena (aripiprazole)
-must overlap w oral apip (or other antipsychotic) for at least 14 days after first inj -deltoid or gluteal -adj dose if on 2d6 or 3A4 inhibitors: -400mg down to 300mg w STRONG inhbitors, 200mg w inhibitors -300mg down to 200mg w STRONG inhbitors, 160mg w inhibitors -AVOIDw 3A4 inducers
36
Abilify Asimtufii (aripiprazole)
-q2month dose -gluteal only -continue oral for 2 weeks after first injection
37
Aristada (aripiprazole lauroxil)
-overlap w oral 3 weeks after first inj unless aristada initio given first
38
Aristada initio
-developed to avoid need for 21-day oral overlap of antipsychotic -AVOID in pt who are poor 2D6 metabolizers or with strong 2D6 or 3A4 inhibitors
39
Immediate release antipsychotic inj/emergencies
-haloperidol (most common) -chlopromazine -fluphenazine -loxapine for inhalation (not common) -Olanzapine immediate release IM CANNOT be given at same time as benzodiazepine immediate release = resp depression
40
EPS sx
-acute dystonia -drug-induced parkinsons -akathisia -tardive dyskinesia
41
Acute dystonia tx
-IM anticholinergic NOW dose -benztropine 2mg -diphenhydramine 50mg
42
Drug-induced parkinsons tx
-oral anticholinergic: -benztropine -trihexyphenidyl -diphenhydramine
43
Akathisia tx
-Beta-blocker: propranolol -Benzodiazepine usually
44
Tardive dyskinesia
-VMAT inhibitors
45
VMAT inhibitor drugs
-Tetrabenazine -Valbenazine -Deutetrabenazine
46
Tetrabenazine
-VMAT inhibitor for TD -not FDA for TD but indicated for huntigtons -black box for suicide (CI) -CI in hepatic impairment -QTc prolongation
47
Valbenazine (Ingrezza)
-VMAT inhibitor for TD -2D6/3A4 substrate -QTc prolongation
48
Deutetrabenazine
-VMAT for TD -2D6 substrate -QTc prolongation
49
Neuroleptic malignant syndrome
-life-threatening MED EMERGENCY -hyperpyrexia -tachycardia -labile BP -muscle rigidity: elevated CK, myoglobinuria -supportive tx -future antipsychotic use is NOT contraindicated
50
Metabolic adverse effects
-hyperglycemia -hyperlipidemia -hypertension -risk: 1. clozapine = olanzapine 2. quetiapine = risperidone = paliperidone = asenapine = iloperidone = cariprazine = brexpiprazole 3. ziprasidone =lurasidone =aripiprazole
51
Metabolic monitoring
-all baseline -personal/fam hx: yearly -wt: 4,8,12 weeks, q3 months -waist: yearly -BP: 12 weeks, yearly -FBG/A1c: 12 weeks, yearly -fasting lipids: 12 weeks, q5years

Therapeutics II (Spring) (51 decks)

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