SGAs Flashcards
Aripiprazole indications
schizo, BPD, MDD augmentation, Sx associated with autism, Tourette’s
Is aripiprazole available as a LAI?
Yes!
Is aripiprazole approved for peds patients?
Yes
Aripiprazole is associated with what side effect?
Impulsivity
Other pearls about aripiprazole
Little weight gain
May be “activating” and less sedating
May cause insomnia, akathisia, restlessness
Asenapine indications
schizo, BPD
Asenapine is CI’ed in what disease state?
Severe hepatic disease
Asenapine puts a patient at high risk for what cardiac event?
QTc prolongation
Asenapine comes in what formulation?
A topical patch (also SL tablet)
Counseling points for asenapine patch
Wear for 24 hours, apply to clean, dry, intact skin on the upper arm, back, abdomen, or hip and rotate with each application
Patches can’t be cut, you can shower but not swim with it, and can’t apply heat
Other pearls about asenapine
Little weight gain
Least sedating and anticholinergic
Anaphylaxis could occur after a single dose
Brexipiprazole indications
schizo, MDD
Brexipiprazole, like aripiprazole, is associated with what side effect?
Impulsivity
Other pearls about brexipiprazole
Dose-related akathisia
Fewer metabolic challenges
Half-life of brexipiprazole
91 HOURS
Cariprazine indications
schizo, BPD
Half-life of cariprazine
2-4 DAYS
Pearls about cariprazine
dose-related akathisia
late occurring side effects due to accumulation and metabolites
Clozapine indications
schizo, schizoaffective disorder
Clozapine is the gold standard for what?
Refractory illness and suicidality
Clozapine is on the REMS list because of what?
Potential for blood dyscrasias
Blood draw procedures for clozapine REMS monitoring
Initiating treatment: blood draw once/week x6 months
After first 6 months: blood draw once q2w x6 months
After 12 months: blood draw qmonth
Clozapine and seizure risk
Higher doses increase seizure risk
What if higher doses of clozapine are needed?
Add on an epileptic drug that can work as a mood stabilizer (Depakote)
What AED should you not use with clozapine?
Carbamazepine!
Other clozapine side effects
Worst offender of METABOLIC CONDITIONS
QTc prolongation, seizures, myocarditis, constipation, hypersialorrhea
How to manage constipation while on clozapine
Establish a bowel regimen because constipation can lead to surgery, hospitalization, or death
Constipation risk in a patient taking clozapine increases with what meds?
Anticholinergic meds and opiates
Smoking and clozapine
Smoking (the smoke itself, not the nicotine) induces clozapine metabolism and may need higher doses of clozapine to be effective
D/C clozapine when the ANC is below what?
<1000
Iloperidone indication
schizophrenia
Iloperidone is most likely to cause what side effect?
Orthostatic hypotension –> slow titration can prevent this!
Iloperidone is not recommended in patients with what disease state?
Severe hepatic impairment
Rare but serious side effect of iloperidone
QTc prolongation
Other info about iloperidone
No prolactin elevation
Less sedating compared to other SGAs
Lurasidone indications
schizo, BPD
Drug interaction with lurasidone
Don’t use with strong CYP3A4 inhibitors/inducers
Lurasidone and prolactin
Lurasidone has no notable prolactin elevation
Lurasidone and weight gain
No notable weight gain
Lurasidone and sedation
Less sedation compared to other SGAs
Lurasidone and orthostasis
Less orthostasis compared to other SGAs
Is lurasidone approved for peds?
Yes
Lurasidone dosing
Needs hepatic and renal dosing adjustments
Lumateperone (Lyrica) indication
schizophrenia
Lyrica and metabolic changes
No significant changes
Lyrica and EPS
Not associated with an increase in EPS
Lyrica monitoring
Monitor blood glucose, lipids, and weight despite no significant metabolic changes
MRI for progressive multifocal leukoencephalopathy
Other Lyrica side effects
Dizziness- caution with overeating and dehydration
Lyrica and fertility
May impair fertility
Lyrica in the third trimester
Patient can experience EPS and withdrawal symptoms during the third trimester
Lyrica and breastfeeing
CI’ed!!
Olanzapine indications
schizophrenia, BPD, MDD
Olanzapine side effects
DRESS, sedation, metabolic issues, QTc prolongation, ANC changes
Olanzapine is also available as what formulation?
LAI
Olanzapine LAI info
Requires a 3-hour observation period after administration due to post-injection sedation and delirium
True or false: olanzapine LAI is in the REMS program
True!
Is olanzapine approved for peds patients?
Yes
Paliperidone indications
schizophrenia and schizoaffective disorder
Paliperidone side effects
QTc prolongation, priapism, thrombotic thrombocytopenic purpura
Is PO overlap required when switching from olanzapine PO to LAI?
NO
What formulation is the PO tablet of paliperidone available as?
OROS tablet, the shell of the tablet can be found in the stool but that doesn’t mean the drug is working
What increases paliperidone bioavailability
Food
LAI formulations of paliperidone available
Sustenna, Trinza, Hafyera
Dosing frequency of Sustenna
qmonth
Trinza dosing frequency
q3months
Hafyera dosing frequency
q6months
The transition from Sustenna to Trinza
You have to be on Sustenna for at least 4 months before Trinza
Is paliperidone approved for peds?
Yes
Pimavaserin (Nuplazid) indications
Hallucinations and delusions associated with Parkinson’s Disease psychosis (this is the only option for this!)
What should you not take while on Pimavanserin and why?
Dopamine agents, because pimavanserin antagonizes dopamine (Parkinson’s is a deficiency of dopamine)
Does pimavanserin carry the same BBW as all other APS?
YES!
Pimavanserin side effects
QTc prolongation, CYP3A4 interactions
Don’t use Nuplazid in what disease state?
Renal dysfunction <30 ml/min
Quetiapine indications
schizophrenia, BPD, MDD
Quetiapine side effects
Sedation, metabolic issues, QTc, cataracts, ACH effects
Quetiapine is frequently misused as what?
A sleep aid- the risks of an APS are still there though
Quetiapine and metabolic effects
Not dose-related, but they’re still there
Is quetiapine indicated for use in peds?
Yes
Risperidone indications
schizophrenia, BPD, symptoms associated with autism
Risperidone side effects
PROLACTIN ELEVATION, EPS, Qtc prolongation, priapism, TTP
Is risperidone available as a LAI?
Yes!
LAI dosage forms available for risperidone
IM and SQ
Risperidone IM LAI form dosing frequency
Dosed q2w with PO overlap for 3 weeks
Risperidone SQ LAI form dosing frequency
Dosed qmonth with no PO overlap needed
Ziprasidone indications
schizophrenia, BPD
Ziprasidone side effect
DRESS
Ziprasidone CI
Patients who are at risk of QTc prolongation
Ziprasidone is available as a LAI: true or false
False, available as a short-acting agent
Paliperidone is a metabolite of…
risperidone
What drug combinations should you avoid with clozapine and olanzapine?
IM benzos (especially lorazepam!)
SGAs most likely to cause sedation
clozapine and quetiapine
SGAs most likely to cause EPS
risperidone and paliperidone
SGAs most likely to cause ACH effects
clozapine
SGAs most likely to cause orthostasis
clozapine and iloperidone
SGAs most likely to cause weight gain
clozapine, olanzapine
SGAs most likely to cause prolactin elevation
risperidone, paliperidone
SGAs most likely to cause CV effects
clozapine, iloperidone, ziprasidone
SGAs available as LAIs
aripiprazole, olanzapine, risperidone, paliperidone
SGAs available as short-acting agents
olanzapine, ziprasidone
