Term
Name the FGAs.
Organize by potency |
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Definition
Low potency: Chlorpromazine, Methotrimeprazine
Intermediate potency: Loxapine, Perphenazine, Zuclopenthixol
High potency: Flupenthixol, Fluphenazine, Haloperidol, Pimozide, Pipotiazine, Thiothixene, Trifluoperazine. |
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Term
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Definition
Aripiprazole, Clozapinem, Paliperidone, Ziprazidone, Olanzapine, Quetiapine, Risperidone
(Aries closed Peter's zipper on questioning reality). |
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Term
Which SGA is the active metabolite of risperidone?
What does this mean for po SE's? |
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Definition
Paliperidone
Fewer po side effects, b/c not metabolized by liver |
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Term
Which SGA's are available as injectables?
Which are long acting?
How frequently are the long acting SGAs dosed ? |
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Definition
Olanzapine, Paliperidone palmitate, Risperidone are available as injectables.
Paliperidone palmitate and risperidone are long acting injectables.
Paliperidone requires loading doses (7 days apart), and then a maintenance doses every month.
Risperidone requires no loading dose, but maintenance dose every 2 weeks. |
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Term
| What is the very important counseling point concerning oral ziprasidone? |
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Definition
Ziprasidone must be taken with food, over 500 calories.
Bioavailability is reduced by 50% when taken without food. |
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Term
All SGAs and FGAs have similar efficacy, what drug is the exception?
Which drug is the only efficacious antipsychotic against treatment resistant Schizophrenia? |
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Definition
Exception: Clozapine
Efficacious against treatment resistant schizophrenia: Clozapine |
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Term
What is first line, SGAs or FGAs?
Which drug is the exception?
Why ? |
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Definition
SGAs are first line
Clozapine is the exception due to the risk of agranulocytosis, and the need for blood monitoring. It is reserved for resistant schizo. |
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Term
What is the most used medication vs psychotic agitation?
Addition of what benzo has proven to be more effective to this therapy? |
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Definition
Haloperidol.
Haloperidol with lorazepam is more effective. |
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Term
What should be avoided when using olanzapine?
What is it associated with? |
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Definition
| Avoid parenteral benzodiazepines. Concomitant use is associated with cardiac and respiratory problems. |
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Term
| Zuclopenthixol acetate is an injectable FGA, what type of patient should not use it. |
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Definition
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Term
How should dosing be titrated in SGA's?
What 2 SGAs are the exceptions?
How should they be titrated? |
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Definition
SGAs are to be started at a low dose, then titrated slowly over 1-2 weeks.
The exceptions are quetiapine XR and ziprasidone.
Ziprasidone should be started at 20-40mg daily and *rapidly* titrated over 1 week to 120-160mg daily.
Quetiapene should be started at 300mg daily then titrated quickly to 400-800mg daily. Can increase dose as soon as 1 day after initiation. |
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Term
| How long should antipsychotic therapy continue at therapeutic dose before switching to another agent due to lack of benefit? |
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Definition
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Term
How long should maintenance therapy continue after a first psychotic episode?
After a second psychotic episode ? |
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Definition
after 1st episode: 1-2 years
after 2nd episode: at least 5 years |
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Term
| Poor medication adherence is associated with schizophrenia, what should be used in these patients? What drugs specifically? |
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Definition
| Long acting IM antipsychotics: Risperidone, or Paliperidone. |
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Term
| How should antipsychotics be discontinued (when treating first and second episode psychoses) ? |
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Definition
| Dose reduced by up to 20% every 2-4 weeks. 1st episode should take 6-12 months. 2nd episode should take 12 - 24 months. |
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Term
| What is more efficacious SGAs or FGAs vs depression in acute psychosis ? Should antidepressants be used in the acute phase? |
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Definition
SGAs more efficacious
no evidence to support used of antidepressants in acute phase. |
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Term
Importance of knowing if a patient on antipsychotics is a smoker?
Which SGAs are particularly important to remember in this case?
What smoking cessation drug should you be careful of due to possible exacerbation of psychosis? |
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Definition
Smoking induces 1A2, clozapine & olanzapine.
Be careful with Bupropion as it can exacerbate psychosis. |
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Term
What rare medical emergency with high mortality rate is associated with all antipsychotics (at any dose)?
Characteristics? |
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Definition
NMS - Neuroleptic Malignant Syndrome
Muscle rigidity, fever, elevation in CK, labile BP, and fluctuating consciousness. |
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Term
What potency FGAs are associated with sedation?
Which SGA's are associated with sedation ? |
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Definition
low potency FGA's
SGA's mostly :clozapine, & quetiapine
mildly: olanzapine & risperidone |
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Term
EPS and TD
FGAs vs SGAs?
Which SGAs can cause akathisia?
Which SGAs can cause EPS? |
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Definition
SGAs are safer than FGAs in terms of TD and EPS
SGAs that can cause EPS: R,P,Z
SGAs that can cause akathisia: A,O |
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Term
Weight Gain, Dyslipidemia & Diabetes in psychoses.
1) Which FGAs have highest weight gain?
2) What is worse for weight gain SGAs or FGAs?
3) Which SGAs cause the worst weight gain, dyslipidemia & glucose abnormalities ?
4) Which SGA is weight neutral? |
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Definition
1) low potency FGAs cause worse weight gain
2)SGAs cause more weight gain than FGAs
3) O,C - *(Causes Overweight)*
4) Ziprasidone is weight neutral, all other SGA's have a mild effect on weight, glucose, and dyslipidemia. |
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Term
Orthostatic hypotension
How common?
What drugs? |
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Definition
Orthostatic hypotension
MOST common antipsychotic side effect
Occurs with low potency FGAs,
SGAs: Most commonly with clozapine, but can happen with others |
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Term
QT prolongation:
1) SGA that causes it the worst. Important not about this SGA and other drugs that cause QT prolongation.
2) FGA's that cause QT prolongation
3) SGA's that cause modest QT prolongation |
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Definition
1) ZIPRASIDONE. Contraindicated with other drugs that cause QT prolongation.
2) Chlorpromazine, pimozide, and haloperidol cause QT prolongation
3) O,Q,R cause modest QT prolongation |
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Term
| Which Antipsychotic is associated with myocarditis, pericarditis, paricardial effusion, HF, MI, |
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Definition
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Term
Which FGAs and SGAs cause HyperRProlcatinemia ?
What are the effects of hyperprolactinemia on men & women
How do you approach antipsychotic induced clinically significant hyperprolactinemia? |
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Definition
Paliperidone, Risperidone can cause hyperprolactinemia. Ziprasidone and Olanzapine can cause transient hyperprolactinemia.
Hyperprolactinemia affects sexual systems in both men and women.
Reduce the dose in clinically significant hyperprolactinemia. |
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Term
Antipsychotics in pregancy.
Safe? What doses should be used?
In breast milk ? Is it worrisome? |
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Definition
Antipsychotics in pregnancy.
Little evidence against use of antipsychotics in pregnancy. Very little SGA and FGA pass into breastmilk. not worrisome |
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