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Schizophrenia Pharma
Behavioral Medicine Pharmacology
Question | Answer |
---|---|
TYPICAL antipsychotics | Haloperidol (Haldol); Fluphenazine (Prolixin); Perphenazine (Trilafon); Thioridazine (Mellaril); Chlorpromazine (Thorazine |
ATYPICAL antipsychotics | Clozapine (Clozaril); Olanzapine (Zyprexa); Risperidone (Risperdal); Quetiapine (Seroquel); Ziprasidone (Geodon); Aripiprazole (Abilify) |
Choice of antipsychotic for: First episode | Atypicals |
Choice of antipsychotic for: Noncompliance | Long-acting medications |
Choice of antipsychotic for: Aggression | Clozapine; High potency typical; Olanzapine and quetiapine |
Choice of antipsychotic for: Insomnia | Olanzapine, quetiapine; Low potency typicals |
Choice of antipsychotic for: Dysphoria | Atypicals |
Choice of antipsychotic for: Suicidal Behavior | Atypicals |
Choice of antipsychotic for: Substance Abuse | Aypticals |
Choice of antipsychotic for: Cognitive problems | Aypticals |
Choice of antipsychotic for: Compulsive water drinking | Clozapine |
Sufficient trial w/typical / atypical antipsychotics = | 4-6 weeks |
Antipsychotics: tx length: first episode | 12 months following sx remission |
Antipsychotics: tx length: multiple episodes | 5 yrs following sx remission |
Antipsychotics: relapse prevention | slow taper (3-9 mo); 20% relapse rate after 1 yr of tx; 50% rate within 6 mo post-d/c of tx |
Antipsychotic tx resistance = | 3 different antipsychotic meds from 2 different classes; hx of poor social functioning |
Only antipsychotic to show improvement in well defined treatment resistance: | clozapine |
Monitoring for clozapine | Due to risk of low WBCs; monitor qwk for 6 mo, q2wks for 6 mo, q4wk for life; greatest risk first 6 mo |
Only true atypical antipsychotic: | clozapine |
Akathisia is an AE of all antipsychotics except: | clozapine |
Cardinal sx of pseudoparkinsonism | Akinesia, bradykinesia; Pill rolling tremor; Cogwheel rigidity; Shuffling gait; Masked facies |
Dystonia risk factors | Young males; High potency agents; High doses; Previous dystonia |
Definition of dystonia | Mx spasms (jaw, tongue, neck) |
Definition of neuroleptic malignant syndrome (NMS) | Autonomic instability; Mx rigidity; Altered consciousness; High temp; Myoglobinuria |
Definition of akathisia | Subjective restlessness; Objective inability to be still |
Definition of tardive dyskinesia | Buccolingual movements (Fly catchers tongue; Puckering); facial movements (grimacing, chewing); Truncal movements (rocking, gyrating); upper / lower extremities (irregular purposeless movements, foot tapping) |
Tx for tardive dyskinesia | switch to atypical |
Treatment for akathisia | Start at low dose; Decrease dose; Switch to an atypical; anticholinergics are ineffective |
Main feature of atypicals is: | diminished EPS and prolactin levels |
Treatment for pseudoparkinsonism | anticholinergics |
Risk factors for tardive dyskinesia | High doses; Long length of tx; Cumulative tx; Increased age; Organic mental disorder; DM; Mood disorder; Female |
NMS mortality = | 10-20% |
Antipsychotic tx algorithm | Trial of SGA; trial of other SGA; [trial of single agent (FGA or new SGA) OR clozapine]; clozapine plus (FGA, SGA, or ECT); trial of single agent (FGA or new SGA); combo tx |
Antipsychotic AE | #Dystonia; akathisia; pseudoparkinsonism; tardive dyskinesia; NMS; CV (ortho hypotension, tachycardia, EKG: prolonged QT / torsades); wt gain; diabetes; hyperlipidemia; anticholinergic; sedation; seizure; GU; thermoregulation / fever; agranulocytosis |
Phenothiazine MOA | inhibition of dopamine receptors. |
Phenothiazine meds | Chlorpromazine (Thorazine). Fluphenazine (Prolixin). Proclorperazine (Compazine). Trifluoperazine (Stelazine). Thioridazine (Mellaril) |
Dibenzapine meds | Clozapine. Olanzapine (Zyprexa). Quetiapine (Seroquel). |
Lithium MOA | increased NE reuptake and serotonin receptor senstivity |