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56 Cards in this Set

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What is the diagnostic criteria for Schizophrenia?
2 of the following 5 symptoms:
1. Hallucinations
2. Delusions
3. Disorganized speech
4. Disorganized behavior
5. Negative symptoms
What are the positive symptoms of Schizophrenia?
Disorganized behavior
Disorganized speech
What are the negative sypmtoms of Schizophrenia?
No facial expression
Poor grooming
Poor social skills
Alogia - thought/speech
Avolition - motivation/drive
Difference between Typical & Atypical antipsychotics?
Typicals block DA2 and affects (+) symptoms.

Atypicals block 5HT2 & dopamine so it affects both (+/-) symptoms.
Schizophrenia SE?

Weight gain
Anticholinergic effects
Movement disorders (Tardive Dyskenisia)
Neuroleptic Malignant Syndrome (NMS)
What has high levels in Schizophrenia?
Dopamine levels are high.
What is EPS? What are the types of EPS?
Extrapyramidal Side effects
- due to Dopamine antagonist activity
- types:
1. Dystonia (hrs-days): painful muscle spasm/laryngospam
2. Akathisia (days-weeks): restlessness
3. Pseudoparkinsonism (weeks-months)
What drugs have the highest risk for EPS?
Typicals and Risperidone
What drug has the lowest risk for EPS?
What is the DoC for dystonia?
Laryngospasm, DoC: IV diphenhydramine 25-50mg
What is Tardive Dyskenisia?
This is due to prolonged blockade of dopamine resulting to tongue, lip, jaw, face & extremity movement.
What is NMS due to? S/Sx?
NMS is due to depletion of DA in the CNS, which results to disruption of muscle contraction & thermostat system.
S/Sx: rigidity, fever, diaphoresis (sweating) altered consciousness, increase in BP & HR
What are the labs to monitor with NMS?
Increase CPK
Increase WBC (CBC)
Management of NMS?
1. D/C antipsychotic
2. Supportive therapy (IV fluid, cooling)
3. Increase in CA by DA agonist (Bromocriptine)
4. Dantrolene (muscle relaxant - tx for malignant hyperthermia) (1mg/kg rapid IV push)
What happens to the prolactin levels when using dopamine antagonists?
Prolactin levels increase, resulting to GALACTORRHEA, AMENORRHEA, GYNECOMASTIA and IMPOTENCE.
List some Typicals for Schizophrenia
Chlorpromazine (Thorazine)
Thioridazine (Mellaril)
Perphenazine (Trilafon)
Trifluoperazine (Stelazine)
Thiothixene (Navane)
Fluphenazine (Prolixin)
Haloperidol (Haldol)
Pimozide (Orap) - QT prolongation
List the Atypicals used for Schizophrenia
Clozapine (Clozaril)
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Aripiprazole (Abilify)
Paliperidone (Invega)
Iloperidone (Fanapt)
Asenaphine (Saphris)
What are the Bipolar meds that come in IM form?
Haloperidol (Haldol): 5-10mg Q1H PRN
Aripiprazole (Abilify): 7.5mg/mL, Q2H; max: 30mg/day
Ziprasidone (Geodon): max=40mg
Olanzapine (Zyprexa IM): may repeat Q2H, max: 30mg
What is a major SE of Zyprexa IM?
Severe orthostatic hypotension
What Bipolar meds come in long acting form (deconate)? Given to whom?
Deconoate: given to patients with good response to oral but non-compliant.
Haldol: 10-15x oral QMonth
Fluphenazine (Prolixin): oral dose/15 Q2 weeks
Risperdal Consta: IM Q2Weeks for >18 yo
Paliperidone (Invega): 234mg on Day 1, 156mg after a week, then maintenace QMonth
What is Clozaril? Dosing? Benefits (3)?
Clozapine (Clozaril)
Dose: BID - start 12.5mg TITRATE
Benefits: doesn't cause EPS, can treat TD, NO effect on prolactin
Side effects of Clozapin?
Clozaril (Clozapine) SE:
*Agranulocytosis: don't start if WBC <3500/mm.
Anti-cholinergic effects except for salivation & sweating.
Hyperglycemia, hyperlipidemia, weight gain
What do you have to check with Clozapin? How often?
Clozapin (Clozaril), check CBC QWeek x 6 months, then bi-weekly x 6 months, then QMonth thereafter. Don't start if WBC <3500/mm.
Who must be registered with what organization before you can dispense Clozapine (Clozaril)?
Prescriber must be registered with the Clozaril National Registry (CNR).
Patient must be registered, too.
Pharmacy must be registered with the CNR to be able to purchase Clozapine.
The ANC/WBC values sent by the prescriber to the pharmacy must be drawn within how many days?
7 days
What is Risperidone? Forms?
Forms: tabs, ODT, solution, IM injection (Consta)
***Not compatible with cola/tea
What are the indications for Risperidone? Age range?
Schizophrenia: 13 - 17 YO
Bipolar Mania: 10 - 17 YO
Autism: 5 - 16 YO, given to treat aggression, deliberate self injury and temper tantrums
How often do you give Consta?
15mg IM every 2 weeks for > 18 YO
What are the limitations to using Risperdal?
Weight gain
Slight increase of prolactin
What is Olanzapine? Max dose? Forms?
Zyprexa, Zydis (ODT), Relprevv (ER injectable susp.)
Max: 20mg QDay, never BID b/c of long half life
How do you take Zydis?
Zyprexa (Zydis), remove from foil with dry hands. Place on top of tongue (ODT).
What are the monitoring parameters when taking Zyprexa?
Glucose: FBG & A1C
***Orthostatic hypotension (IM)
Who should be enrolled in what program before you can dispense the Olanzapine ER injectable suspension?
Zyprexa Relprevv Care Program
- Prescriber
- Patient
- Pharmacy
What is Latuda? Indication?
Latuda (Lurasidone HCl tabs)
Indication: Schizophrenia, 40mg - 80mg QD WITH FOOD
Latuda is contraindicated in the use with? SE?
Contraindications: Inhibitors/Inducers
SE: similar to other atypicals (weight gain, hyperlipidemia, hyperglycemia)
What is Seroquel? Forms? Indications?
Quetiapine (Seroquel/Seroquel XR)

Indications: Schizophrenia/Bipolar, MDD (XR form)
What is the sig for Seroquel XR?
Take QHS, empty stomach.
What is Ziprasidone? Dosing? Max?
Geodon (Ziprasidone), 20mg BID with food. Max: 160mg/day
What is the Geodon dose of acute agitation?
Acute agitation: 10-20mg IM
Why do you need to give Geodon with food?
Geodon bioavailability goes down by 60% if not taken with food.
Indications for Abilify?
Abilify (Aripiprazole)
- Schizophrenia
- Bipolar disorder
- Depression
- Autism: aged 6-17 YO
Abilify comes in what forms?
Abilify DISMELT - contains phenylalanine
1mg/mL solution
IM injection
What are the advantages of Abilify?
- long half life
- low risk of weight gain
- no cardiac effects
- low risk of EPS
What is the dosing for Abilify? Dose when given with inhibitors/inducers?
Give 1/2 the dose with CYP3A4 & 2D6 (Fluoxetine, Quinidine) inhibitors and double when with inducers
What is Paliperidone? Comes in what forms?
Invega (Paliperidone), comes in tabs (ER) and IM injection
What is the dose range for PO Invega?
Invega (Paliperidone) range: 3-12mg QDay
What is the dosing for Invega tabs in renal patients?
Mild renal impairment, max: 6mg
Moderate to severe, max: 3mg
What is the dosing for Invega IM injection?
Day 1: 234mg IM
A week later: 156mg IM
Maintenance: IM inj/month, recommened dose is 117mg/dose
Invega MoA?
- D2 (dopamine type 2)
- S2 (serotonin type 2)
- A2 (alpha 2 adrenergic)
What is Fanapt? Dosing?
Fanapt (Iloperidone) is titrated slowly to avoid hypotension.
Starting dose: 1mg BID
Fanapt interacts with what drugs?
Fanapt (Iloperidone) interacts with CYP3A4 & CYP2D6 inhibitors and inducers.
What is Asenapine? Form? Dosing?
Asenaphine (Saphris), comes in sublingual form (5 & 10mg tabs) given BID.
Asenaphine indications?
Asenaphine (Saphris) is indicated for schizophrenia & bipolar disorder
What Schizophrenia medications can you give if worried about QT prolongation?

Lurasidone (Latuda)
Aripiprazole (Abilify)
Ziprazidone (Geodon)
What are the Schizophrenia medications to avoid if there is a high risk in QT prolongation?
What should you give for resistant depression?
Seroquel XR