Akathisia sxs and time frame it develops and tx
within days to weeks
restlessness w/ anxiety and inability to remain still
tx: benzos or propranolol
Dystonia sxs and time frame it develops and tx
within 24-96 H
prolonged contraction of muscles, painful muscle spasms
ppx and tx: diphenhydramine, benztropine
parkinsonism sxs, time it develops, and tx
days to weeks
tx: anticholinergics, amantadine
tardive dyskinesia (TD) sxs, time it develops, tx
months to years
tongue twisting, facial movements
Ingrezza
first generation antipsychotics low potency: increased sedation, decreased EPS
chlorpromazine
thioridazine
first generation antipsychotics mild potency
loxapine
perphenazine
first generation antipsychotics high potency: decreased sedation, increased EPS
haloperidol
fluphenazine
thiothixene
second gen antipsychotics MOA
block dopamine (D2) and serotonin receptors (5-HT2A)
Abilify and Rexulti (brexpiprazole, Vraylar (cariprazine) MOA
block dopamine (D2) and 5-HT1A partial agonist
Abilify (aripiprazole) and Geodon (ziprasidone) better for which patients
weight neutral (better for obese) works less on BG and lipid elevation, can be activating
Clozapine: reserved for resistant schizophrenia:
SE
agranulocytosis, SZ, constipation, weight gain, increased salivation, increase BG and lipids
Latuda (lurasidone) CI
CYP 34A inducers and inhibitors
take with food >350kcal
Zyprexa (olanzapine) SE
somnolence, metabolic syndrome ( increased wt, BG, lipids) QT prolongation
smoking decreases levels
Invega (paliperidone) SE and notes
OROS tablet, dose adj. w/ CrCl, metabolic syndrome: increased wt, BG, lipids, prolactin, EPS w/ high doses
First gen antipsychotics (FGA): MOA
block dopamine-2 receptors
BBW for FGAs
increased risk of death in older adults with dementia related psychosis, CI in parkinson, increased risk of falls, stroke, heart failure, sudden death, infection
Seroquel (quetiapine) SE and notes
take without food, somnolence, metabolic syndrome increased wt, lipids, BG, low EPS, can use in PD
Risperdal (risperidone) SE
metabolic sydrome, increased BG, wt, lipids, prolactin, EPS higher doses
Geodon (ziprasidone) SE and notes
Take with food, CI in QT prolongation
Administration of Risperdal liquid
use pipette or mix w/ water, coffee, milk, oj
drugs that tx TD
Ingrezza (valbenazine)
Austedo (deutetrabenazine
drugs that tx TD warning
hepatic impairment, somnolence, QT prolongation
Lithium in bipolar
therapeutic range - 0.6-1.2
>1.5 ataxia, coarse hand tremor, V/D
>2.5 CNS depression, arrhythmias, SZ, coma
avoid in pregnancy
