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60 Cards in this Set
- Front
- Back
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How is injectable fluphenazine dosed?
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12.5mg q2 weeks oil for every 10mg the pt was getting
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How is injectable haloperidol dosed?
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150mg qmonth oil divided: 20x oral dose with 100mg max first dose, balance in 3-7 days
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How is injectable risperidone dosed?
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25-50mg q2weeks suspension
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When is an oral risperidone needed after injection?
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3 weeks
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When should APs be dosed?
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qHS b/c of sedation
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How to monitor EPS?
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baseline AIMS then every 6 months at least
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Side effects of AP not mentioned by Phipps?
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skin reactions, impaired heat regulation
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Most common pts for EPS?
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<30 and male
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Prophylaxis for EPS?
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benztropine 2mg bid
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Acute Tx for EPS?
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benztropine 1-2mg IM or PO
or Benadryl 25-50mg IM or PO or Valium 5mg IV |
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Tx for akathisia
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switch to atypical or lower the dose;
acute benztropine 1mg bid or propranolol 20mg qid or lorazepam 0.5mg tid |
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Tx for parkinsonism
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decrease dose or switch to atypical
benztropine 1-2mg bid amantadine |
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Risk factors for tardive dyskinesia
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>6 months tx
elderly female pts with affective/organic brain disorders |
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Tx for tardive dyskinesia
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Vitamin E 800-1200 IU/day
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Sx of Neuroleptic Malignant Syndrome
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altered mental state, lead pipe rigidity, hyperthermia, increased CPK and WBC, autonomic instability
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Tx for NMS
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fluids & electrolytes, symptomatic tx for BP and fever
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MOA of clozapine
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5HT2 and D4 block, some D1, weak D2
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What condition must be met before starting clozapine?
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WBC >3500
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ADR of clozapine and monitoring?
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agranulosytosis: weekly WBC for 6 months, then q2 weeks; stop clozapine if WBC <2000 or granuloctyes <1000
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Dosing of clozapine
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Start 12.5mg/day and increase by 25mg/week to 600mg; increased seizure risk >600mg but max dose 900mg
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Other ADRs of clozapine?
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orthostasis & tachycardia, sedation, weight gain, PE if history, carditis
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Desired clozapine levels?
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250-350 ng/mL
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What increases plasma clozapine?
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fluvoxamine, cimetidine, erythromycin
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What decreases plasma clozapine?
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smoking, phenytoin, carbamazepine, phenobarbital
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Dosing of risperidone?
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4-6mg/day, only atypical if <6mg
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ADRs of risperidone?
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dizziness, postural hypotension, headache, anxiety, weight, anticholinergic effects
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DDI with risperidone?
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SSRIs with caution
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Other receptor effects of risperidone?
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NE antagonist, histamine antagonist
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Comparison of olanzapine to clozapine?
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similar efficacy but olanzapine has greater effect on negative sx
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Dosing?
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Start 10mg (unless elderly then 2.5mg)
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ADRs of olanzapine?
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weight gain, sedation, dizziness, dry mouth, constipation, elevated LFTs without hepatotoxicity
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ADRs of quetiapine?
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sedation, orthostasis, weight gain, headache, reversible LFT elevation...NOT anticholinergic
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Monitoring of quetiapine?
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eye exams baseline and q6months - risk of cataracts?
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Dosing of quetiapine?
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Start 25mg tid; range 150-800mg
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MOA of ziprasidone?
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5HT2/D2 antagonist, NE reuptake block
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Dosing of ziprasidone?
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start 20-40mg bid; 80-160mg/day
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ADRs of ziprasidone?
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nausea, hypotension, sedation, non-dose related QT prolongation...NO weight gain
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CI for ziprasidone?
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cardiac disease
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Risk factors for QT prolongation with ziprasidone?
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cardiac disease
hypothyroidism low serum K or Mg substance abuse |
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Medications that increase QT prolongation with ziprasidone?
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quinidine, TCAs, low potency neuroleptics
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MOA of aripiprazole?
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partial agonist of D2 & HT1-a, antagonist of HT2-a
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Dosing for aripiprazole?
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5-30mg in the morning, start 10-15mg/day
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ADRs of aripiprazole?
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headache, insomnia, anxiety, nausea, akathisia
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Atypical with longest half-life?
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aripiprazole
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Problems with thioridazine?
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significant QT increase, renal pigmentation at doses >800mg/day, CI with paroxetine, fluvoxamine, propranolol, or fluoxetine
use only for pts who fail |
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Steps for tx resistance
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assess trial
adjust dose & interactions switch atypicals adjuncts: risperidone or olanzapine with clozapine add lithium, antidepressant, buspirone, glutamate agonists |
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How do APs cause diabetes?
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altered apolipoprotein fx, insulin receptor resistance, altered glucose transport & metabolism, altered lipid metabolism, abnormal interleukin-6
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Which atypicals have least incidence of diabetes?
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aripiprazole & ziprasidone
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Which receptors increase appetite?
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5HT2-a & -c, H1
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Worst two atypicals for weight gain?
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clozapine & olanzapine
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Atypical monitoring other than baseline:
Hx Weight Waist BP FBG Lipids |
q1yr
qmonth x3mos q1yr in 3mos then 1yr in 3mos then 5yrs |
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Higher risk for diabetes?
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atypical schizophrenia
obesity lack of exercise African American Hispanic Native American |
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Which atypicals cause increased TG?
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olanzapine, clozapine
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Tx for new diagnosis or failure on typicals?
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olanzapine, quetiapine, risperidone
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ADRs with aripiprazole injection?
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headache, nausea, dizziness, somnolence
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ADRs with aripiprazole oral?
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headache, anxiety, insomnia, nausea
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Black box warning on all atypicals?
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elderly pts with dementia at increased risk of death
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What is paliperidone?
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active metabolite of risperidone
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Dose of paliperidone?
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6mg qAM
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ADRs of paliperidone?
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QT prolongation, cardiac, renal and hepatic side effects
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