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Quiz

PSY11 Switching and stopping drugs

Gelöschter Nutzer 8 Fragen Aktualisiert am 14 Okt 2019

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  1. 1By the end of this lecture you will be able to:
    • Understand the impact and limitations of stopping and switching antidepressants
    • Understand the impact and limitations of using prolonged release antipsychotic drugs
    • Interpret recommendations for switching between oral and depot formulations
    • Be aware of the potential reasons for antipsychotic polypharmacy and associated risks

    [blank_start]OK[blank_end]
    1. AOK
  2. 2Antidepressants:
    • Sudden stop not recommended due to increased risk of [blank_start]relapse[blank_end]
    • Slow tapering doesn’t always [blank_start]↓[blank_end] incidence/severity of discontinuation [blank_start]reactions[blank_end]
    • Some may prefer abrupt stop and [blank_start]shorter[blank_end]
    • All have the potential to cause withdrawal phenomena if taken [blank_start]>6[blank_end] weeks
    • Cross [blank_start]tapering[blank_end] preferred but low need if transferring between drugs of the same [blank_start]class[blank_end] (ie can go from one SSRI to another abruptly)
    • Co-administration of some antidepressants, even when cross-tapering, is absolutely contraindicated for example [blank_start]MAOIs and SSRIs[blank_end].

    Follow the Maudsley's guidelines and consider half lives.
    1. Arelapse
    2. Bdecrease
    3. Creactions
    4. Dshorter withdrawal period
    5. E>6
    6. Ftapering
    7. Gclass
    8. HMAOIs and SSRIs
  3. 3Antipsychotics
    TDM -
    • Plasma concentration don’t necessarily [blank_start]reflect[blank_end] brain concentration which can be up to 20 times [blank_start]greater[blank_end]
    • TDM [blank_start]not[blank_end] strictly necessary for all antipsychotics because there are no unequivocal data supporting a relationship between plasma drug concentrations and clinical outcomes or SEs
    - Exception is [blank_start]clozapine[blank_end].

    • After 1-2 years of taking an antipsychotic following a first episode and remaining well, the risk of relapse remains high - up to [blank_start]10-15[blank_end]% risk per month
    • If withdrawing an antipsychotic after 1 year, the risk of relapse is ~ [blank_start]80[blank_end]% and after 2 years [blank_start]98[blank_end]%
    • All psychotics cause discontinuation after some time.
    • [blank_start]Aripiprazole[blank_end] is better for managing long-term CV risk and mortality
    • Maudsley states ‘if a patient has alreadytried [blank_start]olanzapine and risperidone[blank_end] the benefits of switching rather than staying could be marginal’
    • Clozapine, olanzapine worst for [blank_start]weight gain[blank_end]
    • Chlorpromazine, haloperidol worst for [blank_start]EPSEs[blank_end]
    1. Anot
    2. Breflect
    3. Cgreater
    4. Dclozapine
    5. E10-15
    6. F80
    7. G98
    8. HAripiprazole
    9. Iolanzapine and risperidone
    10. Jweight gain
    11. KEPSEs
  4. 4Depot antipsychotics?
    • Lack of or, partial compliance is a key [blank_start]barrier[blank_end] to the management of psychotic disorders and often a contributing factor to [blank_start]relapse[blank_end]
    • Non-adherence is [blank_start]common[blank_end]
    • Optional for patients of Mental Health ([blank_start]compulsory[blank_end] assessment and treatment) Act – 1992
    • Disadvantages – impossible to quickly [blank_start]alter[blank_end] dose as a result of drug-induced side effects, depot injections can be [blank_start]painful[blank_end] for up to 10 days leading to negative views
    • Depots show better [blank_start]correlation[blank_end] between the dose taken and plasma concentrations than oral doses - absorption less [blank_start]variable[blank_end] than oral, no [blank_start]first pass[blank_end] metabolism, compliance better
    1. Abarrier
    2. Brelapse
    3. Ccommon
    4. Dcompulsory
    5. Ealter
    6. Fpainful
    7. Gcorrelation
    8. Hvariable
    9. Ifirst pass
  5. 5• Offer a LAIs (Long-acting injections or depots) to those;
    1. who would [blank_start]prefer[blank_end] this after an acute episode
    2. to avoid [blank_start]non-adherence[blank_end] (either intentional or unintentional)
    3. if an antipsychotic medication is a clinical [blank_start]priority[blank_end] within the treatment plan (forensic/[blank_start]compulsory treated[blank_end] patients)

    Switching from oral to LAIS:
    • For patients who’ve never taken injectable antipsychotics recommend that [blank_start]efficacy AND tolerability[blank_end] is first established with [blank_start]oral[blank_end] doses
    • Previous oral antipsychotics gradually discontinued from time of treatment initiation – [blank_start]cross titration[blank_end]
    1. Aprefer
    2. Bnon-adherence
    3. Ccompulsory treated
    4. Dpriority
    5. Eoral
    6. Fefficacy and tolerability
    7. Gcross titration
  6. 6Some LAIs:

    1. Aripiprazole Maintena
    Duration of action and time to steady state = [blank_start]6-8[blank_end] weeks. Tmax = [blank_start]7-24 days or 5-7 days[blank_end] with continuous therapy. Half-life = [blank_start]30[blank_end] days (300mg) or [blank_start]47[blank_end] days (400 mg).

    2. Olanzapine palmoate
    Given every [blank_start]4 weeks[blank_end]. Suspension in solution injected into [blank_start]gluteal[blank_end] muscle. Duration of action = [blank_start]6[blank_end] weeks. Tmax = [blank_start]2-4 days[blank_end]. T ½ = [blank_start]30 days[blank_end]. Steady state = 12 weeks.

    3. Paliperidone palmitate
    Major active metabolite of [blank_start]risperidone[blank_end], acts at D2 and 5-HT2A receptors. Duration of action ~[blank_start]4[blank_end] weeks. Tmax median [blank_start]13 days[blank_end]. Cmax is 28% higher with [blank_start]deltoid[blank_end] versus gluteal injection. [blank_start]Monthly[blank_end] dosing. Formulations mean no [blank_start]oral[blank_end] test needed first, but first dose is followed by the 2nd at day 8.
    1. A6-8
    2. B7-24 days or 5-7 days
    3. C30
    4. D47
    5. E4 weeks
    6. Fgluteal
    7. G6
    8. H2-4 days
    9. I30 days
    10. Jrisperidone
    11. K4
    12. L13 days
    13. Mdeltoid
    14. NMonthly
    15. Ooral
  7. 7Select the appropriate reason for antipsychotic combinations:
    1. AConfusing sedation with the antipsychotic effect
    2. BFailure to respond to, partial response to, or poor tolerance of, clozapine
    3. CFailing to communicate and plan when switching, so the switch is never fully completed
    4. DWhen clinical improvement occurs before the switch is completed the clinician decides to quite while
      ahead
    5. EUsing high-dose combination to make up for inadequate resources and environment
  8. 8Combo examples:
    Clozapine plus amisulpride
    Clozapine + [blank_start]aripiprazole[blank_end] – minimises cardiac and metabolic risks
    Clozapine + [blank_start]mirtazapine[blank_end] – improved negative symptoms in small RCT
    Clozapine + [blank_start]minocycline[blank_end] – significant effects on working memory, avolition and anxiety/depression
    1. Aaripiprazole
    2. Bminocycline
    3. Cmirtazapine

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Beschreibung
Der Nutzer hat seine Fachbereichs-Information gelöscht. Quiz am PSY11 Switching and stopping drugs, erstellt von Gelöschter Nutzer am 14/10/2019.
Autor
Gelöschter Nutzer
Sprache
English
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33
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Erstellt am 14 Okt 2019 · aktualisiert am 14 Okt 2019
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