Psychiatric - Schizophrenia Antipsychotics

  1. What are the Characteristic symptoms of a schizophrenic?
    • Hallucinations
    • Delusions
    • Disorganized Speech
    • Grossly disorganized or catatonic behavior
    • Negative symptoms
  2. What drugs are used to treat schizophrenia?
    • 1st generation antipsychotics (FGAs or neuroleptics)
    • 2nd generation antipsychotics (SGAs or atypicals)
  3. Which FGAs (neuroleptics)are used to treat schizophrenia?
    • chlorpromazine (Thorazine)
    • thioridazine (Mellaril)
    • haloperidol (Haldol)
    • perphenazine (Trilafon)
    • fluphenazine (Prolixin)
  4. What are the advantages of FGAs (neuroleptics)?
    • cheap
    • effective for positive sx (perphenazine was 2nd best in CATIE trial)
  5. 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
  6. What are the side effects of FGAs (neuroleptics)?
    • EPSE
    • prolactin elevation
    • sexual dysfx
    • anticholinergic effects
    • sedation
    • wt gain
    • dizziness
    • orthostatic hypotension
  7. 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)
  8. How do most of the SGAs (atypicals) work?
    • serotonin-dopamine antagonism
    • (SDA more 5-HT2 than D2)
  9. What is the only drug succussfully used to treat pts refractory to FGAs?
    clozapine (Clozaril)
  10. Which SGAs are better than FGAs for depressive-type sx seen in schizophrenia?
    • aripiprazole (Abilify)
    • quetiapine (Seroquel)
  11. Which antipsychotic is cheapest of all APs (FGA and SGA)?
    resperidone (Risperdal)
  12. Which SGA is the only one that may NOT need to be titrated to an effective dose?
    asenapine (Saphris)
  13. 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
  14. 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
  15. What are the disadvantages of clozapine (Clozaril)?
    • Agranulocytosis
    • Seizures
    • Orthostatic Hypotension
    • Most metabolic problems (wt gain)
    • 2D6 substrate (Fluoxetine, Paroxetine) Hypersalivation
    • Sedation
  16. What are the five (5) BBW of clozapine (Clozaril)?
    • Seizures
    • Agranulocytosis (life-threatening)
    • Myocarditis (fatal)
    • Orthostatic Hypotension
    • Dementia-Related psychosis
  17. What should be done if clozapine (Clozaril) causes agranulocytosis in patients?
    d/c medication if WBC <3,500 or ANC <1,500
  18. What should be done if clozapine (Clozaril) causes seizures in patients?
    if cont'd tx needed, add VPA but keep dose <900 mg/d
  19. 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.
  20. 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
  21. First-line agent for schizophrenia
    risperidone (Risperdal)
  22. The most potent D2 blocker SGA
    • risperidone (Risperdal)
    • good for very psychotic patient
  23. Do NOT mix this SGA with teas or colas
    risperidone (Risperdal)
  24. Which agent is FDA approved for schiz & bipolar in children & adolescents?
    risperidone (Risperdal)
  25. Most commonly SGA used in dementia
    risperidone (Risperdal) (0.25 - 1mg)
  26. What are the disadvantages of risperidone (Risperdal)?
    • Most potent D2 blockade SGA (more EPSE, dose dependent)
    • Most Prolactin elevation
    • 2D6 substrate (Fluoxetine, Paroxetine)
  27. 9-OH metabolite of risperidone (Risperdal) w/ more prolactin elevation SE
    paliperidone (Invega)
  28. Sustained release tablet: do not crush or chew;
    tablet shell may be seen in stool
    paliperidone (Invega)
  29. Relatively free of drug interactions (best in CATIE trial)?
    olanzapine (Zyprexa)
  30. Long-acting injectable dosing q 2-4wks
    olanzapine (Zyprexa)
  31. Most expensive of any AP $$$$
    olanzapine (Zyprexa)
  32. Most metabolic problems & wt gain
    olanzapine (Zyprexa)
Card Set
Psychiatric - Schizophrenia Antipsychotics
Psychiatric - Schizophrenia Antipsychotics