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PHM 701- Alcohol, Seizures, Substance Abuse, Schizophrenia, Depression > SGAs > Flashcards

SGAs Flashcards

(99 cards)

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1
Q

Aripiprazole indications

A

schizo, BPD, MDD augmentation, Sx associated with autism, Tourette’s

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2
Q

Is aripiprazole available as a LAI?

A

Yes!

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3
Q

Is aripiprazole approved for peds patients?

A

Yes

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4
Q

Aripiprazole is associated with what side effect?

A

Impulsivity

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5
Q

Other pearls about aripiprazole

A

Little weight gain
May be “activating” and less sedating
May cause insomnia, akathisia, restlessness

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6
Q

Asenapine indications

A

schizo, BPD

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7
Q

Asenapine is CI’ed in what disease state?

A

Severe hepatic disease

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8
Q

Asenapine puts a patient at high risk for what cardiac event?

A

QTc prolongation

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9
Q

Asenapine comes in what formulation?

A

A topical patch (also SL tablet)

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10
Q

Counseling points for asenapine patch

A

Wear for 24 hours, apply to clean, dry, intact skin on the upper arm, back, abdomen, or hip and rotate with each application

Patches can’t be cut, you can shower but not swim with it, and can’t apply heat

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11
Q

Other pearls about asenapine

A

Little weight gain
Least sedating and anticholinergic
Anaphylaxis could occur after a single dose

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12
Q

Brexipiprazole indications

A

schizo, MDD

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13
Q

Brexipiprazole, like aripiprazole, is associated with what side effect?

A

Impulsivity

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14
Q

Other pearls about brexipiprazole

A

Dose-related akathisia
Fewer metabolic challenges

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15
Q

Half-life of brexipiprazole

A

91 HOURS

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16
Q

Cariprazine indications

A

schizo, BPD

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17
Q

Half-life of cariprazine

A

2-4 DAYS

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18
Q

Pearls about cariprazine

A

dose-related akathisia
late occurring side effects due to accumulation and metabolites

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19
Q

Clozapine indications

A

schizo, schizoaffective disorder

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20
Q

Clozapine is the gold standard for what?

A

Refractory illness and suicidality

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21
Q

Clozapine is on the REMS list because of what?

A

Potential for blood dyscrasias

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22
Q

Blood draw procedures for clozapine REMS monitoring

A

Initiating treatment: blood draw once/week x6 months

After first 6 months: blood draw once q2w x6 months

After 12 months: blood draw qmonth

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23
Q

Clozapine and seizure risk

A

Higher doses increase seizure risk

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24
Q

What if higher doses of clozapine are needed?

A

Add on an epileptic drug that can work as a mood stabilizer (Depakote)

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25
What AED should you not use with clozapine?
Carbamazepine!
26
Other clozapine side effects
Worst offender of METABOLIC CONDITIONS QTc prolongation, seizures, myocarditis, constipation, hypersialorrhea
27
How to manage constipation while on clozapine
Establish a bowel regimen because constipation can lead to surgery, hospitalization, or death
28
Constipation risk in a patient taking clozapine increases with what meds?
Anticholinergic meds and opiates
29
Smoking and clozapine
Smoking (the smoke itself, not the nicotine) induces clozapine metabolism and may need higher doses of clozapine to be effective
30
D/C clozapine when the ANC is below what?
<1000
31
Iloperidone indication
schizophrenia
32
Iloperidone is most likely to cause what side effect?
Orthostatic hypotension --> slow titration can prevent this!
33
Iloperidone is not recommended in patients with what disease state?
Severe hepatic impairment
34
Rare but serious side effect of iloperidone
QTc prolongation
35
Other info about iloperidone
No prolactin elevation Less sedating compared to other SGAs
36
Lurasidone indications
schizo, BPD
37
Drug interaction with lurasidone
Don't use with strong CYP3A4 inhibitors/inducers
38
Lurasidone and prolactin
Lurasidone has no notable prolactin elevation
39
Lurasidone and weight gain
No notable weight gain
40
Lurasidone and sedation
Less sedation compared to other SGAs
41
Lurasidone and orthostasis
Less orthostasis compared to other SGAs
42
Is lurasidone approved for peds?
Yes
43
Lurasidone dosing
Needs hepatic and renal dosing adjustments
44
Lumateperone (Lyrica) indication
schizophrenia
45
Lyrica and metabolic changes
No significant changes
46
Lyrica and EPS
Not associated with an increase in EPS
47
Lyrica monitoring
Monitor blood glucose, lipids, and weight despite no significant metabolic changes MRI for progressive multifocal leukoencephalopathy
48
Other Lyrica side effects
Dizziness- caution with overeating and dehydration
49
Lyrica and fertility
May impair fertility
50
Lyrica in the third trimester
Patient can experience EPS and withdrawal symptoms during the third trimester
51
Lyrica and breastfeeing
CI'ed!!
52
Olanzapine indications
schizophrenia, BPD, MDD
53
Olanzapine side effects
DRESS, sedation, metabolic issues, QTc prolongation, ANC changes
54
Olanzapine is also available as what formulation?
LAI
55
Olanzapine LAI info
Requires a 3-hour observation period after administration due to post-injection sedation and delirium
56
True or false: olanzapine LAI is in the REMS program
True!
57
Is olanzapine approved for peds patients?
Yes
58
Paliperidone indications
schizophrenia and schizoaffective disorder
59
Paliperidone side effects
QTc prolongation, priapism, thrombotic thrombocytopenic purpura
60
Is PO overlap required when switching from olanzapine PO to LAI?
NO
61
What formulation is the PO tablet of paliperidone available as?
OROS tablet, the shell of the tablet can be found in the stool but that doesn't mean the drug is working
62
What increases paliperidone bioavailability
Food
63
LAI formulations of paliperidone available
Sustenna, Trinza, Hafyera
64
Dosing frequency of Sustenna
qmonth
65
Trinza dosing frequency
q3months
66
Hafyera dosing frequency
q6months
67
The transition from Sustenna to Trinza
You have to be on Sustenna for at least 4 months before Trinza
68
Is paliperidone approved for peds?
Yes
69
Pimavaserin (Nuplazid) indications
Hallucinations and delusions associated with Parkinson's Disease psychosis (this is the only option for this!)
70
What should you not take while on Pimavanserin and why?
Dopamine agents, because pimavanserin antagonizes dopamine (Parkinson's is a deficiency of dopamine)
71
Does pimavanserin carry the same BBW as all other APS?
YES!
72
Pimavanserin side effects
QTc prolongation, CYP3A4 interactions
73
Don't use Nuplazid in what disease state?
Renal dysfunction <30 ml/min
74
Quetiapine indications
schizophrenia, BPD, MDD
75
Quetiapine side effects
Sedation, metabolic issues, QTc, cataracts, ACH effects
76
Quetiapine is frequently misused as what?
A sleep aid- the risks of an APS are still there though
77
Quetiapine and metabolic effects
Not dose-related, but they're still there
78
Is quetiapine indicated for use in peds?
Yes
79
Risperidone indications
schizophrenia, BPD, symptoms associated with autism
80
Risperidone side effects
PROLACTIN ELEVATION, EPS, Qtc prolongation, priapism, TTP
81
Is risperidone available as a LAI?
Yes!
82
LAI dosage forms available for risperidone
IM and SQ
83
Risperidone IM LAI form dosing frequency
Dosed q2w with PO overlap for 3 weeks
84
Risperidone SQ LAI form dosing frequency
Dosed qmonth with no PO overlap needed
85
Ziprasidone indications
schizophrenia, BPD
86
Ziprasidone side effect
DRESS
87
Ziprasidone CI
Patients who are at risk of QTc prolongation
88
Ziprasidone is available as a LAI: true or false
False, available as a short-acting agent
89
Paliperidone is a metabolite of...
risperidone
90
What drug combinations should you avoid with clozapine and olanzapine?
IM benzos (especially lorazepam!)
91
SGAs most likely to cause sedation
clozapine and quetiapine
92
SGAs most likely to cause EPS
risperidone and paliperidone
93
SGAs most likely to cause ACH effects
clozapine
94
SGAs most likely to cause orthostasis
clozapine and iloperidone
95
SGAs most likely to cause weight gain
clozapine, olanzapine
96
SGAs most likely to cause prolactin elevation
risperidone, paliperidone
97
SGAs most likely to cause CV effects
clozapine, iloperidone, ziprasidone
98
SGAs available as LAIs
aripiprazole, olanzapine, risperidone, paliperidone
99
SGAs available as short-acting agents
olanzapine, ziprasidone

PHM 701- Alcohol, Seizures, Substance Abuse, Schizophrenia, Depression (23 decks)

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