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Antipsychotics Flashcards

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1
Q

Amisulpride

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. Atypical antipsychotic
  2. Schizophrenia, acute psychosis
  3. Schizophrenia: different strengths for smx: +ve & -ve smx 200-400mg BD, -ve smx only 50-300mg OD.
    Acute psychosis: 200-400mg BD
  4. S,A,O,P,W,H,M

SPECIFIC MONITORING

  • QT PROLONGATION +++
  • Renal fn - ↓ dose
  • Prolactinoma!!
  1. SPECIFIC COUNSELLING:
    - LABELs: 1, 12, 16
    - Insomnia, sleepiness, constipation in first couple of weeks, should ↓.
    - EPSE
    - Anxiety
    - Hyperprolactinaemia
    - Hypersalivation
    - Orthostatic hypotension (infrequent)
    - Bradycardia (rare)
    - Blood dycrasias
    - Lower rate of metabolic abnormalities than other atypicials.
    - Low anticholinergic effects
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2
Q

Aripiprazole

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. Atypical antipsychotic
  2. Schizophrenia, acute psychosis, BPD
  3. Tabs: 5-30mg OD. Usually 15mg OD. ↑ dose @ least 2 weeks after starting.
    CYP2D6 POOR METABOLISES - HALVE INITIAL DOSE
    W/strong CYP34A/CYP2D6 inhibitors, dose ↓ when starting.
    W/strong CYP34A/CYP2D6 induces, ↑ dose as needed.
    Inj: 400mg once a month.
  4. S,A,O,P,W,H,M

SPECIFIC MONITORING
- Hepatic fn: avoid inj in severe impair.
- CYP2D6 POOR METABOLISES - HALF ORAL DOSE
- Strong CYP34A/CYP2D6 induces - manufacturer discourages use.
- Impulse control disorders
can decrease prolactin concentration

  1. SPECIFIC COUNSELLING:
    - LABELs: 1, 16
    - Warn family & friends of risk of impulse control disorders (problems gambling/shopping etc) & monitor for behaviours. Esp pts w/fam hx of OCD, BPD, substance abuse.
    - Lower rate of metabolic abnormalities than other atypicials.
    - Low anticholinergic effects
    - Light-headedness, insomnia, h/aches in first couple of weeks, should ↓.
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3
Q

Asenapine

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. Atypical antipsychotic
  2. Schizophrenia, BPD
  3. WAFER ONLY: Sublingual tab 5-10mg BD
  4. S,A,O,P,W,H,M

SPECIFIC MONITORING
- Hepatic fn - avoid in severe conc ↑ markedly

SPECIFIC COUNSELLING:

  • LABELs: 1, 13, 16
  • Put wafer under tongue, allow to dissolve, do not crush/chew/swallow.
  • Don’t eat/drink for 10mins after taking it.
  • Take the wafer after your other meds.
  • The inside of mouth may feel tingly/numb for ~1hr after taking wafer.
  • First dose hypersensitivity reactions (dyspnoea, rash, anaphylaxis
  • oral mucosal lesions (ulcers)
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4
Q

Brexpiprazole

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. Atypical antipsychotic
  2. Schizophrenia
  3. 1mg OD on days 1-4, then ↑ to2mg OD on days 5-7, then ↑ to 4mg OD from day 8, depending on response. Usual dose 2-4mg OD.
    CYP2D6 POOR METABOLISES - HALVE USUAL DOSE - different to aripip= initial dose.
    W/strong CYP34A/CYP2D6 inhibitors, dose ↓.
    W/strong CYP34A/CYP2D6 induces, manufacturer suggests doubling dose over 1-2 weeks.
  4. S,A,O,P,W,H,M

SPECIFIC MONITORING
- Hepatic fn: avoid in severe impair. REDUCE DOSE MAX 3mg OD
- RENAL IMPAIRMENT: REDUCE DOSE MAX 3mg OD- different to aripip.
- CYP2D6 POOR METABOLISES - HALF DOSE
- Strong CYP34A/CYP2D6 induces
- Impulse control disorders
can decrease prolactin concentration

SPECIFIC COUNSELLING:

  • LABELs: 1, 16
  • Warn family & friends of risk of impulse control disorders (problems gambling/shopping etc) & monitor for behaviours. Esp pts w/fam hx of OCD, BPD, substance abuse.???
  • Lower rate of metabolic abnormalities than other atypicials.
  • Low anticholinergic effects
  • Light-headedness, insomnia, h/aches in first couple of weeks, should ↓.
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5
Q

Chlorpromazine

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. Typical antipsychotic
  2. Schizophrenia, acute and chronic psychosis, short-term management of agitation, intractable hiccup, N&V in terminal illness, severe behavioural disturbances in children.
  3. 25-100mg 3-4 times d. Up to 500-600mg d.
    Paed: 0.5mg/kg q6-8h
  4. S,A,O,P,W,H,M

SPECIFIC MONITORING

  • photosensitivity= children, those who work outdoors - poor choice bc of phototoxic skin reactions
  • Anticholinergic effects (below)
  • CNS depressants/anticholinergic drugs = TCAs ↑ risk of A/Es
  • cholestatic jaundice
  • Hepatic impair- avoid use
  • SEIZURES
  • Respiratory failure/DEPRESSION
  • anticholinergic +++

SPECIFIC COUNSELLING:

  • LABELs: 1, 8!!, 9, 13, 16, A
  • blurred vision, difficulty urinating, constipstion, sleepiness, dry mouth.
  • Tell Dr. if tremor if unusual tiredness, vomiting, yellow skin/eyes, loss of appetite or abdo pain.
  • Temporary relief of dry mouth = sugarless gum/sweets, or saliva substitute
  • EPSE lowest of the typicals
  • anticholinergic +++
  • cholestatic jaundice, photosensitivity, corneal and lens opacities
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6
Q

Clozapine

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. Atypical antipsychotic
  2. Schizophrenia in pts unresponsive or intolerant to other antipsychotics.
  3. 12.5-900mg d.
  4. GENERAL MONITORING
    At baseline and regularly:
    W- Weight&BMI&waist circumference
    E- Effect & improvement - look at why no improving eg: poor compliance, substance misuse, drug interact, inadequate dose.
    E - EPSE
    Dose & effect- use lowest effective dose
    B- BSLs
    B- BP&if clinically indicated ECG, EEG(most with clozapine) and prolactin
    B- FBE
    P- Pneumonia - may ↑ risk
    L- Lipids
    L- LFTs - MANDATORY for CLOZAPINE
    - NMS

SPECIFIC MONITORING
- serum clozapine concs may help determine appropriate dose
- METABOLIC EFFECTS: increased blood glucose, weight gain and dyslipidaemia
- start tx only if WCC & absolute neutrophil count are normal
- BLOOD monitoring is required each week for the first 18 weeks and then each month - agranulocytosis, eosinophilia.
- monitoring for development of myocarditis necessary
- medical supervision&resus facilities must be avail when tx starts bc of possible profound orthostatic hypotension with respiratory or cardiac failure
- Constipation & ensure effective management
- seizures - ↓ THRESHOLD
- Non-compliant for 48 hours, have to retitrate, restart at 12.5 mg daily
- hepatic fn - hepatitis, hepatic necrosis
- renal fn - interstitial nephritis
- BSLs
- anticholinergic +++
- Respiratory failure/depression
- lower seizure threshold!
SEDATION - high dose at night
- hypersalivation- △s the swallowing reflex! - amytriptyline, benztropine, atropine eyedrops in the mouth to tx

  1. SPECIFIC COUNSELLING:
    - anticholinergic ++++
    -LABELs: 1, 9, 12, 13, 16
    - Regular blood tests and other checks while taking clozapine to help your doctor look out for srs S/Es.
    - Tell Dr if severe constipation= if bowel habits △ and/or you have abdo pain.
    - Caffeine/smoking - clozapine dose may need △ if you vary your caffeine intake or if you start/stop smoking tobacco; tell Dr anything △.
    - Clozapine liquid - mixed with water only.
    - drowsiness (occurs in 40%)
    - hypersalivation (can cause aspiration pneumonia)
    - constipation (may result in obstruction, paralytic ileus and death)
    - seizures, headache, tachycardia, hepatitis, neutropenia, vomiting, urinary incontinence, nocturnal enuresis
    myocarditis (usually in the first month of initial treatment but rarely may occur when starting after a break in treatment)
    - EPSE
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7
Q

Haloperidol (Serenace)

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. Typical antipsychotic
  2. Acute and chronic psychosis, acute mania, torrete syndrome, adjunct in tx of hallucinations in alc w/drawal (if diazepam inadequate).
  3. 1-15mg daily in 2-3 doses. Paed: 0.25-1mg daily
    Long acting inj: 50-300mg every 4 weeks. onset of action 2-4 days
  4. S,A,O,P,W,H,M

SPECIFIC MONITORING

  • hepatic impairment - dose reduction
  • HIGHEST EPSE
  • LOW incidence of hypotension and anticholinergic effects
  • tobacco smoke- may ↓ haloperidol levels: start/stop
  • QT PROLONGATION +++
  • lowest risk of seizure (good)
  1. SPECIFIC COUNSELLING:
    - LABELs: 1, 16
    - Tell your dr if you start or stop smoking, dose may need to change.
    - high EPSE
    - S/Es= insomnia, h/aches, constipation, nausea, blurred vision, dry mouth and excessive perspiration.
    - Temporary relief of dry mouth = sugarless gum/sweets, or saliva substitute
    - lowest risk of seizure (good)
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8
Q

Olanzapine (Pryzex, Zyprexa, Zydis)

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. Atypical antipsychotic
  2. Schizophrenia and related psychosis, BPD w/lithium or valproate
  3. Tablet/wafer: 5-20mg OD
    Short-acting inj: 5-10mg, repeated if necessary.
    Long-acting inj: 150-300mg 2-weekly or 300-405mg 4-weekly.
4. S,A,O,P,W,H,M
SPECIFIC MONITORING
- METABOLIC EFFECTS
- tobacco smoke- may ↓ olanz levels: start/stop
- BSLs/HYPERGLYCAEMIA, T2DM
- liver fn = hepatic failure, elevated liver aminotransferases
- VTE
- rhabdo
- anticholinergic +++
- Respiratory failure/depression

SPECIFIC COUNSELLING:

  • anticholinergic ++++
  • LABELs: 1, 8, 16, 13 for wafer only
  • Take 1-2 weeks before an affect.
  • Can cause dry mouth, constipation and weight gain.
  • Temporary relief of dry mouth = sugarless gum/sweets, or saliva substitute
  • SMOKE !!! Tell your dr if you start or stop smoking, dose may need to change.
  • BSLs high blood sugars, peripheral oedema
  • EPSE
  • Tell dr if any unusual muscle pain
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9
Q

Quetiapine (Seroquel, Kaptan)

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. Atypical antipsychotic
  2. Schizophrenia, BPD, GAD, adjunct tx in resistant major depression
  3. Tablet: 25mg BD-800mg OD.
    CR tablet: 300mg-800mg d
  4. S,A,O,P,W,H,M

SPECIFIC MONITORING

  • METABOLIC EFFECTS
  • BSLs HYPERGLYCAEMIA, T2DM
  • liver fn = hepatic failure, elevated liver aminotransferases
  • CARDIOMYOPATHY, myocarditis
  • anticholinergic effects
  • THYROID= consider monitoring thyroid function, particularly in those with a history of thyroid disease

SPECIFIC COUNSELLING:

  • LABELs: 1, 9, 12, 16, 18, A (MR)
  • Take 1-2 weeks before an affect.
  • Can cause dry mouth, constipation, NAUSEA and weight gain.
  • Temporary relief of dry mouth = sugarless gum/sweets, or saliva substitute
  • Tell your dr if you start or stop smoking, dose may need to change.
  • BSLs high blood sugars, peripheral oedema
  • LOWEST EPSE
  • Tell dr if any unusual muscle pain
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10
Q

Risperidone (Rispa) Paliperidone

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. Atypical antipsychotic
  2. Schizophrenia and related psychosis, BPD, behavioural disturbances in autism.
  3. 1mg BD-6mg OD-BD.
    daily doses >4 mg increase the risk of EPSE.

Pali
Adult, oral, start at 6 mg once daily. If required, increase or decrease dose by 3 mg at 4–5‑day intervals.
Usual dose range 3–12 mg once daily.

  1. S,A,O,P,W,H,M

SPECIFIC MONITORING

  • Hepatic impair- half the dose
  • renal impair - dose reduction may be required
  • ELEVATED PROLACTIN LEVELS!!
  • lowest risk of seizure (good)
  • -sexual/ejaculatory problems
  • breast Ca risk

SPECIFIC COUNSELLING:

  • Take 1-2 weeks before an affect.
  • LABELs: 1, 13, 16, 21, A(tab)
  • insomnia, h/aches, nausea, constipation, restlessness, weight gain.
  • Prolactinoma!! galactoerrhia
  • lowest risk of seizure (good)

Pali
Do not cut, crush or chew tablets; swallow them whole. Take them the same way each day (always with food or always on an empty stomach).

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11
Q

GENERAL MONITORING AND COUNSELLING

A 
S-edation
A-nticholinergic effects
O-rthostatic hypotension
P-rolactin increase
W-eight gain
H-yperglycaemia
M-ovement disturbances

GENERAL MONITORING
At baseline and regularly:
W- Weight, BMI, waist circumference
E- Effect & improvement - look at why no improving eg: poor compliance, substance misuse, drug interact, inadequate dose. 
E - EPSE
D- dose and effect- use lowest effective dose
B- BSLs
B- BP and if clinically indicated ECG, EEG and PROLACTIN
B- FBE
P- Pneumonia - may ↑ risk
L- Lipids
L- LFTs - mandatory for clozapine
- NMS

GENERAL COUNSELLING

  • Take 1-2 weeks before an affect.
  • Take regularly important to prevent eps, rather than taking after smx occur, & bc stopping/irregularity= ↑ risk of relapse and suicide.
  • Best to avoid illicit substances bc, can ↓ control over smx, and ↑ risk of relapse.
  • Make sure you understand what EPSEs are, what you can do about them, the risk of tardive dyskinesia w/longterm tx.
  • Tell Dr if involuntary muscle spasms occur, tremors, muscle restlessness or stiffness.
  • NMS
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12
Q

Lurasidone

A
  1. Atypical antipsychotic
  2. Schizophrenia and related psychosis, BPD, behavioural disturbances in autism.
  3. 40–80 mg daily (max 160 mg daily). Increasing the dose may not increase benefit but may increase the risk of adverse effects.
  4. S,A,O,P,W,H,M

SPECIFIC MONITORING

  • hepatic fn
  • renal fn
  • Treatment with strong inducers or inhibitors of CYP3A4—contraindicated (lurasidone is mainly metabolised by CYP3A4 and lack of efficacy or toxicity may occur).
  • increased serum creatinine
  1. SPECIFIC COUNSELLING:
    sedation, insomnia, akathisia, parkinsonism, nausea.
    Take this medicine with food to increase its absorption.
    Avoid grapefruit juice while you are taking this medicine as it may increase lurasidone’s side effects.
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