Ryan Shared "0.1 Psychopharm 2" - 29 Picmonics
With Picmonic, facts become pictures. We've taken what the science shows - image mnemonics work - but we've boosted the effectiveness by building and associating memorable characters, interesting audio stories, and built-in quizzing. Whether you're studying for your classes or getting ready for a big exam, we're here to help.
0.1 Psychopharm 2
1st Generation/Typical LAIs
- BBW: Death in elderly with dementia-related psychosis
- Increase TCA concentration
- Inhibit CYP2D6
- Considerations
- CI in Parkinson's Disease
- CI in Lewy Body Dementia
- Stored in lipophilic sesame oil
- Teratogen - limb malformation, EPS, withdrawal
- Avoid Breastfeeding
- Side effects
- Anticholinergic Effects
- Cataracts
- Agranulocytosis - DC if ANC <1000
- Lower seizure threshold
- QTc Prolongation
- Liver impairment
- Hyperprolactinemia
- Extrapyramidal Symptoms
Dystonia Treatment
- Acute Treatment
- Benztropine (Cogentin)
- Diphenhydramine (Benadryl)
- Diazepam (Valium)
- Slow IV Push
- Maintenance
- Cogentin and Benadryl preferred for maintenance
- Trihexyphenidyl (Artane)
- Benztropine for prophylaxis
- Considerations
- Switch antipsychotic and evaluate for 2 weeks
Akathisia Treatment
- Propranolol (Inderal) 1st line tx
- Clonidine (Catapres) alpha 2 agonist
- Mirtazapine (Remeron)
- Clonazepam (Klonopin)
- Benztropine (Cogentin)
Antipsychotic-Induced Parkinsonism Treatment
- Switch AP to Seroquel or Clozaril
- Benztropine (Cogentin)
- Amantadine (Symmetrel)
- Hypotension and Agitation with amantadine
- Levodopa
Malignant Catatonia
- Fever
- Hypertension
- Tachycardia
- Delerium
- Low serum iron and high creatinine kinase
- Lorazepam and ECT
- Leukocytosis
Clozapine (Clozaril)
- Mechanism
- Atypical Antipsychotic
- Indications
- Schizophrenia
- Levodopa-Induced Psychosis
- Side Effects
- Weight Gain
- Hypersalivation (Sialorrhea)
- Myocarditis
- Agranulocytosis
- Sedation
- Orthostatic Hypotension
- Constipation (Risk of Bowel Ileus)
- Considerations
- Weekly Lab Tests
2 mins
Zyprexa (olanzapine)
- Sedation - less then Clozaril
- Muscarinic (M1) blocker, H1 blocker, alpha-1 blocker
- Cardiometabolic Side Effects
- CYP450 1A2 Metabolism
- Smoking decreases Zyprexa - 1A2 Inducer
- 5HT2A blocker - more potent than D2
- Improves Mood in Bipolar and TRD
- Fluoxetine - Best adjunct for mood
- Caution Luvox (1A2 inhibitor)
- Sexual Dysfunction - 50% of patients
- Monitor DRESS and Post Delirium Sedation Syndrome for Relprevv
- Uncommon EPS
Seroquel (quetiapine)
- CYP450 3A Metabolism
- Hypnotic at 50 mg
- H1 Blocker
- Antidepressant at 300 mg
- Increase DA and NE from 5HT2C blocking and NET
- Antipsychotic at 800 mg
- 5HT2A blocker - more potent than D2
- NET inhibition from Norquetiapine metabolite
- Cataracts??
- Common weight gain, cardiometabolic effects
- Uncommon EPS
Saphris (asenapine)
- MOA
- 5HT2A and D2 antagonism
- CYP 1A2/2D6 metabolism
- Adverse effects
- Common sedation and weight gain
- Uncommon EPS
- Considerations
- Sublingual
- Tongue numbness
- Increases concentration of antihypertensives
- Looks like Remeron
- Indication
- BpD1 Mixed and Manic
Risperdal (risperidone)
- Indications
- BPD Mixed and Manic
- Autism-Associated Irritability
- Bipolar 1 Maintenance (Adults)(Consta)
- Considerations
- Increase concentration of antihypertensives
- Carbamazepine decreases levels
- Paxil and Prozac increases levels
- "Conventional" at higher doses
- Rare seizures
- Common EPS, weight gain, sedation
- Gynecomastia
- Sexual dysfunction - 60-70% of patients
Invega (paliperidone) vs Risperdal
- Indication
- Central D2 and 5HT2A antagonist
- MOA
- Invega FDA approved for Schizoaffective d/o
- Considerations
- QTc Prolongation (additive)
- Increase effect of antihypertensives
- NOT metabolized by liver, so better tolerated than Risperdal
- Renally excreted
- Less sedation, orthostasis, weight gain and fewer EPS than Risperdal
- Caution with 3A4 inducers
- CYP 3A4 substrate
Geodon (ziprasidone)
- Indications
- Schizophrenia acute agitation/delay relapse
- BPD Mixed/manic/maintenance
- Considerations
- DRESS syndrome
- MUST be taken with food, doubles absorption, BID
- Half-life 10 hours
- Increase effect of antihypertensives
- Increase QT prolongation (NOT dose dependent)
- Uncommon weight gain, sedation, tardive
- No weight gain, no dyslipidemia, no insulin resistance
- EPS common
Fanapt (iloperidone)
- Schizophrenia and maintenance only
- Indication
- Considerations
- Increase effects of antihypertensives
- CYP2D6 Metabolism
- Paxil, Prozac, Cymbalta, Quinidine increases levels by inhibiting 2D6
- May increase QT prolongation
- Common weight gain and sedation
Latuda (lurasidone)
- Indication
- Schizophrenia if older than 13
- Bipolar Depression
- Considerations
- CYP3A4 Metabolism
- Levels increase with Prozac, Luvox, nefazodone (3A4 inhibitors)
- Contrindicated with 3A4 inducers (rifampin)
- No H1 blocking activity
- Reduced metabolic risk and sedation
- 5HT7 blocking activity
- Leads to improved mood and cognition
- Common EPS
- Give with food
- Half-life 10 hours
Abilify (aripiprazole)
- Indication
- BPD Mixed and Manic
- Autism-Associated Irritability
- Unipolar MDD (Augmenter)
- Bipolar 1 Maintenance (LAI Maintena)
- MOA
- Partial D2 Agonist
- 5HT1A Partial Agonism (Maintena)
- 5HT2A Blocker
- Less sexual side effects from 5HT2A antagonism
- Metabolism
- CYP2D6 and CYP3A4 Metabolism
- Increased with 2D6 inhibitors (Prozac, Cymbalta, TB meds)
- Decreased with 3A4 inducer carbamazepine
- Adverse effects
- Common Activation and Akathisia
- Risk of Obsessive Compulsive Behaviors (Like gambling)
- Uncommon weight gain and sedation
- No QTc prolongation
- Considerations
- Augment with Abilify for elevated PRL in patients on Risperdal
Vraylar (cariprazine)
- CYP450 metabolism into 2 metabolites
- Long Half-life (start 1.5 mg every other day)
- Better for positive symptoms than 'pips'
- Late onset of adverse effects (2-3 days)
- Common akathisia, GI upset, sedation
- Uncommon NMS, weight gain
- Carbamazepine decreases levels, and Prozac and Cymbalta increases levels
- D3 action at low doses
Rexulti (brexpiprazole)
- Indication
- Schizophrenia, Treatment resistant MDD adjunct
- Adverse effects
- Common weight gain, akathisia, sedation
- Uncommon TD, activation
- Considerations
- Avoid with 3A4 Inducers, adjust for 3A4/2D6 inhibitors
- Risk for compulsive behaviors
Caplyta (lumateperone) Receptors
- Indication
- Schizophrenia
- Receptors
- Robust 5HT2A blocker (more than 2 pips and rip). 60 times D2.
- D2 blocker with some D1 blocking activity
- SERT blocker
- alpha 1 blocker
- 5HT2C blocker
- ADVERSE EFFECTS
- Common sedation
- Uncommon weight gain and metabolic neutral
- Avoid with renal and hepatic impairment (Has 1 dose only)
- Considerations
- 1 evening dose 42 mg with food
- Avoid with 3A4 inducers and 2D6 inhibitors
- Terminal Half-life 18 hours
Nuplazid (pimavanserin)
- Indication
- Parkinsonian Psychosis
- MOA
- Selective 5HT inverse agonist on 5HT2A (blockade)
- CYP3A4 Metabolism
- Adverse effects
- Common weight gain and akathisia
- Uncommon sedation and TD
- Considerations
- 34 mg PO daily dosing without titration
- Adjust dose for severe renal impairment
Vyvanse (lisdexamfetamine)
- Most common long-acting amphetamine
- 12 hour duration
- Low risk of abuse, activated in GI
- Can mix with food
- Levels are steady (calm, slow release) all day
- Start 30 mg, max 70 mg daily
- Increase 10-20 mg q week
Ace Your Medicine (MD/DO) Classes & Exams with Picmonic:
Over 2,040,000 students use Picmonic’s picture mnemonics to improve knowledge, retention, and exam performance.
Choose the #1 Medicine (MD/DO) student study app.
Picmonic for Medicine (MD/DO) covers information that is relevant to your entire Medicine (MD/DO) education. Whether you’re studying for your classes or getting ready to conquer the USMLE Step 1, USMLE Step 2 CK, COMLEX Level 1, or COMLEX Level 2, we’re here to help.
Works better than traditional Medicine (MD/DO) flashcards.
Research shows that students who use Picmonic see a 331% improvement in memory retention and a 50% improvement in test scores.