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therapeutics 2 > Pharmacotherapy of Schizophrenia > Flashcards

Pharmacotherapy of Schizophrenia Flashcards

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1
Q

what are the two main groups of symptoms in schizophrenia?

A

positive symptoms and negative symptoms

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2
Q

what are positive symptoms of schizo

A

delusions
hallucinations
disorganized thoughts and behaviors
abnormal motor behavior

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3
Q

what are negative symptoms of schizo

A

social withdrawal
poor self care
depression

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4
Q

how is smoking related to antipsychotics

A

associated with induction of 1A2 due to hydrocarbons inhaled which can decrease serum concentrations of 1A2 substrate antipsychotics

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5
Q

what are typical antipsychotics and what is the efficacy

A

older agents and mostly D2 receptor antagonists
good efficacy for positive symptoms but can worsen negative symptoms

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6
Q

what are the typical antipsychotics

A

haloperidol
chlopromazine
fluphenazine
perphenazine
loxapine
thioridazine

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7
Q

what is the main side effect of typical antipsychotics

A

EPS

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8
Q

what is the MOA of atypical antipsychotics

A

D2 antagonists and 5HT2a antagonists

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9
Q

what are the side effects of atypical antipsychotics

A

less EPS but more metabolic side effects

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10
Q

what are the 3 types of atypical antipsychotics

A

Pines
Dones
Partial Agonists

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11
Q

what is the MOA of partial agonists

A

stabilize dopamine (not too much or too little)

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12
Q

what are the side effects of partial agonists

A

more akathisia
black box warning for suicidal thoughts/behaviors

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13
Q

what are the 3 partial agonists

A

aripiprazole
brexpiprazole
cariprazine

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14
Q

what are the warnings for ALL antipsychotics

A

-Boxed warning for increased risk of death in elderly patients
-metabolic adverse effects
-EPS
-risk for insomnia, hypotension, and increased risk of falls/fractures

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15
Q

Asenapine (dosage, P450, side effect)

A

-sublingual and patch
-1A2 substrate
-QTc prolongation

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16
Q

what is clozapines p450

A

1A2 substrate (educate smokers)

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17
Q

what is the boxed warning for clozapine

A

neutropenia
orthostasis
bradycardia/syncope
seizures
CV issues

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18
Q

what are the side effects of clozapine

A

lots of weight gain
QTc prolongation
sedation
dry mouth
GI motility

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19
Q

what is the REMS protocol for clozapine

A

monitor weekly x 6 months
biweekly x 6 months
every 4 weeks indefinitely

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20
Q

Olanzapine p450

A

1A2 substrate

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21
Q

olanzapine side effects and warnings

A

significant weight gain and sedation
metabolic syndrome
DRESS warning

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22
Q

what is lybalvi

A

olanzapine + samidorphan

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23
Q

how does lybalvi work

A

opioid antagonist w/ preferential activity at the mu opioid receptor. helps decrease the weight gain associated with olanzapine

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24
Q

quetiapine p450

A

3A4 substrate

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25
quetiapine side effects and warnings
QTc prolongation weight gain and sedation boxed warning for suicide
26
Iloperidone p450
2D6 substrate
27
Iloperidone side effects
QTc prolongation high risk for orthostasis and syncope (creates dosing issue)
28
Lurasidone p450
3A4 substrate
29
Lurasidone side effects
akathisia suicide
30
what should always be taken with lurasidone
350 calories of food to increase bioavailability
31
ziprasidone p450
3A4 substrate
32
what is an absolute CI of Ziprasidone
QTc prolongation
33
what are side effects/counseling of ziprasidone
DRESS warning take w/ food
34
risperidone p450
2D6 substrate
35
risperidone side effects
EPS hyperprolactinemia weight gain sedation orthostasis
36
what atypical antipsychotic is good for mood symptoms
risperidone
37
how is paliperidone eliminated
renally (may need adjustments)
38
what are side effects of paliperidone
EPS hyperprolactinemia weight gain sedation QTc prolongation orthostasis
39
Lumateperone p450
3A4 substrate
40
lumateperone side effects
low weight gain/metabolic risk low risk for EPS or akathisisa
41
pimavanserin p450
3A4 substrate
42
what is pimavanserin used for
treatment of hallucinations or delusions in patient with Parkinson's
43
what is pimavanserin MOA
inverse agonist and antagonist at serotonin receptor
44
haloperidol injection dose, frequency, efficacy
load 20x oral dose maintenance 10x oral dose use z-track very effective every 4 weeks
45
what is the supplementation with risperdal consta
must supplement w/ oral risperidone for 3-4 weeks
46
perseris injection counseling points
abdominal sub q injection avoid beltline must rotate within quadrant on stomach
47
what is the supplementation for perseris
no oral overlap
48
what is the frequency and oraloverlap of rykindo
every 2 week IM injection 7 days of oral overlap
49
where to inject and how often for uzedy
abdominal or upper arm subq inj given once monthly or every 2 months
50
what is the injection schedule of Invega Sustenna
loading dose then booster then every 5 weeks after loading dose
51
where to inject invega sustenna
deltoid
52
how long to oral overlap invega sustenna
if started correctly theres no need for oral overlap
53
when to adjust dose in invega sustenna
moderate to severe renal impairment
54
how to start invega trinza
can start if stable on sustenna for at least 4 doses
55
where to give invega trinza
deltoid
56
when do you not give invega trinza
CrCl < 50 mL/min
57
how to start invega hafyera
can start after 4 doses of sustenna or 1 dose of trinza
58
where to inject invega hafyera
gluteal injection only
59
when to not give invega hafyera
CrCl < 90
60
what is required for zyprexa relprevv
REMS
61
what is a major side effect of zyprexa relprevv
PDSS (post dose delirium sedation syndrome)
62
overlap requirements for abilify maintena
must overlap with oral aripiprazole for at least 14 days
63
where to inject abilify maintena
deltoid or gluteal injections
64
when to adjust the dose adjustments for abilify maintena
if taking 2D6 or 3A4 inhibitors or inducers for more than 14 days as concomitant therapy
65
what is the overlap for abilify asimtufii
continue oral aripiprazole for 2 weeks after 1st injection
66
asimtufii frequency and where to inject
every 2 month dosing gluteal injections only
67
overlap for aristada
oral overlap with aripiprazole for 3 weeks
68
overlap for initio
no need for 3 week overlap
69
when to avoid use of initio
patients who are poor 2D6 metabolizers or 2D6 inhibitors
70
what are the IR/emergency injections
haloperidol, chlorpromazine, fluphenazine

therapeutics 2 (24 decks)

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