Schizophrenia

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  1. chlorpromazine
    • Thorazine
    • FGA
    • Low Potency (1-2)
  2. thioridazine
    • Mellaril
    • FGA
    • Low potency (1-2)
    • QT prolongation (most)
  3. mesoridazine
    • Serentil
    • FGA
    • Less Potent (3)
  4. loxapine
    • Adasuve
    • FGA
    • Oral inhalation
    • Less Potent (4)
  5. perphenazine
    • Trilafon
    • FGA
    • Potency (5)
  6. trifluoperazine
    • Stelazine
    • FGA
    • Potency (6)
  7. thiothixene
    • Navane
    • FGA
    • More Potent (7)
  8. pimozide
    • Orap
    • FGA
    • High Potency (8-10)
    • QT prolongation (most)
  9. haloperidol
    • Haldol
    • FGA
    • High Potency (8-10)
    • QT prolongation
  10. fluphenazine
    • Prolixin
    • FGA
    • High Potency (8-10)
  11. Alpha Receptor
    Hypotension
  12. Histamine Receptor
    Sedation
  13. Muscarinic Receptor
    Anti-SLUD
  14. DA Receptor (nigrostriatal tract)
    EPS
  15. DA Receptor (tuberoinfundibular tract)
    Lactation
  16. aripiprazole
    • Abilify
    • SGA
    • Partial DA agonist
    • Adjunct in MDD
    • Ideal for metabolic syndrome (weight neutral), EPS, lactation/gynecomastia
  17. 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
  18. 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
  19. 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)
  20. 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
  21. olanzapine
    • Zyprexa
    • SGA
    • Weight gain (metabolic syndrome), hyperlipidemia, sedation
    • Increased LFTs
  22. quetiapine
    • Seroquel
    • SGA
    • Weight gain (metabolic syndrome), hyperlipidemia, sedation
    • Increased LFTs
    • Metabolized by 3A4
    • QT prolongation
  23. 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
  24. paliperidone
    • Invega
    • SGA
    • Active metabolite of risperidone
    • Tablet shell may appear in stools
    • No CYP DIs
    • Dose related EPS (movement disorders)
  25. 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)
  26. brexpiprazole
    • Rexulti
    • SGA
    • Weight gain, akathisia
    • DA partial agonist
  27. caripiprazine
    • Vraylar
    • SGA
    • Sz, manic/mixed episodes of Bipolar I
    • EPS, akathaisia
    • High doses- more weight gain
    • Not yet available
  28. Abilify Maintena
    • Aripiprazole
    • SGA
    • Q4 wks
    • - 300 mg if 400 mg is not tolerated
    • 2 wks of oral overlap
  29. Aristada
    • aripiprazole lauroxil
    • SGA
    • Q4 or 6 wks
    • 3 wks of oral overlap
  30. Zyprexa Relprevv
    • olanzapine
    • SGA
    • Q2 or 4 wks
    • Post injection delirium syndrome- monitor 3 Hrs post injection
    • No oral overlap
  31. Invega Sustenna
    • paliperidone palmitate
    • SGA
    • Q4 wks
    • Usual maintenance dose: 156 mg
    • No oral overlap
  32. Invega Trinza
    • paliperidone palmitate
    • SGA
    • Q3 months
  33. Risperdal Consta
    • risperidone
    • SGA
    • Q2 wks
    • 3 wks of oral overlap
  34. 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
  35. Prolixin Decanoate
    • fluphenazine
    • FGA
    • Q3 wks
    • Multiply oral dose by 1.25 (max 100 mg)
    • - Taper down oral dose
  36. 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
  37. 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
  38. 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
  39. 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)
  40. 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
  41. PANSS
    Positive and Negative Syndrome Scale
  42. BPRS
    • Brief Psychiatric Rating Scale
    • Overall how the patient is doing
Author
ID
319438
Card Set
Schizophrenia
Description
IT 3 (MT 2): Schizophrenia
Updated
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