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All antipsychotic agents have following risk.
monitor / counsel and counsel:
NMS, EPS, sedation, anticholinergic effects, seizure, cardiac changes (EKG), Leukopenia, temperature regulation, dermatological rxn, sexual dysfunction
BBW for all antipsychotic agnets?
dementia- related psychosis
clozapine BBW **
- fatalities due to myocarditis & cardiomyopathy
- orthostatic hypotension, bradycardia, syncope and cardiac arrest
- potentially life-threatening agranulocytosis, defined as ANC<500/mm3
antipsychotics are CYP substrates
what are the 2 drugs and it's enzyme highlighted in the lecture?
what are the inducers of it?
how do you mange interaction?
- 1A2: olanzapine, clozapine
- inducers: carbamazepine, smoking
should lower the dose after quit smoking otherwise for clozapine, seizure occurs
why would 2D6 important?
- lots of psych meds inhibit 2D6
- prozac, zoloft, paxil,, etc
- switch to Escitalopram(lexapro) or citalopram (celexa)
what are the antiemetic drugs which are FGA antipsychotics and what do you have to counsel about?
- Counsel the pts who gets Compazine (prochlorperazine) and Reglan(metoclopramide)
- about EPS Sx.
1/5 pts develope EPS w/ compazine
one FGA mentioned for acute psychosis tx in the lecture.
DOC for delirium & last line agent for chronic management psychosis?
what AE do you think about?
- Haloperidol (Haldol)
- think about QT prolongation!!
- avoid in alcohol withdrawal
what is inital dose for clozapine?
how do you dose 5days?
what is initial dose for risperidone?
what 's max vs clinical max dose and associated
- 2mg BID, max 16mg vs clinical max 6.
- after >6mg, no E but more EPS
- in terms of D2 blockade, causing EPS, and hyperprolactemia above 6mg, it's like FGA
Quetiapine low dose is commonly prescried off label. what?
what is starting dose for anti psychosis?
what is dose for off label use?
- commonly for sleep
- 25mg QHS initial dose for antipsychotic
- but 150-750 for maintenance dose
- 25-50mg on for a while is for sleep
what is SGA mentioned in the lecture that needs to be taken with food?
Geodon should be w/ food for efficacy
what is BBW of antipsychotics?
- Elderly patients with dementia-related
- psychosis treated with antipsychotics are at an increased risk of death
- compared to placebo. Most
- deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or
- infectious (eg,
- pneumonia) in nature. Antipsychotics
- are not approved for the treatment of dementia-related psychosis.