schizo/psychosis

dystonia

painful muscle contraction

• ppx/tpx: central-acting anticholinergics

akathisia

restlessness w anxiety

• tpx: benzo, propanolol

parkinsonism

tremor, abnormal gait, bradykinesia

• tpx: anticholinergic, propanolol (tremor)

tardive dyskinesia

abnormal facial movement, can be irreversible

• tpx: stop drug, replace w 2nd gen antipsychotic, valbenazine, deutetrabenazine

dyskinesia

abnormal movement

schizophrenia

dopamine, serotonin, glutamate

schizophrenia diagnosis

DSM-5

must have delusion, hallucination, disorganized speech

• negative

  • loss of interest

  • lack of emotion

  • cant carry out activities

  • poor hygeine

  • social withdrawal

  • loss of motivation

  • lack of speech

• positive

  • hallucination

  • delusion

  • disorganized thinking

  • difficulty paying attention

schizophrenia treatment

• SGA: lower EPS

• FGA (higher risk EPS)

FGA

• low: chlorpromazine, thioridazine

• mid: loxapine, perphenazine

• high: haloperidol, fluphenazine, thiothixene, trifluoperazine

block D2

• BOX: death in elderly with dementia psychosis

• warnings: cardio (QTc, stroke orthostasis/falls), anticholinergic, CNS depression, EPS, hyperprolactinemia, NMS

• s/e: sedation, dizziness, anticholinergic

• can give anticholinergic for EPS

• lower potency: more sedative, less EPS

• higher potency: less sedative, more EPS

thioridazine

• BOX: QTc

SGA

block D2 and 5HT2A

• BOX: death in elderly with dementia psychosis

• warning: stroke, falls, QTc

• less EPS: quetiapine

• less metabolic: lurasidone

• less QTc: lurasidone, olanzapine, quetiapine

• incr prolactin: risperidone, paliperidone

• DDI: benzos, dopamine blockers

abilify

abilify mycite - tabs w sensor

abilify maintena - monthly

abilify aristada initio - q4-8w

abilify asimtufii - q2m

aripiprazole

SGA

• s/e: akathisia, activating

clozaril

versacloz suspension

clozapine

SGA

• 3rd line: only if TF x2

• BOX: neutropenia/agranulocytosis (REMS), myocarditis/cardiomyopathy, seizure

• s/e: constipation, metabolic, hypersalivation

• start: ANC 1500+

  • stop: ANC<1000

• smoking reduces levels

latuda

lurasidone

SGA

• s/e: somnolence, EPS, nausea, less metabolic than other SGA

zyprexa

zyprexa zydis ODT

zyprexa relprevv injection - q2-4w

olanzapine

SGA

• BOX: admin and monitor x3h for sedation, REMS (relprevv)

• s/e: somnolence, metabolic

• smoking reduces levels

invega

invega sustenna - monthly

invega trinza - q3m

invega hafyera - q6m

palperidone

SGA

• s/e: incr prolactin, EPS, QTc, metabolic

seroquel

quetiapine

• s/e: somnolence, metabolic, low EPS risk

• take XR QHS without food or light meal

risperidal

risperidal consta - q2w

rykindo - q2w

perseris (SC) - monthly

uzedy (SC) - q1-2m

risperidone

SGA

• s/e: incr prolactin, EPS, QTc, metabolic

• cannot mix w coffee/tea

geodon

ziprasidone

SGA

• CI: QTc

saphris SL

secuado patch

asenapine

SGA

• no food/drink 10 min after dose

• CI: severe hepatic impairement

• s/e: tongue numbness

nuplazid

pimvanserin

serotonin inverse agonist and antagonist

indication: psychosis w Parkinson’s

• warnings: QTc

• s/e: edema, confusion

ingrezza

valbenazine

VMAT2 inh

indication: TD

• warnings: somnolence, QTc

austedo

deutetrabenazine

VMAT2 inh

indication: TD

• CI: hepatic impairment

• warnings: somnolence, QTc

neuroleptic malignant syndrome

• D2 blockage, within 2 wks of treatment or high dose of injections

• most common w FGAs

• s/x: hyperthermia, muscle rigidity, mental status, tachy/HTN

• labs: incr CPK and WBC

• tpx: stop antipsychotic, supportive care, cooling, relax muscles (benzos, dantrolene)