-
chlorpromazine
- Thorazine
- FGA
- Low Potency (1-2)
-
thioridazine
- Mellaril
- FGA
- Low potency (1-2)
- QT prolongation (most)
-
mesoridazine
- Serentil
- FGA
- Less Potent (3)
-
loxapine
- Adasuve
- FGA
- Oral inhalation
- Less Potent (4)
-
-
-
-
pimozide
- Orap
- FGA
- High Potency (8-10)
- QT prolongation (most)
-
haloperidol
- Haldol
- FGA
- High Potency (8-10)
- QT prolongation
-
fluphenazine
- Prolixin
- FGA
- High Potency (8-10)
-
Alpha Receptor
Hypotension
-
Histamine Receptor
Sedation
-
Muscarinic Receptor
Anti-SLUD
-
DA Receptor (nigrostriatal tract)
EPS
-
DA Receptor (tuberoinfundibular tract)
Lactation
-
aripiprazole
- Abilify
- SGA
- Partial DA agonist
- Adjunct in MDD
- Ideal for metabolic syndrome (weight neutral), EPS, lactation/gynecomastia
-
asenapine
- Saphris
- SGA
- Sublingual (do not swallow, no food/drink for 10 mins after)
- Ideal for metabolic syndrome (weight neutral), difficulty swallowing
- Smoking does not affect absorption
- Movement disorders
-
clozapine
- Clozaril
- SGA
- Ideal for suicidal or Tx refractory
- Pregnancy Category B
- BBW- agranulocytosis, seizures, orthostatic hypotension, myocarditis, respiratory and cardiac arrest
- ADR- anticholinergic effects (constipation, dry eyes/mouth), lots of sedation, metabolic syndrome
- Monitor for agranulocytosis (ANC <500)
- - Initiation: General - 1,500; BEN 1,000 (wkly x 6 months, Biwkly x 6 months, then monthly)
- - Blood work (ANC) must not be older than 7 days
-
iloperidone
- Fanapt
- SGA
- Significant orthostatic hypotension (greatest in 1st week)
- - Dose related- titrate up to 12 mg BID max (re-titrate if missed 3+ days)
-
lurasidone
- Latuda
- SGA
- Max dose- 160 mg/day
- Renal & hepatic dose adjustment
- Pregnancy category B
- Take with 350 calories
- Blocks 5HT7 receptor
- Dose related akathisia (movement disorders)
- 3A4 metabolism
-
olanzapine
- Zyprexa
- SGA
- Weight gain (metabolic syndrome), hyperlipidemia, sedation
- Increased LFTs
-
quetiapine
- Seroquel
- SGA
- Weight gain (metabolic syndrome), hyperlipidemia, sedation
- Increased LFTs
- Metabolized by 3A4
- QT prolongation
-
risperidone
- Risperdal
- SGA
- Dose related EPS (>6 mg/day)- movement disorders
- - Give w/Cogentin (benztropine) to prevent tremors
- High doses- gynecomastia, lactation, menstrual cycle disruption
- Metabolized by 2D6, 3A4
- QT prolongation
-
paliperidone
- Invega
- SGA
- Active metabolite of risperidone
- Tablet shell may appear in stools
- No CYP DIs
- Dose related EPS (movement disorders)
-
ziprasidone
- Geodon
- SGA
- Take with 500 calories of food
- QT prolongation (highest risk of SGAs)
- Low doses (<40 mg="" may="" be="" associated="" with="" activation="" agitation="" br="">- Need to increase dose to 80 mg
- Weight neutral (ideal for metabolic syndrome)
-
brexpiprazole
- Rexulti
- SGA
- Weight gain, akathisia
- DA partial agonist
-
caripiprazine
- Vraylar
- SGA
- Sz, manic/mixed episodes of Bipolar I
- EPS, akathaisia
- High doses- more weight gain
- Not yet available
-
Abilify Maintena
- Aripiprazole
- SGA
- Q4 wks
- - 300 mg if 400 mg is not tolerated
- 2 wks of oral overlap
-
Aristada
- aripiprazole lauroxil
- SGA
- Q4 or 6 wks
- 3 wks of oral overlap
-
Zyprexa Relprevv
- olanzapine
- SGA
- Q2 or 4 wks
- Post injection delirium syndrome- monitor 3 Hrs post injection
- No oral overlap
-
Invega Sustenna
- paliperidone palmitate
- SGA
- Q4 wks
- Usual maintenance dose: 156 mg
- No oral overlap
-
Invega Trinza
- paliperidone palmitate
- SGA
- Q3 months
-
Risperdal Consta
- risperidone
- SGA
- Q2 wks
- 3 wks of oral overlap
-
Haldol Decanoate
- haloperidol
- FGA
- Q4 wks
- LD- 20x oral dose
- - DN exceed 100 mg, remainder given in 3-7 D
- - Can stop oral dose if 1st injection is e100 mg
- - Decrease dose by 25%, then by 25%
- NLD- 10x oral dose
-
Prolixin Decanoate
- fluphenazine
- FGA
- Q3 wks
- Multiply oral dose by 1.25 (max 100 mg)
- - Taper down oral dose
-
Dystonia
- Abnormal tonicity affecting the face, head, or neck
- Tx- Anticholinergics (increase DA, decrease ACh)
- - Benadryl (diphenhydramine) 25-50 mg IM
- - Cogentin (benztropine) 1-2 mg IM (acute)
- - Lower the dose of the antipsychotic or switch to another agent
-
Akathisia
- Inner restlessness
- Tx- Beta blockers or Benzodiazepines
- - DOES NOT respond well to anticholinergic agents
- - Propranolol 30-120 mg/day (can use metoprolol or atenolol)
- - Benzodiazepines: diazepam, lorazepam, clonazepam
- Monitoring: Barnes Akathisia Rating Scale
-
Pseudoparkinsonism
- Symptoms resemble Parkinson’s disease
- Tx- anticholinergics
- - Cogentin (benztropine) 1-6 mg/day
- - Benadryl (diphenhydramine) 25-300 mg/day
- - Artane (trihexyphenidyl) 5-15 mg/day
- - Amantadine 100-300 mg/day (not AC, increases DA)
- - Decrease the dose or switch to another agent
-
Tardive Dyskinesia
- Stereotypical involuntary movements
- Tx- Switch agents (SGA) or slowly lower the dose
- Monitor: Abnormal Involuntary Movement Scale (AIMS) or Dyskinesia Identification System Condensed User System (DISCUS)
-
Neuroleptic Malignant Syndrome
- Blocking too much DA
- - mscl rigidity, hyperthermia
- D/C offending agent
- Supportive Tx
- - Bromocriptine 1-2.5 mg/dose
- - Dantrolene 4-8 mg/day (divided) mscl rigidity
- - Amantadine 100 mg QD-TID
-
PANSS
Positive and Negative Syndrome Scale
-
BPRS
- Brief Psychiatric Rating Scale
- Overall how the patient is doing
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