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44 Cards in this Set

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low potency typical agents
-chlorpromazine
-thioridazine
typical agents MOA
dopamine antagonists (greater affinity at D-2 yhan D-1) that have effects on all 4 dopaminergic pathways
decreased dopamine release or dopaminergic inactivation occurs after how many days?
21d
low poteny or high potency agents have less specificity for dopamine receptors
low potency
low potency agents are associated with:
-EPS rxns
-sedation
-postural hypotension
-seizure threshold
-ECG
-anticholinergic adverse effects
-fewer EPS rxns than high potency
-more sedation
-more postural hypotension
-greater effect on SZR threshold and ECG
-more frequent anticholinergic effects
receptor blockade for typical AP
-histamine
-muscarinic
-a1 adrenergic
-dopamine D2
adverse effects of dopamine D2 blockade
-EPS
-prolactin elevation
dystonia treatment
-benztropine 1-2mg IM
-diphenhydramine 25-50mg IM

-above may be given as scheduled oral doses for at least 1 month after dystonia resolved
dystonia prophylaxis
benztropine may be given when high potency APs initiated
akathisia treatment
-propanolol
-diazepam
pseudoparkinsonism treatment
-benztropine 1-2mg bid
-trihexyphenidyl 2-5mg tid
-diphenhydramine 25-50mg tid
-amantadine 100mg bid

-give for 6w-3m after sxs resolve
tardive dyskinesia treatment
-decrease dose of typical AP
-switch to atypical AP
-vitamin E 1200-1600IU/d
-BZDs
-botulinum toxin
-clozapine
APs that have highest potential to cause SZRS
-clozapine
-chlorpromazine
neuroleptic malignant syndrome treatment
-d/c AP
-dopamine agonist - bromocriptine
-skeletal muscle relaxants - dantrolene
APs most likelt to cause ECG changes and prolong QTC interval
-thioridazine
-ziprasidone
agents most likely to cause increase in prolactin
-typical APs
-risperidone
fluphenazine oral to deconoate
10mg/day oral = 12.5mg IM q2wk
haloperidol oral to deconoate
10mg/day oral = 100-150mg IM q4wk
(initial injection shouldn't exceed 100mg)
atypical antipsychotics (6)
-clozapine
-risperidone
-olanzapine
-quitiapine
-ziprasidone
-aripiprazole
list 7 potential advantages of atypical agents over conventional agents
1)improved response to neg sxs
2)mood stabilizing effects
3)pos response in pts refractory to traditional agents
4)reduced risk of EPS
5)reduced risk of TD
6)improved compliance
7)minimal effect on serum PL
clozapine FDA indications
1)schizophrenia, tx resistant
2)suicidal behavior
(reserved for pts refractory to at least 2 adequate trials of other AP drugs)
clozapine adverse effects (6)
-hypersalivation
-tachycardia
-constipation (antichol effec)
-weight gain
-glucose dysregulation
-increased lipids
list 4 black box warnings for clozapine
1)agranulocytosis and granulocytopenia
2)myocarditis
3)seizures
4)orthostasis
clozapine therapy guidelines based on WBC and granulocyte count
WBC<3500, h/o myeloproliferative d/o, previous clozapine-induced agranulocytosis or granulocytopenia
do not initiate treatment
WBC 3000-3500
granulocyte count >1500
-interrupt therapy
-perform twice weekly WBC and differential counts
WBC <3000
granulocyte count <1500
-interrupt therapy
-may resume therapy if no s/x of infection develop, WBC >3000 and granulocyte count >1500
-twice weekly blood counts until WBC>3500
WBC <2000
granulocyte <1000
-consider bone marrow aspiration
-possible protective isolation
-antibiotics if infection develops
-DO NOT RECHALLENGE
clozapine monitoring
CBC must be drawn weekly x6months; then biweekly x6months; then q4wks thereafter
clozapine initial dose
12.5-25mg qhs
increasing clozapine dose
25mg daily until a dosage of 300mg daily is achieved (subsequent dose changes should be made once weekly in small increments)
maximum clozapine dose
900mg/daily
how to restart patients who have had a brief interval off clozapine (2 days or more)
treatment needs to be reinitiated at 25mg/day
risperidone FDA indications
1)schizophrenia
2)bipolar mania (acute)
risperidone adverse effects (2)
1)EPS (higher doses)
2)prolactin elevation (higher doses)
risperidone doses exceeding what are not recommended and associated w/ more EPS and adverse effects
6mg
olanzapine FDA indications
1)schizophrenia
2)agitation associatged w/ schizophrenia
3)bipolar mania (acute)
4)bipolar d/o maintenance
olanzapine adverse effects (3)
1)weight gain
2)glucose dysregulation
3)increased lipids
quetiapine FDA indications
1)schizophrenia
2)bipolar mania (acute)
quetiapine adverse effects (2)
1)drowsiness
2)lens examination to detect cataract formation recommended at initiation and at 6-month intervals
ziprasidone FDA indications
1)schizophrenia
2)agitation associated w/ schizophrenia
3)bipolar mania
ziprasidone adverse effects (1)
1)QTC prolongation
aripiprazole FDA indications
1)schizophrenia
2)bipolar mania
aripiprazole MOA
-partial agonist at D2 and 5HT1A receptors
-5HT2A antagonist
-moderate alpha-1 adrenergic blockdade
-moderate antihistaminergic effect
List 5 monitoring and assessment parameters for atypical APs
1)wt and ht
2)waist circumference
3)fasting glucose
4)fasting lipid panel
5)blood pressure
1)baseline, 4wks, 8wks, 12wks, thenquarterly
2)baseline, then annually
3-5)baseline, 12wks,then annually