Clozapine
Clozapine has 5 black box warnings including this one that may cause ____, brady cardia, and syncope. Predisposition may include dehydration and use of antihypertensive medications.
What is orthostatic hypotension.
According to AIMS (the Advancing Integrated Mental Health solutions) and UpToDate, you should monitor A1C and lipid panel for antipsychotics ___ after initiation and annually if normal.
What is 12 weeks / 3 months.
All patients receiving long-term antipsychotic drugs should be regularly screened for the development of TD. This can be done by direct observation with this scale.
What is the Abnormal Involuntary Movement Scale (AIMS).
The lack of taking medications correctly has been associated with adverse outcomes and higher costs of care. Long-acting injectable medications are thought to increase this medical term meaning to the extent to which patients take medication as prescribed.
What is adherence.
Due to its dopamine antagonist action this antiemetic if used long-term should be regularly screened for the development of tardive dyskinesia.
What is metoclopramide (Reglan).
Clozapine is FDA approved for treatment-resistant schizophrenia. To be authorized to prescribe clozapine you need to sign up and be certified with this monitoring system.
What is REMS (Risk Evaluation and Mitigation Strategy).
During the first six months of clozapine administration, regular monitoring and registry reporting of neutrophil count should be done at this interval.
Aripiprazole LAI made by two manufacturers have inection interval of typically q___ weeks/months.
What is q month (Abilify Maintena or qmonth 441 - 882 Aristada or q6 weeks 882 mg)
Clozapine may cause hypersalivation which also goes by this medical term.
What is sialorrhea.
Clozapine has 5 black box warnings including this one which is the reason why you monitor the absolute neutrophil count (ANC) and for the general population baseline ANC must be at least 1500 / mm^3 and at least 1000 for patients with documented benign ethnic neutropenia.
What is severe neutropenia / agranulocytosis.
During the second six months of clozapine administration, regular monitoring and registry reporting of neutrophil count should be done at this interval.
What is every other week.
Risperidone (Risperdal Consta) has an injection interval of q___ weeks/months.
What is q2 weeks. Requires period of overlap of 3 weeks with oral risperidone.
Likely due to the anticholinergic properties of clozapine it can cause constipation or a severe form with the inability to pass the accumulation of dry hard feces/stool or gas which also goes by this medical term.
What is obstipation.
Clozapine has 5 black box warnings including this one which may be a neurological complication and is dose-related and may be a reason to possibly need an EEG.
What are seizures.
Clozapine is metabolized by this p450 enzyme that is notable if the patient is a smoker as this may induce this CYP enzyme resulting insignificantly lower clozapine serum concentration in smokers.
What is CYP1A2.
Olanzapine injection (Zyprexa Relprevv) is administered 150-300 mg q2 weeks or 300-405 mg once/month. Because of the risk for sedation (including coma) or delirium this LAI must be administered in a registered health care facility with ready access to emergency response services and the patient must be observed for at least ___ hours.
What is 3 hours.
Classical antipsychotics may aggravate catatonia. The Busch-Francis Scale can help screen and give a severity score for catatonia. The following can be tested during repositioning of patient, patient offers initial resistance before allowing him/herself to be repositioned, similar to that of a bending candle (also defined as slow resistance to movement as the patient allows the examiner to place his/her extremities in unusual positions. The limb may remain in the position in which they are placed or not).
What is waxy flexibility.
Clozapine has 5 black box warnings including this serious cardiac risk which is why you may get labs including troponin.
What is myocarditis, cardiomyopathy, and mitral valve incompetence.
Risperidone is mainly metabolized by this cytochrome p450.
What is CYP2D6.
Paliperidone Invega comes as a once monthly injection but you can get this form of paliperidone injection that requires an injection q___ weeks/months.
What is Invega Trinza q3 months. Use only after patient has been tolerating 1-m,onth paliperidone palmitate injections for at least 4 months.
Classical antipsychotics may aggravate catatonia. The Busch-Francis Scale can help screen and give a severity score for catatonia. This is the term sued when patient's mimic the examiner's movements.
What is echopraxia.