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PHCY320 (Psychiatry) Quiz am PSY11 Switching and stopping drugs, erstellt von Mer Scott am 14/10/2019.

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Mer Scott
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PSY11 Switching and stopping drugs

Frage 1 von 8

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By 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

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    OK

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Frage 2 von 8

1

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

Follow the Maudsley's guidelines and consider half lives.

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    relapse
    decrease
    reactions
    shorter withdrawal period
    >6
    tapering
    class
    MAOIs and SSRIs

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Frage 3 von 8

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Antipsychotics
TDM -
• Plasma concentration don’t necessarily brain concentration which can be up to 20 times
• TDM 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 .

• After 1-2 years of taking an antipsychotic following a first episode and remaining well, the risk of relapse remains high - up to % risk per month
• If withdrawing an antipsychotic after 1 year, the risk of relapse is ~ % and after 2 years %
• All psychotics cause discontinuation after some time.
is better for managing long-term CV risk and mortality
• Maudsley states ‘if a patient has alreadytried the benefits of switching rather than staying could be marginal’
• Clozapine, olanzapine worst for
• Chlorpromazine, haloperidol worst for

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    not
    reflect
    greater
    clozapine
    10-15
    80
    98
    Aripiprazole
    olanzapine and risperidone
    weight gain
    EPSEs

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Frage 4 von 8

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Depot antipsychotics?
• Lack of or, partial compliance is a key to the management of psychotic disorders and often a contributing factor to
• Non-adherence is
• Optional for patients of Mental Health ( assessment and treatment) Act – 1992
• Disadvantages – impossible to quickly dose as a result of drug-induced side effects, depot injections can be for up to 10 days leading to negative views
• Depots show better between the dose taken and plasma concentrations than oral doses - absorption less than oral, no metabolism, compliance better

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    barrier
    relapse
    common
    compulsory
    alter
    painful
    correlation
    variable
    first pass

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Frage 5 von 8

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• Offer a LAIs (Long-acting injections or depots) to those;
1. who would this after an acute episode
2. to avoid (either intentional or unintentional)
3. if an antipsychotic medication is a clinical within the treatment plan (forensic/ patients)

Switching from oral to LAIS:
• For patients who’ve never taken injectable antipsychotics recommend that is first established with doses
• Previous oral antipsychotics gradually discontinued from time of treatment initiation –

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    prefer
    non-adherence
    compulsory treated
    priority
    oral
    efficacy and tolerability
    cross titration

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Frage 6 von 8

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Some LAIs:

1. Aripiprazole Maintena
Duration of action and time to steady state = weeks. Tmax = with continuous therapy. Half-life = days (300mg) or days (400 mg).

2. Olanzapine palmoate
Given every . Suspension in solution injected into muscle. Duration of action = weeks. Tmax = . T ½ = . Steady state = 12 weeks.

3. Paliperidone palmitate
Major active metabolite of , acts at D2 and 5-HT2A receptors. Duration of action ~ weeks. Tmax median . Cmax is 28% higher with versus gluteal injection. dosing. Formulations mean no test needed first, but first dose is followed by the 2nd at day 8.

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    6-8
    7-24 days or 5-7 days
    30
    47
    4 weeks
    gluteal
    6
    2-4 days
    30 days
    risperidone
    4
    13 days
    deltoid
    Monthly
    oral

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Frage 7 von 8

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Select the appropriate reason for antipsychotic combinations:

Wähle eine der folgenden:

  • Confusing sedation with the antipsychotic effect

  • Failure to respond to, partial response to, or poor tolerance of, clozapine

  • Failing to communicate and plan when switching, so the switch is never fully completed

  • When clinical improvement occurs before the switch is completed the clinician decides to quite while
    ahead

  • Using high-dose combination to make up for inadequate resources and environment

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Frage 8 von 8

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Combo examples:
Clozapine plus amisulpride
Clozapine + – minimises cardiac and metabolic risks
Clozapine + – improved negative symptoms in small RCT
Clozapine + – significant effects on working memory, avolition and anxiety/depression

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    aripiprazole
    minocycline
    mirtazapine

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