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33 Cards in this Set
- Front
- Back
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Schizophrenia Background
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D/t excess dopamine
Signs/symptoms ---> hallucinations, delusions, disorganized thinking and behavior |
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Negative s/s
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Loss of interest in everyday activities
Lack of emotion Inability to plan or carry out activities Poor hygiene Social withdrawal Loss of motivation (avolition) Poverty (lack of) speech (alogia) |
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Positive s/s
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Hallucinations (auditory and visual)
Delusions Disorganized thinking/behavior Difficulty paying attention |
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Diagnostic criteria for Schizophrenia
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Must have 2+ of positive or negative symptoms
Delusions, hallucinations, OR disorganized speech MUST be present |
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Antipsychotics target the ____________ symptoms of schizophrenia.
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Positive
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Meds that can cause psychotic symptoms
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Amphetamines
Methamphetamine, ice, crack Cannabis Cocaine Dextromethorphan Phencyclidine (PCP), MDPV (bath salts) Lysergic acid diethylamide (LSD), other hallucinogens Anticholinergics (esp. high doses) Dopamine, dopamine agonists used for Parkinson's Interferons Steroids Stimulants |
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Long-acting Injections
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Haloperidol decanoate - Q4wks
Risperdal Consta - Q2wks Invega Sustenna - Q4wks Ability Maintena - Q4wks Increased adherence Used in acute care settings prior to release of patients to the street |
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Orally Disintegrating Tablets (ODTs)
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Help solve the problem of "cheeking"
SGAs ---> clozapine, olanzapine, aripiprazole, asenapine |
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Acute IM Injections
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Short and fast
Work "stat" to help calm down an acutely agitated, psychotic patient Often mixed w/ other drugs (BZDs, anticholinergics) DO NOT give BZDs and olanzapine together IM d/t orthostasis risk |
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Patients with Cardiovascular Risk
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Avoid agents w/ risk of QT prolongation ---> ziprasidones, phenothiazines (esp. thioridazine)
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Overweight Patients or those with Metabolic Issues
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Avoid agents w/ significant metabolic risk ---> olanzapine, quetiapine
Choose - aripiprazole, ziprasidone, asenapine, lurasidone |
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Patients with high prolactin levels
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Causes galactorrhea, sexual dysfunction, gynecomastia, irregular or missed periods
Is a concern w/ risperidone, paliperidone |
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Patients w/ history of tardive dyskinesia or other movement disorder
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AVOID risperidone, paliperidone, lurasidone
RECOMMENDED -- quetiapine (for Parkinson's patients) |
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BLACK BOX Warning for all Antipsychotics
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Increase risk of mortality in elderly patients w/ dementia-related psychosis (d/t increased risk of stroke and infxn)
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Neuroleptic Malignant Syndrome
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Rare but highly LETHAL
- Mostly w/ FGAs; due to D2 blockade - Medical emergency; most cases occur w/in 2 wks of starting therapy or immediately following high doses of injectables + multiple oral doses S/S - hyperthermia, "lead pipe" muscle rigidity, mental status changes, elevated CPK, WBCs Tx ---> STOP antipsychotic; supportive care |
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First Generation Antipsychotics
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Block D2 and serotonin 2A receptors
Low potency - Chlorpromazine, thioridazine Mid potency - loxapine, perphenazine High potency - fluphenazine, haloperidol, trifluoperazine, thiothixene SE - sedation, EPS, dystonias, akathisia, Parkinsonism, tardive dyskinesias, orthostasis, QT prolongation |
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Haldol
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Haloperidol; is a butyrophenone; also used for tics and vocal outbursts d/t Tourette's
PO - 0.5-2 mg BID-TID, up to 100 mg/d IV - 5-10 mg (HIGH QT risk) IM - decanoate; 10-20 x the PO dose |
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Second Generation Antipsychotics
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Block D2 and serotonin 2A receptors
Clozapine, olanzapine, risperidone, quetiapine, ziprasidone, aripiprazole, palieridone, iloperidone, asenapine, lurasidone |
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Clozaril
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Clozapine
Use ONLY if failed to respond to tx w/ 2 standard AP treatments, or if had significant ADRs (most effective AP, but use limited d/t severe SEs 300-900 mg/d, divided; start w/ 12.5 mg; titrate on and of BLACK BOX - agranulocytosis, cardiac arrest, cardiomyopathy, seizures (dose related) SE - agranulocytosis, seizures, myocarditis, orthostasis, metabolic issues, QT prolongation Clozaril registry (REMS drug); WBC > 3500, ANC >2K to start; check weekly x 6 months, then q2weeks x 6 months, then monthly |
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Zyprexa, Relprevv injection
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Olanzapine
10-20 mg QHS PO; Relprevv inj. Q2-4 wks (REMS drug) BLACK BOX - sedation, delirium following Relprevv (monitor 3 hrs post inj) SE - sedation, metabolic issues |
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Risperdal
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Risperidone (PO, ODT, Consta)
4-16 mg/d divided; Consta ---> 25-50 mg Q2wks SE - EPS (esp high doses), increased prolactin (sexual issues, gynecomastia), metabolic issues **At greater than 6 mg/d - increased risk of EPS, increased prolactin |
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Seroquel
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Quetiapine (used in Parkinson's patients)
400-800 mg/d divided BID; XR is QHS taken either w/o food or w/ light meal SE - sedation, orthostasis, increased metabolic issues **2nd lowest risk of EPS** |
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Geodon
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Ziprasidone
40-160 mg/d divided BID Acute IM inj. - 10-20 mg CONTRA - QT risk (prolongs QT interval) *Take w/ food* |
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Abilify
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Aripiprazole (PO, ODT, Maintena inj)
D2 and serotonin 1A partial agonist; serotonin 2A antagonist 10-15 mg QAM PO; Maintena - Qmonthly SE - anxiety, insomnia, *activating*, no/low weight gain |
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Invega
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Paliperidone (Sustenna inj)
3-12 mg/d; CrCl < 50 mL/min -> 3 mg/d Sustenna - Qmonthly IM *OROS delivery* *active metabolite of risperidone* SE - increased prolactin, EPS (esp. high doses), QT prolongation, metabolic issues |
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Saphris
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Asenapine
10-20 mg/d SUBLINGUAL NO food/drink for 10 min after dose SE - somnolence, tongue/mouth numbness, prolongs QT interval |
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Antipsychotic Drug Interactions
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Smoking - reduces plasma levels of olanzapine, clozapine
ALL APs can prolong QT interval Clozapine - avoid use w/ drugs that lower seizure threshold |
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Antipsychotic Patient Counseling
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Slightly increased risk of serious and possibly fatal SEs when used in older adults w/ demetia
Contact Dr if experiencing uncontrollable movements of the mouth, tongue, cheeks, jaw, arms, or legs Immediate medical attention if fever, sweating, severe muscle rigidity, and confusion Caution when driving - may cause dizziness/drowsiness Avoid alcohol |
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Clozapine Patient Counseling
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Can cause agranulocytosis (low WBCs); will have to test blood regularly
Can cause seizures, esp. w/ higher doses or if increased too quickly May rarely cause myocarditis; seek immediate medical attention if weakness, difficult/rapid breathing, chest pain, leg swelling |
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Patient Counseling for Olanzapine, clozapine, risperidone, paliperidone, quetiapine
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Risk of weight gain, elevated cholesterol, HTN, and hyperglycemia
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Asenapine SL Patient Counseling
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Place SL tablet under the tongue --- allow to dissolve completely
DO NOT eat/drink for 10 minutes after dose Tongue WILL feel numb after dose |
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FazaClo, Abilify Discmelt, Risperdal M-Tab, Zyprexa Zydis Patient Counseling
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Using dry hands, open foil blister and immediately place tablet in mouth
DO NOT push tablet through foil blister Use liquid only if needed CONTAINS phenylalanine |
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Risperdal oral soln
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Admin directly from pipette, or mix w/ water, coffee, OJ, or low-fat milk
NOT cola or tea |
