SGA Side Effects
SGA that causes QT prolongation
Ziprasidone (Geodon)
3 agents that increase lithium levels
ACEs/ARBs/dehydration/elderly/renal dysfunction/NSAIDs, etc
Invega Sustenna, Perseris, Uzedy, Aristada if used with Initio, Zyprexa Relprevv
GH is a 20 year old female who presents with depressive symptoms accompanied by voices telling her to kill herself. She has a past manic episode. Please recommend an appropriate treatment option.
CLLO-Q
Only SSRI containing product FDA approved for bipolar depression
Symbyax (olanzapine/fluoxetine)
Two SGAs that must be taken with food; must specify how much food
Ziprasidone: 500 calories
Lurasidone: 350 calories
Preferred agents for OTC pain relief in lithium-treated patients
Aspirin, sulindac, acetaminophen
Only LAIAs that are administered SQ
Perseris and Uzedy (risperidone)
We never use ______ monotherapy in a patient with bipolar depression due to the risk of switching into mania and inefficacy.
Antidepressant
Only SGA that does not exhibit dopamine antagonist effects; works as M1/M4 agonist
Cobenfy
Patients with ______ require ANC to be greater than or equal to 1000 cells/cubic mL to start clozapine; does not increase risk of agranulocytosis.
Benign Ethnic Neutropenia
Target dose of lamotrigine in patients receiving treatment with concomitant Depakote
100 mg/day
Part of REMS program due to risk of Post-Injection Delerium and Sedation Syndrome
Zyprexa Relprevv
Two antipsychotics FDA-approved for bipolar depression that have a low likelihood of inducing metabolic side effects.
Lumateperone and Lurasidone
Recommended monitoring parameter and monitoring frequency for patients on clozapine for the first-year of treatment
ANC and weekly x 6 months, once every 2 weeks x 6 months
BBW for all antipsychotics
If miss more than ____ days of lamotrigine, the dose must be retitrated due to the risk of SJS/TEN.
5
A patient is stablized on Abilify and is going to be switched to Aristada. She does not want to take any oral overlap. What do you do?
Give Aristada Initio 675 mg IM once and one 30 mg PO tablet
Two SGAs that act more like typical antipsychotics (FGAs) when given at higher doses (also cause hyperprolactinemia)
Risperidone and Paliperidone
Why must the dose of clozapine be titrated?
Dose-related seizures and orthostasis!
Two SGAs that are the most likely to cause metabolic side effects.
Olanzapine and Clozapine
Lamotrigine
A patient is stabilized on risperidone and being switched to Invega Sustenna. What is the loading dose regimen and is oral overlap required?
234 mg IM day 1 followed by 156 mg IM day 8; no oral overlap required
Olanzapine and Clozapine
5 Black Box Warnings associated with Clozapine Use
Aganulocytosis, orthostasis/bradycardia, seizures, myocarditis/cardiomyopathy, increased risk of mortality in elderly