IPT 6 schizophrenia therapeutics

Haloperidol brand

Haldol

Chlorpromazine brand

Thorazine

Fluphenazine brand

Prolixin

Thiothixene brand

Navane

Trifluoperazine brand

Stelazine

Thioridazine brand

Mellaril

Perphenazine brand

Trilafon

Loxapine brand

Loxitane

Chlorpromazine (Thorazine) ADEs

gray-blue skin, photosens, seizure, orthostasis

Thioridazine (Mellaril) ADEs

high QT prolongation risk

Perphenzine (Trilafon) ADEs

mid-potency -> balance of EPS and antichol

Perphenzine (Trilafon) pearl

used for intractable hiccups

Haldol ADEs

Very high EPS, low antichol

Seroquel XR pearl

take on empty stomach

Risperidone LAIs

Risperdal Consta: IM Q2 weeks w/ PO overlap x3 weeks

Perseris: IM Q month w/ no PO overlap

Paliperidone (Invega) pearl

leaves ghost tablet

OROS: once daily

Brexpiprazole (Rexulti) vs Abilify

No clear advantage

Cariprazine (Vraylar)

No prolactin effect

Approved for bad depressive episodes

Prolactin elevating antipsychotics

Risperidone, paliperidone, typical AP

Elevated prolactin effects

menstrual disturbances, gynecomastia, reduced fertility, E suppression, bone density, T suppression

If metabolic EPS:

switch to abilify, geodon, lurasidone, or asenapine

Mesolimbic pathway

positive sx

Mesocortical pathway

negative and cognitive sx

Nigrostriatal pathway

EPS and TD

Tuberoinfundibular pathway

prolactin release

Positive symptoms examples

hallucinations, delusions

Negative sx examples

no motivation or pleasure, poor psychosocial fxn

Cognitive sx

can't function at work or pay bills, poor social function

Differential diagnosis causing psychotic sx

substance abuse, prescribed, and disease

Substance abuse DD

cocaine, ETOH, amphetamines, bath salts, weed

Prescribed DD

corticosteroids, anticholinergic, levodopa, digoxin

Disease DD

infection, tumor, lesions, epilepsy, neurodegenerative disorders

Lab monitoring DD

thyroid function, CBC w/ differential, general chemistries

FGA low potency drug ex

chlorpromazine, thioridazine, mesoridazine

FGA high potency drugs ex

haldol, fluphenzine, thiothixene, trifluoperazine

FGA high potency effects

More EPS

Less antichol/sedation

FGA low potency effects

Less EPS

More antichol/sedation

LAIs

Haldol, fluphenazine, olanzapine, risperidone (2), paliperidone, Abilify (2)

LAIs w/ oral overlap

Abilify Maintena, Aripiprazole Lauroxil (Aristada), risperidone (Risperdal Consta)

NMS

Neuroleptic malignant syndrome

NMS sx

hyperthermia, confusion, diaphoresis, tachycardia

NMS vs SS

NMS: rigidity

SS: myoclonus/hyperreflexia, GI complaints