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Quiz Time: Antipsychotics

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Solved Quiz Time: Antipsychotics

Post  Admin on Sat Jun 09, 2012 1:07 pm

Quiz Time: Antipsychotics

Q: Which of the following statement is FALSE regarding Antipsychotics?

(a) Avoid using beta blockers with Ziprasidone.
(b) During the initial weeks of treatment, Aripiprazole 15mg is superior to 30mg.
(c) Optimal D2 receptor occupancy for maximizing benefits & reducing EPS with Risperidone is 70-80%.
(d) Paliperidone is superior to Risperidone in terms of safety in patient with impaired renal clearance capacity.
(e) Among atypicals, Olanzapine causes maximum weight gain (compared to others).


Last edited by Admin on Sun Jun 10, 2012 12:14 pm; edited 1 time in total

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Solved Re: Quiz Time: Antipsychotics

Post  adisuper on Sat Jun 09, 2012 3:34 pm

answer should be d
as clozapine and olanzapine are known to cause max wt. gain among SGAs and aripiprazole is ideally started at a dose of 15 and then dose is increased or decreased based on response
for max benefit and min. EPS risperidone is started at a dose of 4mg/day corresponding to a d2 receptor occupancy of 70-80%

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Solved Re: Quiz Time: Antipsychotics

Post  Admin on Sat Jun 09, 2012 5:02 pm

Good Job. Correct Answer: D.

Paliperidone has 80% renal excretion, so avoid in patient with impaired renal clearance capacity.

Avoid using beta blockers with Ziprasidone- low pulse risks Torsades.

Agree with explanation given by Adisuper.

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Solved Re: Quiz Time: Antipsychotics

Post  Admin on Sat Jun 09, 2012 6:56 pm

adisuper wrote:answer should be d
as clozapine and olanzapine are known to cause max wt. gain among SGAs

Which antipsychotic causes more weight gain: Clozapine or Olanzapine?

Question Question


Last edited by Admin on Sun Jun 10, 2012 6:37 pm; edited 1 time in total

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Solved Re: Quiz Time: Antipsychotics

Post  P450 on Sun Jun 10, 2012 12:47 pm

Clozapine

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Solved Re: Quiz Time: Antipsychotics

Post  Admin on Sun Jun 10, 2012 12:55 pm

P450 wrote:Clozapine

Olanazapine has high incidence (56%) of weight gain, compared to Clozapine (31%).

Source: ASCP Model Psychopharm Curriculum Fifth Edition, but this is an old edition.

Do you have any recent studies (after 2008) indicating that Clozapine causes more weight gain that Olanazapine.

Thanks

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Solved Re: Quiz Time: Antipsychotics

Post  P450 on Sun Jun 10, 2012 6:12 pm

I have two papers from 2009 and one in 2008. One of them from 2009 is just the updated PORT recommendations and summary statements (1) which states:

"In summary, the relative risk for weight gain among antipsychotic medications
is clozapine = olanzapine > low-potency FGA medications > risperidone = paliperidone = quetiapine > medium-potency FGA medications > high-potency antipsychotic
medications = molindone = aripiprazole = ziprasidone (see ‘‘Pharmacological Prevention and Treatmentof Antipsychotic-AssociatedWeight Gain in Schizophrenia Summary Statement’’ section in the Supplementary Material for further details)."

The next in 2009 is not exactly what we are looking for but still helpful: Second-generation versus first-generation antipsychotic drugs for schizophrenia (2), which was published in the Lancet which did show a very modest increase in weight gain when comparing clozapine to 1st gen antipsychotics when compared to olanzapine.

The other paper from 2008 is authored by Henry Nasrallah and published in Molecular Psychiatry (3) which states:

"A meta-analysis by Allison et al.35 determined that patients receiving standard
doses of most antipsychotic drugs experienced weight gain versus placebo after 10 weeks and that the amount of weight gain varied by agent, most likely reflecting differing degrees of action on serotonergic, dopaminergic, cholinergic, histaminergic and other neurotransmitter systems (Figure 2). In this analysis, patients given clozapine and olanzapine treatment had the greatest weight gain. These results were recently confirmed in active comparator studies comparing weight gain in patients treated with different atypical antipsychotics.2,36,37"

This table is then displayed:



The older papers I have seem to be consistent with clozapine having more weight gain than olanzapine. I'm not sure which studies the ASCP reviewed to come up with that data. Do you have their references?

1. The 2009 Schizophrenia PORT Psychopharmacological Treatment Recommendations and Summary Statements. Schizophrenia Bulletin vol. 36 no. 1 pp. 71–93, 2010
2. Second-generation versus fi rst-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet 2009; 373: 31–41
3. Atypical antipsychotic-induced metabolic side effects: insights from receptor-binding profiles. Molecular Psychiatry (2008) 13, 27–35

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Solved Re: Quiz Time: Antipsychotics

Post  Admin on Sun Jun 10, 2012 6:37 pm

Thanks for this impressive explanation.
Clap Clap

No reference is given by ASCP.
I agree with your references regarding Clozapine> Olanzapine weight gain.

I found this similar table from meta-analysis published in 2009:
(Am J Psychiatry. 1999 Nov;156(11):1686-96.)


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