ANTIPSYCHOTICS
Name 1 first-generation and 2 second-generation antipsychotics
1st: haloperidol, fluphenazine, etc
2nd: olanzapine, aripiprazole, quetiapine, risperidone, paliperidone, clozapine, etc
Watch out! Use of SSRI/SNRIs in individuals with bipolar disorder may induce this phenomenon
What is “a switch to mania / manic switch”
This SSRI may be a good option for individuals who endorse partial adherence to medications
What is Fluoxetine
Two advantages of using antipsychotic LAIs compared to oral formulations
improved adherence, reduced relapse/readmission rate, decreased mortality, frequent contact with medical provider, decreased pill burden
Confusion, agitation, diarrhea, tremors, muscle rigidity, high fever (severe), seizures (severe) are signs/symptoms of this medication-induced syndrome
What is serotonin syndrome
Antipsychotic medications help manage delusions, hallucinations, thought disorders, and bizarre behavior, which are classified as these kinds of target symptoms
What are positive symptoms
The use of this mood stabilizer is contraindicated in pregnancy
What is Depakote (neural tube defects)
Tricyclic antidepressants (nortriptyline, amitriptyline, doxepin, etc.) may cause these side effects (name 1)
Drowsiness, orthostasis, anticholinergic SEs, weight gain
This antipsychotic is available in LAI formulations dosed every month, every 3 months, and every 6 months
Paliperidone (Invega Sustenna, Trinza, Hafyera)
How many days after initiation/dose change should lithium levels be checked?
What is ~5 days
____ –generation antipsychotics are effective in treating positive symptoms, but can worsen negative symptoms
What is "first"
Concurrent use of lamotrigine and valproate affects lamotrigine serum concentrations in this way
What is: increases lamotrigine level by ~50% (requires 50% dose reduction)
Venlafaxine (Effexor) acts as an SSRI up until this dose, where we start to see NE effects
What is ≥ 150 mg
This LAI antipsychotic does NOT require oral overlap (name one)
What is paliperidone (Invega), aripiprazole (*Abilify/Aristada), risperidone (Uzedy, Perseris)
Medication that is used to treat drug-induced EPS
What is benztropine (Cogentin)
(can worsen TD by increasing dopamine)
First-generation antipsychotics are associated with increased risk of developing NMS, due to their antagonism of these receptors
What is dopamine
This antipsychotic may be used for treatment of mania in bipolar disorder (name one)
Aripiprazole, Quetiapine, Paliperidone, Risperidone, Asenapine, Cariprazine
Three agents that can be used as adjunctive therapy with an antidepressant for treatment-resistant depression
What is aripiprazole (Abilify), brexpiprazole (Rexulti), lumateperone (Caplyta), quetiapine XR (Seroquel), cariprazine (Vraylar), esketamine (Spravato), olanzapine + fluoxetine (Symbyax)
Reason why olanzapine LAI (Zyprexa Relprevv) is not frequently used
REMS: 3hr post-dose observation
(risk of post-injection delirium/sedation)
This is the therapeutic range for lithium serum concentrations (bonus for level associated w/ increased toxicity, symptoms)
What is 0.6-1.2 mEq/L
Toxicity: > 1.5 mEq/L - ataxia, AKI, hand tremor, CNS depression, arrhythmia
Three serious side effects associated with Clozapine
What is agranulocytosis, orthostatic hypotension, severe constipation, myocarditis/cardiomyopathy, seizures, metabolic syndrome
This antipsychotic is effective for management of both manic and depressive symptoms in bipolar disorder (name one)
Quetiapine, Asenapine
When used in combination, this antidepressant (CYP2D6 inhibitor) causes a ~50% increase in aripiprazole (CYP2D6 substrate) drug levels
What is fluoxetine (or paroxetine)
Fluphenazine and haloperidol decanoate (LAI formulations) must be administered using this technique
Z-tracking (oil-based)
Medications in this drug class are used to treat tardive dyskinesia (TD) secondary to antipsychotic use
What are VMAT2 inhibitors (valbenazine [Ingrezza], deutetrabenazine [Austedo])
(regulates/decreases dopamine by blocking transport to synaptic cleft)