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Schizophrenia Pharma

Behavioral Medicine Pharmacology

QuestionAnswer
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
Created by: Abarnard