schizophrenia antipsychotics Flashcards
(22 cards)
best efficacy for schizophrenia
clozapine
save it for resistant cases d/t agranulocytosis
highest weight gain (thus, also concerned about DM, dyslipidemia and anticholinergic)
clozapine and olanzapine
lowest to NO wt gain (thus less concern for DM and hyperlipidemia)
ziprasidone, lurasidone*, aripiprazole
iloperidone (Fanapt) has moderate weight gain and low DM and dyslipidemia
use these if worried about QT prolongation
abilify, latuda, rexulti, vraylar
for resistant depression recommend
abilify, seroquel XR, symbyax, brexipiprazole (rexulti)
for bipolar disorder recommend
risperidone, geodon, abilify, seroquel, saphris, latuda, zyprexa, vraylar
only sublingual
asenapine (saphris) = rapidly absorbed
what comes in ODT
clozapine, olanzapine, aripiprazole, and risperidone
use with food
lurasidone and ziprasidone
take on an empty stomach
quetiapine XR
most antipsychotic drugs are metabolized via the cytochrome P450 system if the liver
what is the exception
paliperidone (80% is excreted unchanged via the kidneys, only 10% inactivated by hepatic enzymes)
paliperidone is the only medication of this class for which no dose adjustment is recommended in pts with impaired liver function
concern regarding CYPs 2D6 and 3A4
aripiprazole and brexipiprazole
concern regarding CYP3A4 only
quetiapine, ziprasidone, lurasidone, cariprazine
concern regarding CYP2D6 only
iloperidone and risperidone
concern regarding CYP1A2 only
clozapine, olanzapine, asenapimne
most orthostatic HTN
clozapine and iloperidone
concerned on negative impact on impulse control d/t partial dopamine agonist effect
aripiprazole
brexipiprazole (rexulti)
cariprazine (vraylar)
olanzapine KEY POINTS
dosage forms: tabs, ODT, suspension
must have pt, pharmacy and MD enrolled in REMs program
1a2 substrate (decrease dose by 1/3 w/ strong inhibitors e.g., fluvoxamine, cipro)
does not cause EPS
MOST anticholinergic, wt gain (concern about increased blood sugars and hyperlipidemia), sedation
no effect on prolactin
CONCERN W/ AGRANULOCYTOSIS thus want ANC (monitored at pharmacy) to be >/= 1500/microliters –> IF SIGNS OF INFECTION OR NEUTROPENIA GO TO MD
BOXED WARNING for orthostatic HTN
ALSO HAS CHOLINERGIC PROPERTIES –> can cause hypersalivation and sweating
Solutions
[mnemonic for antipsychotic drug formulations]
H-CAR
clozapine
aripiprazole
risperidone
ODT
[mnemonic for antipsychotic drug formulations]
O-CAR
olanzapine
clozapine
aripiprazole
risperidone
Long-acting Injectable
[mnemonic for antipsychotic drug formulations]
O-PAR-HF
olanzapine
paliperidone
aripiprazole
risperidone
haloperidol
fluphenazine
NMS definition + what to monitor to determine possible NMS
[from PNN schizophrenia chapter]
NMS = life-threatening; d/t the depletion of DA in the CNS: disruption of muscle contraction & disruption of thermostat system
LABS:
-increase CPK (muscle breakdown)
-LFT
-increase in WBC (CBC)
-metabolic acidosis
