Therapeutics of antipsychotics Flashcards
T/F: Antipsychotics are used in schizophrenia for reduction in symptoms but do not eliminate the symptoms
True
What are the three SGAs that have the greatest efficacy, what order is the efficacy
Clozapine, Olanzapine, Risperidone/ Clozapine Olanzapine, Risperidone
T/F: There is no difference in efficacy between First generation antipsychotics and second generation antipsychotics
False: Clozapine, Olanzapine, and Risperidone have the highest amount of efficacy among all antipsychotics while first generation antispychotics have no difference in efficacy
T/F: Patients should be put on clozapine before combination treatment
True
What type of dosing should be done for a 1st episode compared to the chornically ill, partial responder who is tolerating
Lower than usual, titrate above usual dose range
What type of antipsychotic agent should be chosen after the first episode (stage 1) , stage 2, stage 3
Atypical for a 6 week period, typical or atypical not tried in stage 1, clozapine
Which AP is considered first line if the patient also has suicidal ideation
Clozapine
What is the therapeutic trial for APs, initial symptom improvement, duration of treatment
4-12 weeks, 1-2 weeks, one year
What is the most common side effects of SGAs, FGAs
Metabolic complications, Extrapyramidal side effects (EPS)
What is the BBW for antispsychotic agents
Elderly patient with demntia-related psychosis treated with antipsychotic drugs are at an increased risk of death
What is a rare but deadly risde effect of FGAs, symptoms
Neurpoleptic Malignant Syndrome/ muscle rigidity, hyperpyrexia (really high fever), altered consciousness
What are the early onset types of EPS, Late onset
Akathisia, Dystonic reactions, Pseudoparkinsonism/ Tardive dyskinesia
How is akathisia treated
Propanolol, short term BZDS (lorazepam), anticholinergic (benztropine or diphenhydramine)
Which EPS symptoms is seen in 90% of patients within 4 days, which antispsychotics are more likely to cause this, treatment
Dystonic reactions, high dose or high potency typical antipsychotics, Stop offending agent or antichoinergic or BZD
What are the treatment options for pseudoparkinsonism
Reduce dose, switch to another agent with lower D2 affinity or high M1 affinity, anticholiergic agents
How is tardive dyskinesia treated, prevented
Reduce dose, stop, switch (may not get better)/ minimize daily dose, AIMS at baseline then 6 months then yearly
Which antipsychotic is most known to cause QTc prolongation
Ziprasidone
Which antipsychotic is wieght neutral, potentially loose weight
Ziprasidone, Molindone
Which antipsychotics are associated with the most sedation
Chlopromazine, Clozapine, and quetiapine/ Olanzapine (moderate)
Which antipsychotics are associated with the most EPS (strongest D2 affinity)
Haloperidol, perhenzazine
What antipsychotics are associated with the most anticholinergic effect
Chlorpromazine, Clozapine
Which antipsychotics are associated with orthostasis
Chorpromazine, Clozapine, iIloperidone
What antispychotics are associated with the high increases in prolactin
Haloperidol, perphenzine, Risperidone/paliperidone
Which antispychotic is has the least amount of side effects
Aripiprazole
What must be done before a patient is given long-acting injectable agents
Must try PO before switching to long-acting to establish tolerability
Which long acting injectable agents must be done every 2-4 weeks
Haloperidol, fluphenazine, risperidone, Olanzapine
Which long-acting injectable is every 4 or 8 weeks, every 3 months
Arpiprazole, Paliperidone
What is the low potency FGA, side effects
Chlopromazine, High sedation, high anticholinergics, high orthostasis
What are the two high potency FGAs, side effects
Haloperidol and Fluphenazine/ High EPS and Increasing prolactin levels
What are the recommended SGAs in stage 1
Aripirazole, olanzapine, quetiapine, risperidone, ziprasidone
What are the indications for clozapine, what is the the therapeutic trial
treatment resistant schizophrenia and sucidal behabior associated with schizophrenia, 12 weeks
What is the BBW for clozapine
Seizures, leukopenia/neutropenia/agranulocytosis, myocarditis/cardiomyopathy
What are the common side effects of clozapine
Drowsiness, weight gain, tachycardia, orthostatic hypotension, constipation
How does the REMS program for clozapine work
ANC must be AT LEAST 1000/uL for general population and must be AT LEAST 500/uL for patient with documented Benign Ethnic Neutropenia (BEN)/ weekly blood monitoring for 1st 6 months, then every 2qweeks for 6 months then even every 28 days if ANC is at goal
Which antipsychotic is known for increased risk of hyperlipidemia and hyperglycemia
Olanzapine
What are side effects of ziprasidone, what is special about its kinetics
moderate sedation, moderate EPS, nausea, akathisia/ must take with food (absoprtion 50% lower without food)
Which is the FDA warning for using aripiprazole
Compulsive and excessive urge and behaviors
What is the active metabolite of paliperidone, advantage
Paliperidone. not sifnificantly metabolized by CYPs
What other antipsychotic has a warning of QTc prolongation and also has NE-alpha antagonism
Iloperidone
Which antipsychotic is the only sublingual tablet, tip
Asenapine, avoid eating and drinking for 10 minutes after administration
What are pharmcokinetic tips for lurasidone
Must take with food (weight neutral)
Which antipsychotics are effected by smoking
Clozapine and Olanzapine
Which APs have the most drug-drug interactions
Clozapine and Perphenazine
Which typical APs have significant weight gain
Chlopromazine, thioridazine
Which atypical APs have significant weight gain
Clozapine, Olanzapine, risperidone
