SCHIZOPHRENIA -D3

DSM V

2+ symptoms x 6 months

1 bold + non bold

\
bold = delusions, hallucinations, disorganized speech

x1 month

\
non bold = disorganized thinking, negative symptoms

x6 month

positive symptoms

things that are present that should not be present

negative symptoms

things that are absent that should not be absent

cognitive symptoms

attention, memory, function

hallucination

someone has a false perception that they think is real

\-visual, auditory, olfactory gustatory, tactile

delusion

fixed false belief

thought broadcasting

pt thinks that ppl can hear/aware of their thoughts

thought insertion

pt thinks that thoughts they have are NOT theirs and that someone else puts them into their mind

alogia

negative symptom

poverty of speech, keep having to ask pt lots of questions to get more info

anhedonia

negative sx

lost interest in activities they used to enjoy previously

avolition

negative sx

demotivation

lack of self directed behavior

blunted flat affect

negative sx

dulled for constricted response, where a person’s emotional response is not as intense as normally expected

FGA

D2 antagonist (primarily)

M1 antagonist

Histamine antagonist

Alpha-adrenergic antagonist

\
higher incidence of EPS

\
also known as “typical antipsychotics”

D2 antagonist

EPS symptoms due to DA buildup

Nigrostriatal

Mesolimbic

Mesocortical

Tuberinfundibular

M1 antagonist

anticholinergic effects

red as a beet

hot as a hare

dry as a bone

stuffed pipe

blind as a bat

histamine antagonist

sedation

weight gain

alpha adrenergic antagonist

orthostatic HoTN

dizziness

neuroleptic malignant syndrome

more common FGA > SGA

\
autonomic instability

AMS

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MUSCLE RIGIDITY

ELEVATED CREATININE KINASE (MUSCLE BREAKDOWN)

dantrolene or bromocriptine

treatment for NMS

SGA

D2 antagonist

5HT2 antagonist

M1 antagonist

Histamine antagonist

Alpha-adrenergic antagonist

\
lower incidence of EPS

\
HIGHER INCIDENCE OF METABOLIC ABNORMALITIES THAN FGA

\
also known as “atypical antipsychotics”

clozapine

most effective

REMS: mandatory ANC

WEIGHT GAIN

last resort when 4 SGAs have been used an failed

>1500

ANC for non-BEN

initiation of clozapine

>1000

ANC for BEN

initiation of clozapine

ANC for non BEN

D/C clozapine

ANC for BEN

D/C clozapine

thioridazine

WORST (FGA) at QT

risperidone and paliperidone

WORST at hyperprolactinemia

SGA

BBW for antipsychotics

elderly patients w/ dementia related psychosis treated w/ antipsychotics are at an increased risk of death compared to placebo

4-6

takes ____ weeks to see full benefit of antipsychotics

2 episodes

treatment duration

consider lifelong is > ___ in the past 5 years

haloperidol, fluphenazine, thiothixene

FGA

highest potency, lowest anticholinergic, highest EPS

thioridazine and chlorpromazine

FGA

lowest potency, highest anticholingeric, highest sedation, lowest EPS

pseudoparkinsonism

part of EPS big 4

immediate onset (hours-days-weeks)

\
stoop posture

shuffling gait

rigidity

bradykinesia

tremors at rest

pill rolling

benztropine and amantadine

treatment for pseudoparkinson sx of EPS

acute dystonia

part of EPS big 4

sudden severe muscle spasms

\
most risk for pt naive antipsychotics

onset of 5 days

\
facial grimacing

involuntary upward eye movement

muscle spasms of tongue, face, neck, back (arch)

laryngeal spasms

lorazepam, diphenhydramine, IM benztropine

treatment for acute dystonia

akathisia

part of EPS big four

most common type of EPS

\
restless

trouble standing still

paces the floor

feet in constant motion

rocking back of forth

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MOTION

propranolol, nadolol, metoprolol

beta blockers used for akathisia

tardive dyskinesia

abnormal involuntary movements

\
delayed onset of 6 months after initiation of antipsychotics, cumulative exposure to D2 antagonists

\
protrusion and rolling of tonue

sucking and smacking movements of lip

chewing motion

facial dyskinesia

involuntary movement of body and extremes

VMAT inhibitors

depletes DA in nerve terminals

treatment for tardive dyskinesia

negates need to d/c, reduce dose, or change antipsychotic therapy

acceptable to continue mood stabilizers or antidepressants if on ____

tetrabenazine, deutetrabenazine, valbenazine

VMAT 2 inhibitors- big 3

tetrabenazine

treats TD

BBW: increased risk of depression and ideation for pt w/ HC

\
C/I in actively suicidal or untreated/poorly treated depression

deutetrabenazine

treats TD

BID

take with food

C/I: HEPATIC impairment

DDI: CYP2D6

valbenazine

treats TD

Qday

DDI:CYP3A4 and CYP2D6

clozapine = olanzapine > risperidone = quetiapine

TOP 4 of WEIGHT GAIN, hyperglycemia, lipid abnormalities

pseudoparkinsonism, acute dystonia, akathisia, tardive dyskinesia

EPS big 4 (all)

aripiprazole

lowest metabolic risk

SGA

not as sedating

\
same as brexipiprazole

lurasidone

lower metabolic risk

SGA

take w/ food

avoid grapefruit

olanzapine

highest metabolic risk

drug levels lower in CYP1A2

quetiapine

weight gain and sedating

SGA

risperidone

highest EPS

highest prolactin

of SGA

\
RISE EPS AND PROLACTIN

ziprasidone

highest QT of SGA

low metabolic risk

haloperidol and fluphenazine

1st gen

LAI

abilify maintena, aristada, zyprexa relprevv, invega sustena, invega trinza, risperidal consta, perseris

AA O PP RR

2nd gen LAI

all

abilify maintena and aristada

AA of 2nd gen LAI

\
AA O PP RR

zyprexa relprevv

o of 2nd gen LAI

\
AA O PP RR

\
NO SUPPLEMENT

3 hour observation time

invega sustenna and invega trinza

PP of 2nd gen LAI

\
AA O PP RR

risperidal consta and perseris

RR of 2nd gen LAI

AA O PP RR

abilify maintena and aristada and risperidal consta

ALL 3 SGA LAI

requires PO overlap

aristada and risperidal consta

SGA LAI

PO overlap 21 days (3 weeks)

abilify maintena

PO overlap 14 days (2 weeks)

SGA LAI

risperidal consta

CONSTANTLY

SGA LAI

\
Q2 weeks

invega trinza

SGA LAI

\
Q3months!

B52 cocktail

acute agitation

old treatment

benadryl, haloperidol, lorazepam

B52 components

acute agitation treatment

B52

\
ziprasidone

olanzapine

aripiprazole

loxapine

weekly

how often should we monitor ANC

MON 1-6

every other week

how often should we monitor ANC

MON 7-12

monthly

how often should we monitor ANC

AFTER ONE YEAR