Please enable JavaScript.

Coggle requires JavaScript to display documents.

Schizophrenia (Clinical presentation (Positive sx (Hallucination (sense),…

- - - - Illicit substances (ketamine, NMDA antagonist)
      - Meds (stimulants, anti-PD meds)
      - Diseases (neurosyphilis, BPD)
    - - 1st-line: SGA
        
        clozapine
        (only agent
        w/ superior efficacy)
        
        Best for suicidality/aggression :check:
        
        Acute agitation :question:
        
        short-acting IM :check:
        
        Poor adherence
        
        LAI :check:
        
        subtrates metabolism
        
        CYP 1A2 inhibitors/inducers :forbidden:
        
        Carbamazepine :red_cross: agranulocytosis
        
        Monitoring: ANC > 1500, metabolic ADRs, DD orthostatic hypo, taper for 1-2 wks when d/c
        
        Poor adherence
        
        LAI
        
        Differentiate by bridging requirements
        
        Cost (expensive)
        
        Dosing frequency
        
        Can pt come into clinic?
        
        3-mo one has step-therapy requirement
        
        Second-line: FGA
        
        Olanzapine
        
        ADRs :warning:
        
        WG +++
        
        HLD +++
        
        Sedation ++
        
        Anticholinergic++
        
        :red_cross: CYP 1A2 inhibitors/inducers
        
        Precautions
        
        :!: Smoking decreases olanzapine levels
        
        :!: Severe hypotension when IM is combined w/ lorazepam
        
        :!: IM ER: BBW: sedation (coma) & delirium
        
        Dosing 5-10 mg qdaily. titrate weekly to 20 mg
        Agitation (IM): 10 mg initial. 2nd dose 2+ hrs later PRN
        
        Quetiapine
        
        Indications
        
        Schizophrenia
        
        Bipolar mixed
        
        Bipolar depression
        
        Bipolar maintenance
        
        :warning: ADRs
        
        WG++
        
        HLD +++
        
        Sedation ++
        
        QT prolongation ++
        
        Orthostatic hypotension ++
        
        DDIs
        
        CYP3A4 inducers/inhibitors
        
        Dose:
        
        25 mg BID initially
        
        Increase 25-50 mg daily to 300-400 mg divided in 2-3 doses.
        Max 750 mg daily
        
        Dose must reach 200 mg for antipsychotic effect (activating D2 receptors)
        
        Risperidone
        
        Indications
        
        Bipolar mania
        
        Schizophrenia
        
        Bipolar maintenance
        
        :warning:ADRs
        
        WG ++
        
        HLD +
        
        EPS +++
        
        Prolactin elevation +++
        
        Sedation +
        
        Orthostatic ++
        
        QTc prolong +
      - Benzodiazepines