Schizophrenia Brand/Generics

Question 1

*Thorazine

Answer 1

Chlorpromazine

Question 2

Thioridazine

Answer 2

Mellaril

Question 3

Mesoridazine

Answer 3

Serentil

Question 4

*Loxitane

• Indication
• Administration

Answer 4

*Loxapine

• Indication: acute agitation ass w/ scz or bipolar I disorder
• Adm by a healthcare professional 10mg PO inhalation using a inhaler

Question 5

Molindone

Answer 5

Moban

Question 6

Perpenazine

Answer 6

Trilafon

Question 7

Trifluoperazine

Answer 7

Stelazine

Question 8

Thiothixene

Answer 8

Navane

Question 9

*Prolixin

Answer 9

Fluphenazine

Question 10

• Haldol

- Major SEs

Answer 10

Haloperidol

• QT Prolongation, Tordades de pointes

Question 11

• ORAP

- Indication

Answer 11

PIMozide

• Indication: used for Tourette’s only

Question 12

SEs of these drugs

Anticholinergic SEs

Extrapyramidal SEs

• Causes:
• S/S
• Agents have higher risk
• Agents have lowest risk

Tardive dyskinesia
- Cause

Neuroleptic malignant syndrome

• S/S
• Cause
• Management

Answer 12

SEs: WASH MEN

• Weight gain: block histamine H1 receptor
• Anticholinergic: block cholinergic receptor
• Sedation: Block histamine
• Hypotension: block alpha-adrenergic
• Movement disorder - Tardive dyskinesia
• EPSE
• Neuroleptic Malignant Syndrome (NMS)

Anticholindergic SEs => Anti- SLUDGE

• Salivation
• Lacrimation
• Urination
• Defecation
• GI motility
• Excretion

Extrapyramidal SEs
- Causes: due to dopamine antagonist activity
- S/S
Dystonia: hrs - day: painful muscle spasm laryngospasm
IV diphenhydramine 25-50mg
Akathisia: days to weeks. Restlessness
Propanolol 30-100 mg QD
Pseudoparkinsonism: weeks to mo
Decrease Ach or Inc dopamine. Benztropine,
Trihexyphenidyl, diphenhydramine, amantadine

Tardive Dyskinesia
- Cause: hypersensitivity rxn due to prolonged blockade of dopamine. Tongue, lip, jaw, face, and extremity movement

Neuroleptic Malignant syndrome
- S/S: rigidity, fever, diaphoresis, altered consciousness, incr BP, increased HR
- Cause: due to depletion of DA in CNS = disruption of muscle contraction, disruption of thermostat system
- Management
D/C drug
Supportive therapy: IV fluid, cooling
Increase DA by DA agonist (bromocriptine)
Dantrolene: muscle relaxant tx of malignant hyperthermia

Question 13

Agents for rapid transquilization given IM

HAZO

Answer 13

• Haloperidol: 5-10mg IM Q1H prn
• Aripiprazole 7.5mg/mL repeat in 2H max 30mg/d
• Ziprasidone 10-20mg IM. Max 40
• Olanzapine 2.5-10mg IM. May repeat in 2H. Max 30mg/d

Question 14

Deconate agents

• Halol
• Fluphenazine
• Resperdal
• Paliperidone
• Ability maintain
• Zyprexa Relprevv

Answer 14

• Halol 10-15x PO given monthly
• Fluphenazine Q2W
• Risperdal Consta: > 18 y.o given by 25mg (max 50) deep IM Q2W
  Give PO x 3wks then stop PO
• Paliperidone Palmitate
  Give 234mg on day 1, then 156mg on week later.
  MD given 117 IM injection once a month
• Ability maintena IM depot QM
• Zyprexa relprevv (olanzepine ER)
  150mg to 300mg Q2W or
  405 mg Q4W

Question 15

Clozaril

• MOA
• Indication
• Dose
• Benefits
• SEs

Answer 15

Clozapine:

=» Must register in Clonazril National Register (CNR)

• MOA: block D4, 5HT2, alpha, histamine
• Indication: Szc (treatment resistant)
• Dose: 300-900mg/day
• Benefits: doesn’t cause EPS or TD or prolactin level
• SEs:
  Agranulocytosis: WBC > 3.5K, ANC > 2k
  Hypersalivation and sweating
  SZ
  Hyperglycemia/lipidemia
  Wt gain
  Sedation

Question 16

Resperdal
Resperdal consta

• Indication
• Forms
• Disadvantage

Answer 16

Risperidone

• Consta: IM inj Q2W => Give 1st dose of oral dosage form. Continue for 3wks then d/c oral
• Indication: scz, bipolar mania, autism
• Forms: Tab, disintergrating tabs, sol’n, IM inj (consta)
• SEs: higher risk of EPS

Question 17

Zyprexa
Zyprexa Relprevv
Zydis = ODT

- Zyprexa Relprevv dose
  Warning, registration
- Indication
- SEs
- Monitor
- Zydis counseling ODT

Answer 17

Olanzapine
- Atypical

Zyprexa Relprevv:

• ER => give 150-300mg PO Q2W or 405mg Q4W
• Can cause post injection delirium/sedation
• Must register in ZYPREXA RELPREVV pt care program
• Indication: Scz, bipolar, depression, depression resistant use with fluoxetine
• SEs: Wt gain and DM, hyperG/lipidemia
• Monitor: wt, glucose, lipids, orthostatic hypoTN (IM)

Zydis counseling ODT

• Must keep tablet in blister pack until ready to take
• Open the package n peel back the foil from the tablet blister
• Do not push a tablet through the foil; you may damage the tablet
• Using dry hands, remove the tablet - place it in your mouth. It will begin to dissolve right away
• Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing
• Swallow several times. If desire, pt may drink liquid to help swallow the dissolve tablet

Question 18

Seroquel

• Indication
• Dose
• Benefit

Answer 18

Quetiapine

• Indication: Scz, bipolar, major depression
• Dose: 100-800mg/d HS empty stomach
• Benefit: lowest anticholinergic of all atypical

Question 19

Geodon

• Indication
• Dose
• Benefits
• Disadvantage

Answer 19

Ziprasidone

• Indications: Scz, bipolar
• Dose: start 20mg PO BID with Food. Max 80mg BID
• Benefit: least weight gain and DM
• SEs: Prolong QT

Question 20

Abilify
Ability Maintena

• Indication
• Dose
• Adv

Answer 20

Aripiprazole

• Abilify DISMELT: contain phenylalamine
• Ability Maintena: QM injection
• Indication: Scz, bipolar, depression, autism
• Dose 10-15mg QD. Max 30mg
  Maintena: 400mg IM QM
• Adv:
  Long elimination half life
  Low risk of wt gain
  No cardiac effects
  Relatively low risk EPS

Question 21

InVEGA

• Indication
• Dose
• Paliperidone palmitate
• SEs

Answer 21

PaLIPerdone

• Indication: scz
• Dose: 3-12 mg PO QD
  => Drug delivers over 24H using innovative OROS
• Paliperidone Palmitate Inj: 117 mg QM
  => Start 234mg on D1 then 156 mg 1W later
• SEs: QT prolong

Question 22

Fanapt

• Indication
• Dose
• SE

Answer 22

ILoperidone

• Indication: scz
• Dose: start 1mg BID. Target 6-12mg BID due to
• Orthostatic hypoTN

Question 23

Saphris

• Form
• Indication
• MOA
• Dose
  Direction to take
• SEs

Answer 23

Asenapine

• Sublingual only. Swallow = not working
• Indication: scz, bipolar
• MOA: serotonin, adrengergic alpha, dopamine, and histamine
• Dose:
  Scz: 5mg SL BID. Do not drink or eat for 10min after arm
  Bipolar: 5-10mg BID
• SEs: serious allergic rxn
  Do not use in pt w/ dementia-related psychosis = death

Question 24

Latuda

Answer 24

Lurasidone

• Indication: scz
• Dose: 40-80mg QD with FOOD
• SEs: neutropenia, leukopenia

Question 25

- Highest wt gain - No wt gain, DM, dyslipidemia - No QT - Agents for depression - Agents from bipolar - Agents for autism

Answer 25

Wt gain - Clozapin n olanzepine No wt gain - Ziprassidone, aripiprazole, paliperidone, asenapine No QT = AI LO - Saphris, abilify, latuda, zyprexa Depression - Abilify, seroquel, zyprexa Bipolar - Resperidone, geodon, ability, seroquel, saphris, zyprexa Autism - abilify and resperdone

Question 26

Dantrium - Indication

Answer 26

Dantrolene - Muscle relaxant tx of malignant hyperthermia

Question 27

Adusuve - Class

Answer 27

Loxapine - Typical

Question 28

FazaClo

Answer 28

Clozapine - Form: ODT - I: SZP resistant

Question 29

Versacloz - Form - Expiration - Indication

Answer 29

Clozapine - Form: Yellow suspension. Protect from light. Shake 10s b/4 use. - Exp 100 days after bottle is opened - I: SZP resistant