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What is the acute dosing for ziprasidone IM?
10-20 mg IM q2-4 hours. max 40 mg/day
What is the acute dosing for olanzapine IM?
2.5-10 mg IM; repeat again in 2 hours, then 4 hours for each dose after that. Max of 30 mg/day.
What is the acute dosing for aripiprazole?
5.25-9.75 mg IM q 2 hours prn. Max 30 mg/day
Typical antipsychotics MOA.
Block D2 receptors
What is a low potency typical antipsychotic?
How frequently are atypicals dosed initially? When are they usually taken?
BID - QID
In the evening if possible - (sedating)
Atypical antipsychotics MOA.
- 5HT/DA antagonists
- Effective for positive AND negative symptoms
- Little increase in prolactin
What is the biggest risk of clozaril and how to you monitor it?
- Weekly to monthly monitoring of CBC
What might happen in the first few hours of a patient who received IM zyprexa relprevv?
How and in what dose is asenapine taken?
- 5 mg sublinual BID (~35% bioavailability)
- Max 20 mg/day
- Weight gain similar to risperidone
How often do you receive aripiprazole injection (Abilify Maintena)?
What are the initial and maintenance doses for Iloperidone (Fanapt)?
- Initial: 1 mg po BID
- Maintenance: 6-12 mg BID
- Max: 24 mg/day
Who shouldn't take iloperidone?
Hepatic impairment pts (little data available)
This atypical has a lower risk for weight gain and somnolence. It has a low risk of akathisia, and dose related tachycardia.
How should lurasidone (Latuda) be taken?
- Inital: 40mg/day
- Maintenance: 80 mg/day
- Take with food (>350 calories)
- Weight neutral/weight loss
Extrapyramidal symptoms are much more common with typical antipsychotics. Name a few of these symtpoms.
- Acute dystonia
- Tardive dyskinesia
How would you counteract acute dystonia? (2 ways)
- Diphenhydramine 25-50 mg IM
- Benztropine 1-2 mg IM
How would you counteract akathisia? (2 ways)
- Propranolol 20-30 mg TID, increased to 120 mg/day
What class of medication would you use to treat pseudoparkinsonism?
Anticholinergics (benztropine, trihexyphenidyl, diphenhydramine, amantadine)
How long does it usually take for pseudoparkinsonism to manifest after starting therapy and who would most likely be affected?
- 1-3 months after therapy started
- Increased risk with pts over 40, females, and higher doses
What scale is used to assess tardive dyskinesia?
AIMS (Abnormal Involuntary Movement Scale)
This antipsychotic has very low rates of tardive dyskinesia and may be indicated in pts who experience TD from other medications, usually typical antipsychotics.
How would you treat neuroleptic malignant syndrome?
- D/C antipsychotic
- Use bromocriptine, dantrolene, or amantadine
- Supportive care
(High/Low) potency antipsychotics are more commonly associated with orthostatic hypotension?
Which med has the highest risk of QTc prolongation?
- (higher risk with electrolyte imbalance)
- D/C if QT interval > 500 msec
Which atypicals have the fewest amount of metabolic side effects?
What should you be cautious of in patients taking lamotrigine concomitantly with valproate?
Lamotrigine does not affect hepatic metabolic enzymes so there is a low potential for interactions. BUT lamotrigine may be _____ or _____. One agent that typically does this is _____.
What is the starting dose and eventual maintenance dose for lamotrigine?
How long does it take to titrate up?
- 25 mg po qd (qod if pt is on VPA)
- Titrate up to 200 mg qd over 6 weeks
Who should receive carbamazepine (CBZ)?
Pts who are intolerant or refractory to lithium; rapid cyclers or mixed states
Why should you not combine CBZ with clozapine?
Bone marrow suppression