TREATMENT NR547 EXAMS LATEST UPDATE
Pines
SGA
Sedation is a common side effect.
Least risk of EPS.
High risk for weight gain and metabolic abnormalities.
Olanzapine (Zyprexa)
"Pine" SGA
FDA approved for treatment in those age 13 and older.
Best tolerated antipsychotic, but high metabolic risk.
Highest risk for weight gain, blood dyscrasias, QT prolongation, CVD, cerebrovascular
effects, hyperglycemia, and hyperprolactinemia.
Requires up to 30% dosage increase for patients who smoke.
Quetiapine (Seroquel)
"Pine" SGA
FDA approved for treatment in those age 13 and older.
Moderate metabolic risk.
Low EPS risk.
Risk for orthostatic hypotension, blood dyscrasias (neutropenia, leukopenia, and
agranulocytosis), QT prolongation, weight gain, and renal/hepatic impairment.
Asenapine (Saphris)
"Pine" SGA
FDA approved for age 10 and older.
Available as sublingual and patch.
Low metabolic risk.
Clozapine (Clozaril)
"Pine" SGA
Approved for treatment resistant schizophrenia and chronic suicidal behavior in
schizophrenia or schizoaffective disorder.
Not indicated for acute presentation of schizophrenia.
Low EPS risk.
ANC must be >1500 when used and requires regular monitoring of WBC, granulocyte,
and neutrophil counts.
High metabolic risk, highest risk for weight gain, black box warning: may cause severe
neutropenia. Contraindicated in liver disease/failure. Not a first choice treatment.
Clozapine monitoring schedule
Baseline ANC, CBC should be monitored weekly for 6 months, every 2 weeks for
months 6-12, then monthly thereafter. It is the only medication approved by FDA for
preventing suicide in clients with schizophrenia.
2 Dones and a Rone
SGA
Less sedating and cause less weight gain, but higher risk for hyperprolactinemia and
EPS.
Risperidone (Risperidol)
, "Done" SGA
FDA approved for age 13 and older.
Moderate metabolic risk, highest risk for hyperprolactinemia.
Risk of blood dyscrasias, QT prolongation, cardiovascular and cerebrovascular effects.
Dose not interact with CYP3A4 inhibitors or inducers, therefore, can be administered
with medications like Amiodarone.
Paliperidone (Invega)
"Done" SGA
FDA approved for ages 12 and older.
Moderate metabolic risk
Ziprasidone (Geodon)
"Done" SGA
FDA approved for age 10 and older.
IM dosing in acute agitation associated with schizophrenia.
Low metabolic risk, lowest risk for weight gain.
Contraindicated with QT, recent MI, or uncompensated HF.
High incidence of rash/urticaria r/t Stevens-Johnson syndrome and drug reaction with
eosinophilia and systemic syndrome (DRESS).
Iloperidone (Fanapt)
"Done" SGA
Moderate risk for weight gain, low risk for hyperlipidemia.
Lurasidone (Latuda)
"Done" SGA
FDA approved for age 13 and older.
Should be taken with food, at least 350 calories for maximum absorption.
Low metabolic risk.
2 Pips and a Rip
Low risk for metabolic side effects and weight gain.
Potential for EPS.
Aripiprazole, Brexpiprazole, Cariprazine
Aripiprazole (Abilify)
"Pip" SGA
Low metabolic risk, weight gain, and orthostatic hypotension.
Brexpiprazole (Rexulti)
"Pip" SGA
Considered pro-cognitive.
Low metabolic risk.
Cariprazine (Vraylar)
"Rip" SGA
Low metabolic risk.
First generation antipsychotics
Effective for positive symptoms but higher incidence of unwanted side effects, such as
dystonia, parkinsonism, akathisia, and TD, which increase with long term use. FGA are
generally not first choice but may be selected in hospitalization in clients with psychosis
needing quick treatment for positive symptoms. Others may need an FGA due to failed
treatment with SGA, symptom severity, or availability of long-acting injectable.
Pines
SGA
Sedation is a common side effect.
Least risk of EPS.
High risk for weight gain and metabolic abnormalities.
Olanzapine (Zyprexa)
"Pine" SGA
FDA approved for treatment in those age 13 and older.
Best tolerated antipsychotic, but high metabolic risk.
Highest risk for weight gain, blood dyscrasias, QT prolongation, CVD, cerebrovascular
effects, hyperglycemia, and hyperprolactinemia.
Requires up to 30% dosage increase for patients who smoke.
Quetiapine (Seroquel)
"Pine" SGA
FDA approved for treatment in those age 13 and older.
Moderate metabolic risk.
Low EPS risk.
Risk for orthostatic hypotension, blood dyscrasias (neutropenia, leukopenia, and
agranulocytosis), QT prolongation, weight gain, and renal/hepatic impairment.
Asenapine (Saphris)
"Pine" SGA
FDA approved for age 10 and older.
Available as sublingual and patch.
Low metabolic risk.
Clozapine (Clozaril)
"Pine" SGA
Approved for treatment resistant schizophrenia and chronic suicidal behavior in
schizophrenia or schizoaffective disorder.
Not indicated for acute presentation of schizophrenia.
Low EPS risk.
ANC must be >1500 when used and requires regular monitoring of WBC, granulocyte,
and neutrophil counts.
High metabolic risk, highest risk for weight gain, black box warning: may cause severe
neutropenia. Contraindicated in liver disease/failure. Not a first choice treatment.
Clozapine monitoring schedule
Baseline ANC, CBC should be monitored weekly for 6 months, every 2 weeks for
months 6-12, then monthly thereafter. It is the only medication approved by FDA for
preventing suicide in clients with schizophrenia.
2 Dones and a Rone
SGA
Less sedating and cause less weight gain, but higher risk for hyperprolactinemia and
EPS.
Risperidone (Risperidol)
, "Done" SGA
FDA approved for age 13 and older.
Moderate metabolic risk, highest risk for hyperprolactinemia.
Risk of blood dyscrasias, QT prolongation, cardiovascular and cerebrovascular effects.
Dose not interact with CYP3A4 inhibitors or inducers, therefore, can be administered
with medications like Amiodarone.
Paliperidone (Invega)
"Done" SGA
FDA approved for ages 12 and older.
Moderate metabolic risk
Ziprasidone (Geodon)
"Done" SGA
FDA approved for age 10 and older.
IM dosing in acute agitation associated with schizophrenia.
Low metabolic risk, lowest risk for weight gain.
Contraindicated with QT, recent MI, or uncompensated HF.
High incidence of rash/urticaria r/t Stevens-Johnson syndrome and drug reaction with
eosinophilia and systemic syndrome (DRESS).
Iloperidone (Fanapt)
"Done" SGA
Moderate risk for weight gain, low risk for hyperlipidemia.
Lurasidone (Latuda)
"Done" SGA
FDA approved for age 13 and older.
Should be taken with food, at least 350 calories for maximum absorption.
Low metabolic risk.
2 Pips and a Rip
Low risk for metabolic side effects and weight gain.
Potential for EPS.
Aripiprazole, Brexpiprazole, Cariprazine
Aripiprazole (Abilify)
"Pip" SGA
Low metabolic risk, weight gain, and orthostatic hypotension.
Brexpiprazole (Rexulti)
"Pip" SGA
Considered pro-cognitive.
Low metabolic risk.
Cariprazine (Vraylar)
"Rip" SGA
Low metabolic risk.
First generation antipsychotics
Effective for positive symptoms but higher incidence of unwanted side effects, such as
dystonia, parkinsonism, akathisia, and TD, which increase with long term use. FGA are
generally not first choice but may be selected in hospitalization in clients with psychosis
needing quick treatment for positive symptoms. Others may need an FGA due to failed
treatment with SGA, symptom severity, or availability of long-acting injectable.
