schizo therapeutics Flashcards
(60 cards)
1
Q
first week response of medication use
A
- medicated cooperation
- less agitation
- decreased hallucinations
2
Q
weeks 2-4 response of medication use
A
- improved socialization
- hygiene
- mood
- improved hallucinations/delusions
3
Q
weeks 4-8 response of medication use
A
- improved thought disorder
- less hallucination/delusions
- appropriate conversations
4
Q
duration of treatment after first episode
A
12 months after remission
5
Q
duration of treatment after 2nd episode
A
likely life-long
6
Q
response to treatment is considered
A
20% improvement in symptoms
7
Q
olanzapine ODT is absorbed where
A
the gut
8
Q
general antipsychotic dosing
A
- start Qd to QID
- titrate to control symptoms
- taper slowly if switching
9
Q
withdrawal symptoms of antipsychotics
A
nausea
headache
10
Q
medication selection
A
- First episode = 2nd Gen
- Second choice = 2nd gen or 1st gen
- Third choice = clozapine
- Fourth choice = clozapine augment
11
Q
first generation antipsychotics
A
chlorpromazine perphenazine haloperidol fluphenazine loxapine
12
Q
aripiprazole (abilify) dosing
A
- 10 to 30 mg/day
- no renal adjustment
- adjust in severe hepatic impairment
13
Q
aripiprazole side effects
A
GI
akathisia
insomnia
*High risk fo extrapyramidal events and somnolence in adolescents
14
Q
aripiprazole cautions
A
CV disease
HTN
15
Q
clozapine (clozaril) benefits
A
improves suicidality, violence
16
Q
clozapine dosing
A
- 12.5 mg - 900 mg daily, titrate slowly
- avoid in CKD
- caution in hepatic failure
17
Q
clozapine side effects
A
- high metabolic risk
- sedation
- hypotension
- agranulocytosis
18
Q
clozapine monitoring
A
CBC with REMS for agranulocytosis weekly for the first 6 months
19
Q
Olanzapine (zyprexa) dosing
A
5-20 mg daily
no renal dose adjustment
20
Q
olanzapine contraindications
A
narrow-angle glaucoma
21
Q
olanzapine side effects
A
- extreme weight gain
- sedation
22
Q
paliperidone (invega) dosing
A
- 3-12mg daily
- adjust for renal impairment
23
Q
paliperidone side effects
A
- orthostatic hypotension
- headache
- akathisia
24
Q
quetiapine (seroquel) dosing
A
- IR and ER
- 50-800 mg qday
- start 25 mg for elderly
- take ER one hour before meal
- no renal dose adjustment
25
quetiapine side effects
- sedation
- orthostatic hypotension
- weight gain
26
risperidone (risperdal) dosing
- 1-16 mg daily
| - adjust for renal and hepatic impairment
27
risperidone side effects
highest EPS rate of 2nd gens
28
ziprasidone (geodon) dosing
- 20 - 80 mg BID with food
- no renal dose adjustment
- do adjust for hepatic impairment
29
ziprasidone side effects
- risk of QTc prolongation
| - *low weight gain*
30
asenapine (saphris) dosing
- start 5 mg SL BID
- max is 10 mg BID
- do not eat or drink for 10 minutes after taking
- no adjustment for renal impairment
31
asenapine contraindications
hepatic impairment
32
asenapine side effects
- general antipsychotic side effects (anticholinergic, orthostatic hypotension)
- LOW WEIGHT GAIN
33
iloperidone (fanapt) dosing
- initial 1 mg bid, titrate slowly to 12 mg bid
| - no renal adjustment
34
iloperidone side effects
- tachycardia
- hypotension
- low risk of akathisia and weight gain
35
lurasidone (latuda) dosing
- start 40 mg daily
- maintenance dose up to 80 mg daily
- taken with food
- adjust renally and hepatically
36
lurasidone side effects
- akathisia is common
- somnolence
- weight neutral or loss
37
brexpiprazole (rexulti) dosing
-1mg daily titrated to max of 4mg daily
38
brexpiprazole side effects
- less akathisia
| - favorable metabolic profile
39
cariprazine (vraylar) dosing
- 1.5 mg daily up to max of 6 mg
| - avoid in renal and hepatic problems
40
cariprazine side effects
- favorable metabolic profile
| - side effects are delayed due to long half life
41
short acting prn injectables max doses
- haloperidol no max
- olanzapine 30 mg/day
- ziprasidone 40 mg/day
- aripiprazole 30 mg/day
42
olanzapine long acting (zyprexa relprevv) monitoring
must be kept on site for 3 hours to watch for sedation and delirium
43
paliperidone (invega trinza)
- long acting, 3 month formulation
| - must have had 5 doses of invega sustenna before getting trinza
44
how to treat delirium
- nonpharm approach
- antipsychotics if there is risk of self harm
- avoid benzos
45
acute agitation nonpharm
- decrease noise and stimulation
- observe carefully
- calm communication
- open ended questions
- avoid challenging delusions
- orientation
46
medications for acute agitation
- lorazepam po or im ever 1-2 hours
- short acting injectables
- loxapine
47
avoid combining what drugs with olanzapine
benzos due to sedation
48
extrapyramidal side effects of antipsychotics
- acute dystonia
- pseudoparkinsonism
- akathisia
- tardive dyskineasia
- neuroleptic malignant syndrome
49
treatment for acute dystonia
benztropine
| diphenhydramine
50
treatment for akathisia
propranolol
| benzos
51
treatment for pseudoparkinsonism
anticholinergics (benztropine, diphenydramine)
52
tardive dyskinesia treatment
tetrabenzine
reserpine
clozapine if indicated
53
treatment for neuroleptic malignant syndrome
dantrolene
54
drugs with highest risk of orthostatic hypotension
clozapine
| olanzapine
55
drugs with lowest risk of orthostatic hypotension
aripiprazole
brexiprazole
cariprazine
56
drugs with highest risk of QTc prolongation
thioridazine
ziprasidone
iloperidone
haloperidol
57
drugs with most sedation
olanzapine
| clozapine
58
drug with least sedation
aripiprazole
59
drugs with lower risk of metabolic problems
asenapine
iloperidone
aripiprazole
60
monitoring for atypical antipsychotics
- weight every 4 weeks
- waist circumference annually
- blood pressure and fasting glucose @ 12 weeks then annually
- fasting lipids @ 12 weeks then every 6 years
