exam 3

What all schizophrenia includes

Psychosis

Fixed false belief, cannot be corrected by logic

Delusion

False sensory perception without real external stimulus

Hallucination

DOC for persistent suicidal attempts, history of TD, and persistent aggression

Clozapine

First gen antipsychotic that requires titration due to orthostasis

Clozapine

This is used to treat hypersalivation due to clozapine

Atropine 1% ophthalmic solution as a mouth rinse

This drug has mandatory ANC monitoring

Clozapine

CYP1A2 inducers (smoking) decrease this drugs SDL by 50%

Clozapine

REMS drug requiring ANC reporting

Clozapine

Minimum ANC requirements for clozapine

1500, if BEN, 1000

This can cause DRESS reactions

Olanzapine

This has a low risk of QT prolongation

Olanzapine

This IR formulation may require multiple daily dosing

Quetiapine

This drug may be useful in elderly but has a BBW for dementia w psychosis

Risperidone

This has a high prolactin increase and increased seizure risk

Risperidone

Risperidone max TDD

6mg

The only antipsychotic that requires renal dosing

Palperidone

Palperidone cannot be used under this CrCl

80

Antipsychotic with the highest prolactin stimulation/seizure risk

Palperidone

Only agent approved in schizoaffective disorder

Palperidone

This antipsychotic may cause Wolff-Parkinson white arrhythmia at high doses

Iloperidone

This antipsychotic is sublingual only

Asenapine

This antipsychotic must be taken with 500 cal

Ziprasidone

This has a product warning for QT prolongation and requires baseline EKGs

Ziprasidone

This is weight neutral but must be administered with 350cal

Lurasidone

This is contraindicated in the use of potent CYP3A4 inhibitors and inducers

Lurasidone

This antipsychotic has NMDA receptor modulation

Lumateperone

This is contraindicated in UGT inhibitors - quinidine, atazanavir, diclofenac, VPA, probenecid

Lumateperone

Highest risk of QT issues

Geodon, IV haloperidol

Lowest risk of QT issues

Olanzapine or any 3rd gen agent

What to do if unresponsive to med changes

Reassess diagnosis and compliance

Acute treatment of decompensated

Scheuled, oral atypical agent

DOC for acute treatment of decompensated

Haloperidol

Best phase to initiate smoking cessation

Maintenance phase

What trails the current therapy is derived from

CATIE

How to improve adherence

Alternative ROA - ODT, liquids, patch, IM injection

This LAI requires refrigeration

Risperdal Consta

This LAI has drug interaction dose adjustments

Ability Maintena

These LAIs require Z track IM technique

Typical antipsychotics

Treatment for catatonia

High dose, scheduled benzodiazapines

DOC for Catatonia treatment

Clonazepam 2-4mg or Lorazepam 2-4mg

Lithium drug interactions

Thiazides, NSAIDs, ACE inhibitors

Lithium citrate to carbonate conversion

Lithium citrate liquid 8mg/5mL = 300mg lithium carbonate

Lithium target drug levels

0.8-1.2

Lithium dose change of 300mg

0.2-0.4 mEq/L change in plasma concentrations

Lithium pregnancy category

D

This drug DR and ER are not interchangeable

Divalproex

Divalproex DR dosing

BID-TID

Divalproex ER dosing

qAM

What to do in Divalproex use if low serum albumin (under 3.6)

Request free VPA or adjust dose

Divalproex pregnancy category

D

This drug has hematologic side effects

Carbamazepine

Hematologic side effects of carbamazepine

Agranulocytosis, thrombocytopenia, aplastic anemia

Carbamazepine BBW

Rash/SJS - if develops DC immediately

Carbamazepine pregnancy category

D

When CBC is monitored in carbamazepine

Every 3-6mo

Lamotrigine pregnancy category

C

Safest in pregnancy

Lamotrigine

Akathesia treatment

Propranolol

Psuedoparkinsonianism treatment

Benztropine and trihexyphenidyl

Lithium time to steady state

5-7d

Metabolic syndrome waist circumfrance

40

Dystonia can lead to this

Death

Low potency agents

Chlorpromazine and thioridazine

Low potency chlopromazine and thioridazine have the highest risk of what

Sedation, constipation, orthostatic hypotension

Order of weight gain

Clozapine is highest, then Risperidone and Lurasidone

ANC calculation

Nuetrophil % (WBC)

Dystonia

Life threatening movement disorder

Over 4 manic episodes per year

Rapid cycler

Lithium time to response

10-14d

Lithium self limiting side effects

Fine hand tremor, GI issues, sedation

If lithium self limiting effects persist over 14d

Consider toxicity

Divalproex DR acute target dosing

Patient weight in lbs multiplied by 10, rounded to nearest 500mg

Divolproex minimum concentration required to cross BBB

50mcg/mL

Lamotrigine ADR

SJS

Carbamazepine side effect

Nystagmus/rapid eye movement

This drug causes weight loss

Topiramate

Phenytoin salt form and pH

Sodium salt pH 7

Valproate BBW

Hepatotoxicity, teratogenicity, pancreatitis

This is 30x more potent than Levetiracetam

Brivaracetam

What topiramate inhibits

Carbonic anhydrase

Keto diet

90% calories is fat

Phenytoin therapeutic range

10-20mg/L