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60 Cards in this Set

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How is injectable fluphenazine dosed?
12.5mg q2 weeks oil for every 10mg the pt was getting
How is injectable haloperidol dosed?
150mg qmonth oil divided: 20x oral dose with 100mg max first dose, balance in 3-7 days
How is injectable risperidone dosed?
25-50mg q2weeks suspension
When is an oral risperidone needed after injection?
3 weeks
When should APs be dosed?
qHS b/c of sedation
How to monitor EPS?
baseline AIMS then every 6 months at least
Side effects of AP not mentioned by Phipps?
skin reactions, impaired heat regulation
Most common pts for EPS?
<30 and male
Prophylaxis for EPS?
benztropine 2mg bid
Acute Tx for EPS?
benztropine 1-2mg IM or PO
or Benadryl 25-50mg IM or PO
or Valium 5mg IV
Tx for akathisia
switch to atypical or lower the dose;
acute benztropine 1mg bid
or propranolol 20mg qid
or lorazepam 0.5mg tid
Tx for parkinsonism
decrease dose or switch to atypical
benztropine 1-2mg bid
amantadine
Risk factors for tardive dyskinesia
>6 months tx
elderly
female
pts with affective/organic brain disorders
Tx for tardive dyskinesia
Vitamin E 800-1200 IU/day
Sx of Neuroleptic Malignant Syndrome
altered mental state, lead pipe rigidity, hyperthermia, increased CPK and WBC, autonomic instability
Tx for NMS
fluids & electrolytes, symptomatic tx for BP and fever
MOA of clozapine
5HT2 and D4 block, some D1, weak D2
What condition must be met before starting clozapine?
WBC >3500
ADR of clozapine and monitoring?
agranulosytosis: weekly WBC for 6 months, then q2 weeks; stop clozapine if WBC <2000 or granuloctyes <1000
Dosing of clozapine
Start 12.5mg/day and increase by 25mg/week to 600mg; increased seizure risk >600mg but max dose 900mg
Other ADRs of clozapine?
orthostasis & tachycardia, sedation, weight gain, PE if history, carditis
Desired clozapine levels?
250-350 ng/mL
What increases plasma clozapine?
fluvoxamine, cimetidine, erythromycin
What decreases plasma clozapine?
smoking, phenytoin, carbamazepine, phenobarbital
Dosing of risperidone?
4-6mg/day, only atypical if <6mg
ADRs of risperidone?
dizziness, postural hypotension, headache, anxiety, weight, anticholinergic effects
DDI with risperidone?
SSRIs with caution
Other receptor effects of risperidone?
NE antagonist, histamine antagonist
Comparison of olanzapine to clozapine?
similar efficacy but olanzapine has greater effect on negative sx
Dosing?
Start 10mg (unless elderly then 2.5mg)
ADRs of olanzapine?
weight gain, sedation, dizziness, dry mouth, constipation, elevated LFTs without hepatotoxicity
ADRs of quetiapine?
sedation, orthostasis, weight gain, headache, reversible LFT elevation...NOT anticholinergic
Monitoring of quetiapine?
eye exams baseline and q6months - risk of cataracts?
Dosing of quetiapine?
Start 25mg tid; range 150-800mg
MOA of ziprasidone?
5HT2/D2 antagonist, NE reuptake block
Dosing of ziprasidone?
start 20-40mg bid; 80-160mg/day
ADRs of ziprasidone?
nausea, hypotension, sedation, non-dose related QT prolongation...NO weight gain
CI for ziprasidone?
cardiac disease
Risk factors for QT prolongation with ziprasidone?
cardiac disease
hypothyroidism
low serum K or Mg
substance abuse
Medications that increase QT prolongation with ziprasidone?
quinidine, TCAs, low potency neuroleptics
MOA of aripiprazole?
partial agonist of D2 & HT1-a, antagonist of HT2-a
Dosing for aripiprazole?
5-30mg in the morning, start 10-15mg/day
ADRs of aripiprazole?
headache, insomnia, anxiety, nausea, akathisia
Atypical with longest half-life?
aripiprazole
Problems with thioridazine?
significant QT increase, renal pigmentation at doses >800mg/day, CI with paroxetine, fluvoxamine, propranolol, or fluoxetine

use only for pts who fail
Steps for tx resistance
assess trial
adjust dose & interactions
switch atypicals
adjuncts: risperidone or olanzapine with clozapine
add lithium, antidepressant, buspirone, glutamate agonists
How do APs cause diabetes?
altered apolipoprotein fx, insulin receptor resistance, altered glucose transport & metabolism, altered lipid metabolism, abnormal interleukin-6
Which atypicals have least incidence of diabetes?
aripiprazole & ziprasidone
Which receptors increase appetite?
5HT2-a & -c, H1
Worst two atypicals for weight gain?
clozapine & olanzapine
Atypical monitoring other than baseline:
Hx
Weight
Waist
BP
FBG
Lipids
q1yr
qmonth x3mos
q1yr
in 3mos then 1yr
in 3mos then 5yrs
Higher risk for diabetes?
atypical schizophrenia
obesity
lack of exercise
African American
Hispanic
Native American
Which atypicals cause increased TG?
olanzapine, clozapine
Tx for new diagnosis or failure on typicals?
olanzapine, quetiapine, risperidone
ADRs with aripiprazole injection?
headache, nausea, dizziness, somnolence
ADRs with aripiprazole oral?
headache, anxiety, insomnia, nausea
Black box warning on all atypicals?
elderly pts with dementia at increased risk of death
What is paliperidone?
active metabolite of risperidone
Dose of paliperidone?
6mg qAM
ADRs of paliperidone?
QT prolongation, cardiac, renal and hepatic side effects