Pharmacology of Schizophrenia Flashcards Preview

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Flashcards in Pharmacology of Schizophrenia Deck (27):
1

DA Receptor Blockade: Efficacy vs Toxicity

Need >60% D2 blockade for efficacy
>80% = EPS

2

What is the relationship between FGA potency and prominent side effects?

Low potency = anticholinergic and antihistaminergic effects
High potency = EPS

3

What drug interactions do you need to keep in mind with FGAs?

CYPs

4

Which SGAs may attenuate TD sx?

Seroquel and Clozapine

5

What does the BBW for clozapine say?

Agranulocytosis
Seizures
Cardiac complications

6

Important side effects with clozapine

Hypotension
Bowel Obstruction
Sedation
Weight gain
Metabolic side effects

7

Clozapine Titration

Slow
If miss 2 doses, must start titration from beginning
Nicotine lowers clozapine levels
12.5-25mg then increase by 25mg daily to target dose between 300mg

8

Goal WBC and ANC

WBC: >3.5
ANC: >2
Weekly for 6 months
Then every 2 weeks for 6 months
Then Every 4 weeks forever

9

Clozapine Registry Guidelines

WBC 2-3/ANC 1-1.5 = interrupt therapy, wait then rechallenge
WBC<1 = d/c and do not rechallenge

10

Risperidone

Most "typical"
Highest EPS of SGAs
Hypotension

11

Olanzapine

Highest metabolic side effects and wt gain (w/ clozapine)
Smoking lowers levels

12

Seroquel

May improve TD
SEDATION and weight gain

13

Ziprasidone

500 calories of food + BID
Activating at low doses
Affects NE and SR too

14

Abilify

Partial agonist
Best side effect profile
Akathisia

15

Paliperidone

Similar to risperidone and similar side effects
ER capsule found in stool

16

Saphris (asenapine)

Sublingual

17

Lurasidone

Great side effect profile minus sedation
MUST be taken with food

18

LAIA

There are several LAIAs to improve compliance
Most every 2-4 weeks
Deltoid or gluteal administration

19

Risperidone LAIA

Bridge with oral therapy for 3 weeks

20

Invega

First 2 doses should be deltoid (fear of needles - don't do)

21

Zyprexa LAIA BBW

Post injection delirium
Monitor for 3 hours after injection!

22

Abilify LAIA

Oal overlap for 2 weeks

23

Akathisia Treatment

Lower dose, but if stable on that dose give propranolol

24

Screening Tool to Test for TD

AIMS
Abnormal Involuntary Movement Scale

25

SGAs with worst metabolic side effect profile

Olanzapine and Clozapine

26

Hyperpolactinemia

FGAs and risperidone are the WORST
Add Abilify or bromocriptine

27

Drooling

Most common with clozapine
Ipatropium NS and atropine eye drops SL