Psychosis - Tx Guidelines, EPS Flashcards
(41 cards)
First episode psychosis: What should be used?
2nd generation antipsychotic (less AEs and equal efficacy relative to first-gens)
First episode psychosis: tx duration?
Min 18 mths
T or F: First episode psychosis: indefinite tx is absolutely unnecessary
F
Indef tx is not unreasonable
First episode psychosis: All antipsychotics are essentially equally effective
T (you would choose the one with the best AE profile, and you would use the lowest effective dose)
First episode psychosis: how long would an adequate trial be?
4-6 weeks
T or F: 2nd gen antipsychotics are better tolerated than 1st gens
T
Acute exacerbation: what should we do first when tx’ing this?
Screen for nonadherence, substance use (e.g. cannabis), and drug interactions
Acute exacerbation: Assuming no nonadherence, substance use, or drug interactions, what do we do next?
Increase antipsychotic dose OR change antipsychotic
Trial for 6-8 wks to determine effect
(if switching, cross taper is usually the preferred method to prevent AP withdrawal)
Maintenance and relapse prevention: How to tx mood changes?
Mood stabilizers or antidepressants
Maintenance and relapse prevention: How long should maintenance tx be?
2 yrs (possibly up to 5 yrs)
Treatment resistant schizophrenia: When do we determine that someone’s schizophrenia is treatment-resistant?
≥ 2 positive sx’s of mod severity
OR
1 positive sx of severe severity
…after ≥ 2 adequate antipsychotic trials (6-8 wks long = ea. trial period) for po
OR
…after 6 weeks of steady state for long-acting injection
Treatment resistant schizophrenia: Before tx’ing this, what should we do?
Ensure
- adherence
- no substance use
- no DIs
- appropriate dose
Treatment resistant schizophrenia: 1st line tx?
Clozapine (an atypical antipsychotic)
What drug is most effective for tx-resistant schizophrenia?
Clozapine
Clozapine: important AEs
agranulocytosis, myocarditis, constipation
Clozapine: Why is continuous blood monitoring req’d?
Risk of agranulocytosis
Clozapine: Re-titrate up if doses are missed for how long?
> 48h
Clozapine: When does clozapine become non-rechallengeable?
if total WBC < 2.0 x 10^9
OR
ANC (absolute neutrophil count) < 1.5 x 10^9
…during clozapine tx
When a pharmacist is dispensing clozapine for tx-resistant schizophrenia, what must the pharmacist make sure of?
That the pt is enrolled with the A.A. Clozapine Program and ensure most recent bloodwork is in green or yellow zone
T or F: Augmenting clozapine with an antipsychotic is well supported in the literature for partial responses to clozapine for clozapine-resistant schizophrenia
F
Evidence is mixed
What’s last line tx if clozapine-resistance isn’t overcome with antipsychotic augmentation?
ECT
What comorbidity should we screen all psychosis pts for?
substance use disorder (since substances like stimulants and cannabis are assoc w/ psychosis and worse outcomes)
Tx for psychosis + substance use disorder?
Any antipsychotic (limited data saying clozapine)
Most EPS’s are due to what?
DA blockade (MOA of antipsychotics)
