Schizophrenia 2

Question 1

Ziprasidone

Answer 1

IND: Schizo, bpd, agitation/aggression
MOA: SGA & 2 Additional:
Agonist at 5HT1A. (Anxiolytic and reduce negative s/s)
Moderately inhibits reuptake of serotonin and NE (antidepressant effects)
Oral caps must be consumed with a meal of 500 calories or more
BOX: SGA
CON: QTc prolongation
ADR: CNS s/s. GI. QTc prolongation

Question 2

Lurasidone

Answer 2

IND: Schizo, bpd
MOA: SGA and 5HT1A partial agonist.
BOX: Suicidal thoughts and behaviors in kids-YA
CON: Use with strong CYP inhibitors or inducers
ADR: Endo/metabolic. Nausea. Viral inf. CNS

Question 3

Aripiprazole

Answer 3

IND: Schizo, bpd, depression
MOA: D2 PARTIAL AGONIST; limit + s/s
5HT2A Antagonist (SGA)
5HT1A Agonist (Anxiolytic)
BOX: Suicidal thoughts/behaviors in kids-YA
CON: 
ADR: endo/metabolic. Akathasia

Question 4

Brexipiprazole

Answer 4

IND: schizo, depression
MOA: Remember same things as other piprazole
BOX: n/a
CON:
ADR:

Question 5

Cariprazine

Answer 5

IND: Schizo, bpd
MOA: D2 PARTIAL AGONIST AND 5HT2A AND 5HT1A AND AN EXTREMELY LONG HALF LIFE OF 2-4 DAYS. Dosing changes are going to take weeks to months to get to therapeutic effect
BOX: Kids suicide
CON:
ADR: nausea

Question 6

Switching Antipsychotics

Answer 6

Cross titration: Gradually d/c one while titrating the new agent
Abrupt change: Can start titrating new agent OR
Can start at full dose of new agent; these pts at most risk

Question 7

Long acting Injectable (Depot) Antipsychotics

Answer 7

INCREDIBLY HELPFUL FOR NON-ADHERENT OR IMPULSIVE PATIENTS
Help prevent relapse
No increased rate of adverse drug reactions

Question 8

D/c of therapy

Answer 8

Typically chronic, not normal to discontinue therapy
If stopping; gradual dose reduction over weeks to months in a controlled environment
Monitor closely for recurrence
Not required for long-acting injectables due to the half life elimination being much slower