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What are the Characteristic symptoms of a schizophrenic?
- Hallucinations
- Delusions
- Disorganized Speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
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What drugs are used to treat schizophrenia?
- 1st generation antipsychotics (FGAs or neuroleptics)
- 2nd generation antipsychotics (SGAs or atypicals)
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Which FGAs (neuroleptics)are used to treat schizophrenia?
- chlorpromazine (Thorazine)
- thioridazine (Mellaril)
- haloperidol (Haldol)
- perphenazine (Trilafon)
- fluphenazine (Prolixin)
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What are the advantages of FGAs (neuroleptics)?
- cheap
- effective for positive sx (perphenazine was 2nd best in CATIE trial)
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What are the disadvantages of FGAs (neuroleptics)?
- MANY SE!
- failure to change insight or judgment
- lack of efficacy in 20-30% of pts
- may worsen negative sx
- DI with drugs that affect gastric pH
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What are the side effects of FGAs (neuroleptics)?
- EPSE
- prolactin elevation
- sexual dysfx
- anticholinergic effects
- sedation
- wt gain
- dizziness
- orthostatic hypotension
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Which SGAs (atypicals) are used to treat schizophrenia?
- clozapine (Clozaril)
- risperidone (Risperdal)
- paliperidone (Invega)
- olanzapine (Zyprexa)
- quetiapine (Seroquel)
- ziprasidone (Geodon)
- aripiprazole (Abilify)
- iloperidone (Fanapt)
- asenapine (Saphris)
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How do most of the SGAs (atypicals) work?
- serotonin-dopamine antagonism
- (SDA more 5-HT2 than D2)
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What is the only drug succussfully used to treat pts refractory to FGAs?
clozapine (Clozaril)
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Which SGAs are better than FGAs for depressive-type sx seen in schizophrenia?
- aripiprazole (Abilify)
- quetiapine (Seroquel)
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Which antipsychotic is cheapest of all APs (FGA and SGA)?
resperidone (Risperdal)
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Which SGA is the only one that may NOT need to be titrated to an effective dose?
asenapine (Saphris)
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How are the SGAs associated with metabolic problems (ranking)?
- up to 100lbs/y
- 10-20lbs in a few months
- clz, olz > risp, quet >ase > zip, ari
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What are the advantages of clozapine (Clozaril)?
- the only AP effective for tx refractory Schizophrenics
- the only AP FDA approved to reduce risk of recurrent suicidal behavior
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What are the disadvantages of clozapine (Clozaril)?
- Agranulocytosis
- Seizures
- Orthostatic Hypotension
- Most metabolic problems (wt gain)
- 2D6 substrate (Fluoxetine, Paroxetine) Hypersalivation
- Sedation
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What are the five (5) BBW of clozapine (Clozaril)?
- Seizures
- Agranulocytosis (life-threatening)
- Myocarditis (fatal)
- Orthostatic Hypotension
- Dementia-Related psychosis
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What should be done if clozapine (Clozaril) causes agranulocytosis in patients?
d/c medication if WBC <3,500 or ANC <1,500
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What should be done if clozapine (Clozaril) causes seizures in patients?
if cont'd tx needed, add VPA but keep dose <900 mg/d
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What can be done to control hypersalivation caused by clozapine (Clozaril)?
procyclidine (Kemadrin) 5mg
MOA: Procyclidine exerts an atropine-like action and produces an antispasmodic effect on smooth muscle. This agent is a potent mydriatic and inhibits salivation.
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What are the advantages of risperidone (Risperdal)?
- First-line agent
- many dosage forms
- most potent D2 blocker SGA (good for very psychotic pt)
- FDA approved for schiz and bi-polar in children and adolescents
- cheapest AP available
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First-line agent for schizophrenia
risperidone (Risperdal)
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The most potent D2 blocker SGA
- risperidone (Risperdal)
- good for very psychotic patient
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Do NOT mix this SGA with teas or colas
risperidone (Risperdal)
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Which agent is FDA approved for schiz & bipolar in children & adolescents?
risperidone (Risperdal)
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Most commonly SGA used in dementia
risperidone (Risperdal) (0.25 - 1mg)
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What are the disadvantages of risperidone (Risperdal)?
- Most potent D2 blockade SGA (more EPSE, dose dependent)
- Most Prolactin elevation
- 2D6 substrate (Fluoxetine, Paroxetine)
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9-OH metabolite of risperidone (Risperdal) w/ more prolactin elevation SE
paliperidone (Invega)
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Sustained release tablet: do not crush or chew;
tablet shell may be seen in stool
paliperidone (Invega)
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Relatively free of drug interactions (best in CATIE trial)?
olanzapine (Zyprexa)
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Long-acting injectable dosing q 2-4wks
olanzapine (Zyprexa)
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Most expensive of any AP $$$$
olanzapine (Zyprexa)
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Most metabolic problems & wt gain
olanzapine (Zyprexa)
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