RXPrep - Schizo/psychosis and Bipolar

Avolition

lack of motivation

alogia

relative absence of speech

dystonia

a condition of abnormal muscle tone

prolonged contraction

akathisia

restlessness

parkinsonism

tremors abnormal gait, bradykinesia

tardative dyskinesia

abnormal facial movements - mouth, tongue

can be irreversible

FGA vs. SGA and what receptors they block

FGA: block dopamine receptors

SGA: blck serotonin and doopamine

What generation antipsychotics have less EPS?

second gen

For cute "stat" relief of a agitated, psychotic patient, what can you give them?

ex?

IM antipsychotic; often mixed with other drugs

BZDs, anticholinergics (dystonias)

"haldol cocktal" haloperidol, lorazepam, diphenhydramine"

What is used to help with dystonia?

anticholinergics; diphenhydramine, benztropine

What can be given to help with akathisia?

propranolol

anticholinergics

BZD

What can be given to help with parkinsonism?

anticholinergics

propranolol (tremor)

What are the main BBW with antipsychotics?

not indicated for agintation control in elderly with dementia-related psychosis

increased risk of stroke in those with demenia

What are the 5 main/big warning with FGA?

CV: QT, orthostasis, falls

Anticholinergic

CNS depression

EPS

^ prolactin

Abilify SE

akathisia

AA -- makes hyper

What are the FGA?

chlorpromazine

thioridazone

loxapine

haloperidol

fluphenazine

thiothixene

trifluoperazine

What are the SGA?

abilify

clozapine

lurasidone

olanzapine

paliperidone

quetiapine

risperidone

ziprasidone

asenapine

brexpiprazole

...

What SGA has a REMS for neutropenia/agrenulocyteosis and what are the ANC goals in order to start/stop treatment?

clozapine

ANC must be >1500 to start and must stop if <1000

What are three things to remember for BBW/ADR with clozapine?

heart: myocariditis and cariomyopathy

ANC: neutropenia

~~~: seizures dose related

What three SGA are best to AVOID metabolic syndrome (CVD, diabetes, etc)

abilify

lurasidone

ziprasidone

Latuda

lurasidone

What one SE with lurasidone

dystonias

What AP has a REMs program for the inj due to sedation and delirium and must be admin in doc office + 3 hours post-observation

olanzapine

Invega

paliperidone

Which paliperidone inj must be given after the other (4 months after)?

invega Trinza

invega sustenna first

Which AP have ^ prolactin as a SE?

paloperidone

risperidone

FGA's

Seroquel

quetiapine

____ is often used for psychosis in PD

quetiapine

What AP has a XR formulaton that should be taken at night without food or very small meal?

quetiapine

What AP must you take with food?

ziprasidone

What SQA has QT prolonging risks?

ziprasidone

abilify - small

What SL AP can cause tongue numbness?

Saphris - asenapine

What are the top AP with the MOST QT-prolonging risks ? (4)

zipazidone (only SGA)

haloperidol

thioridazine

chlorpromazine

What AP have the most EPS?

FGA's

risperidone

paliperidone (higher doses)

What AP is PREFERRED if limiting EPS?

quetiapine

What drugs are the WORST for metabolic risk?

olanzapine

quetiapine

What AP is used third line due to ADRs?

clozapine

What drug is approved for psychosis in PD?

pimavanserin

What AP has BBW for QT-prolonging

thioridazine

What medications are approved for treating tardive dyskinesia and whats the MOA?

valbenazine

deutetrabenzine

"benazine)

VMAT2 inhib

neuroleptic malignant syndrome s/s

-mental status changes

-severe muscle rigidity

-autonomic changes (elevated temperature (101-103), tachycardia, BP lability)

Lithium is used for:

a. psychosis

b. depression

c. bipolar

d. all the above

c - for mania or depressive episodes

Describe the difference between bipolar I and II

I - mania typeically with bouts of depression (but not required) psychosis and delusions present or requires hospitalization

II - hypomania with depressive episodes >2 weeks, doesn't lead to hospitalization or have psychosis

What medications can treat both mania and depression (bipolar) without inducing the other?

traditional mood stabilizers:

-lithium

-valproate

-carbamazepine

-lamotrigine

When are antipsychotics and antidepressants used in bipolar?

AP - stabilize mood when mania with psychosis occuring

AD - ONLY in combo with mood stabilizers

What drug class can induce or worsen mania in someone with bipolar?

antidepressants

What are the mainstays for acute treatment options of bipolar?

in mania: valproate, lithium, or antipsychotic

in depression: lithium, lamotrigine (alt)

What are the mainstays for maintenance of bipolar disorder?

lithium and valproate if monotherapy +/- antipsychotics or antidepressants

Alt: lamotrigine, carbamazepine, SGA's

What's the difference btwn schizophrenia and bipolar?

Schizophrenia causes symptoms that are more severe than the symptoms of bipolar disorder. People with schizophrenia experience hallucinations and delusions.

Medguides are required with what medication classes seen in these disease states?

antipsychotics - due to risk of death in elderly with dementia-related psychosis

antidepressants - risk of suicidal

What's the safest option in pregnancy for bipolar ?

lurasidone - but only if bipolar depression

otherwise: lamotrigine

What SGA's are preferred in bipolar?

arirpiprazole

quetiapine

ziprasidone

risperidone

olanzapine

For severe bipolar, what is the treatment plan typically?

mood stabilizer + SGA

valproate or lithium + SGA

MOA of lithium

proposed to influence the reuptake of serotonin and/or NE

Therapeutic level of lthium

0.6-1.2

What levels of lithium are considered toxic and what side effects could be expected?

>1.5 - ataxia, hand tremor, vomiting

>2.5 - CNS depression, arrhythmia, seizure, coma

What are the SE with Lithium?

LITHIUM(W)s -

levels

increased urination

thirsty/tremors

hypothyroid

Interactions (ACE/ARB/Diuretics/NSAIDs^)

upset stomach

mental status

weight gain

DDI with lithium

low Na: ACE inhib, thiazides, NSAIDs wil ^ Li

Seritonergic drugs

converting between lithium:

-tabs/capsules

-liquid

-mEq

5 mL = 8 mEq of ion = 300 mg capsule