Term
aripiprazole (abilify)
atypical antipsychotic
third generation, sometimes included as a second generation, mood stabilizer
MECHANISM OF ACTION |
|
Definition
da partial agonist - *partial agonism at da 2 receptors
- reduces da output when da concentrations are high, thus improving + symptoms and mediating antipsychotic actions.
- increases da output when concentrations are low, thus improving cognitive, --, and mood symptoms.
- actions at da 3 receptors could theoretically contribute to efficacy.
- partial agonism at 5ht1a receptors may be relevant at clinical doses.
- blockade of 5ht2a may contribute at clinical doses to cause enhancement of da release in certain brain regions, thus reducing motor se's and possibly improving cognitive and affective sx's.
|
|
|
Term
aripiprazole (abilify)
dopamine partial agonist, atypical antipsychotic, third generation, sometimes included as a second generation, also a mood stabilizer
USUAL DOSING RANGE |
|
Definition
|
|
Term
aripiprazole (abilify)
dopamine partial agonist, atypical antipsychotic, third generation, sometimes included in second generation, also a mood stabilizer
APPROVED FOR: |
|
Definition
schizophrenia (ages 13 and older)
maintaining stability in schizophrenia
acute mania/mixed mania (ages 10 and older)
bipolar maintenance
depression (adjunct)
autism related irritablilty in children (ages 6-17) |
|
|
Term
aripiprazole (abilify)
dopamine partial agonist, atypical antipsychotic, third generation, sometimes included as a second generation, also a mood stabilizer
DOSAGE FORMS |
|
Definition
tablets: 2mg, 5mg, 10mg, 15mg, 20mg, 30mg
orally disintegrating tablet: 10mg, 15mg
oral solution: 1mg/ml
injection: 9.75mg/1.3ml |
|
|
Term
aripiprazole (abilify)
dopamine partial agonist, atypical antipsychotic, third generation, sometimes included as a second generation, also a mood stabilizer
BEST AUGMENTING COMBOS FOR PARTIAL RESPONSE |
|
Definition
| valproic acid (valproate, divalproex, divalproex er), other mood-stabilizing anticonvulsants (carbamazepine, oxcarbazepine, lamotrigine), lithium, benzodiazepines. |
|
|
Term
aripiprazole (abilify)
dopamine partial agonist, atypical antipsychotic, third generation, sometimes included as a second generation, also a mood stabilizer
TEST PRIOR TO STARTING |
|
Definition
| wt, ht, bmi, waist circumference, bp, fasting plasma glucose, fasting lipid profile, personal and family hx of dm, obesity, dyslipidemia, htn, and cvd. |
|
|
Term
aripiprazole (abilify)
dopamine partial agonist, atypical antipsychotic, third generation, sometimes included as a second generation, also a mood stabilizer
MONITOR AFTER STARTING |
|
Definition
bmi q3mo, then quarterly
consider fasting triglycerides monthly, for several months for those at high risk of metabolic complications
bp, fasting plasma glucose, fasting lipids within 3 months, then annually but earlier and more frequently for patients with dm or who have gaind >5% of initial wt. *be vigilant for dm ketoacidosis, patients with hx of leucopenia/neutropenia should have cbc first few months. |
|
|
Term
aripiprazole (abilify)
dopamine partial agonist, atypical antipsychotic, third generation, sometimes included as a second generation, also a mood stabilizer
SIDE EFFECTS |
|
Definition
by blocking alpha 1 adrenergic recptors, it can cause dizziness, sedation, and hypotension.
partial agonist actions at da2 receptors in the striatum can cause motor side effects
partial agonist actions at da2 receptors can also cause nausea, occasional vomiting, and activating se's |
|
|
Term
aripiprazole (abilify)
dopamine partial agonist, atypical antipsychotic, third generation, sometimes included as a second generation, also a mood stabilizer
HOW TO DOSE |
|
Definition
initial approved recommendation is 10-15mg/day; max approved dose 30mg/day
oral solution doses can be substituted for table doses on a mg-per-mg basis up to 25mg (pts receiving 30mg tab should receive 25mg solution) |
|
|
Term
aripiprazole (abilify)
dopamine partial agonist, atypical antipsychotic, third generation, sometimes included as a second generation, also a mood stabilizer
HOW TO STOP |
|
Definition
slow down-titration (over 6-8wks) especially when simultaneously beginning a new antipsychotic
rapid discontinuation could theoretically lead to rebound psychosis and worsening sx's. |
|
|
Term
aripiprazole (abilify)
dopamine partial agonist, atypical antipsychotic, third generation, sometimes included as a second generation, also a mood stabilizer
PHARMACOKINETICS |
|
Definition
metabolized primarily by CYP450 2D6 and CYP450 3A4
mean elimination half-life 75hrs and 94hrs for major metabolite. |
|
|
Term
aripiprazole (abilify)
dopamine partial agonist, atypical antipsychotic, third generation, sometimes included as a second generation, also a mood stabilizer
DRUG INTERACTIONS |
|
Definition
ketoconazole and possibly other CYP450 3A4 inhibitors such as nefazodone, fluvoxamine, and fluoxetine may increase plasma levels.
carbamazepine and possibly other inducers of CYP450 3A4 may decrease level plasma levels.
quinidine and possibly other inhibitors of CYP450 2D6 such as paroxetine, fluoxetine, and duloxetine may increase levels.
may increase levels of antihypertensives
may antagonize levodopa, dopamine agonists |
|
|
Term
aripiprazole (abilify)
dopamine partial agonist, atypical antipsychotic, third generation, sometimes included as a second generation, also a mood stabilizer
PREGNANCY |
|
Definition
risk category c
psychotic sx's may worsen during pregnancy and some form of tx may be necessary
may be preferable to anticonvulsant mood stabilizers if tx is required during pregnancy |
|
|
Term
aripiprazole (abilify)
dopamine partial agonist, atypical antipsychotic, third generation, sometimes included as a second generation, also a mood stabilizer
PRIMARY TARGET SYMPTOMS |
|
Definition
+ sx's psychosis
-- sx's of psychosis
cognitive sx's
unstable mood
aggressive symptoms |
|
|
Term
chlorpromazine (thorazine)
conventional antipsychotic, neuroleptic, phenothiazine, dopamine 2 antagonist, aniemetic
APPROVED FOR |
|
Definition
| schizophrenia, nausea, vomiting, restlessness and apprehension before surgery, acute intermittent porphyria, manifestations of manic type of manic-depressive illness, tetanus (adjunct), intractable hiccups, combativenesss and/or explosive hyperexcitable behavior (in children), hyperactivity, and pscyhosis. |
|
|
Term
chlorpromazine (thorazine)
conventional antipsychotic, neuroleptic, phenothiazine, dopamine 2 antagonist, aniemetic
MOA |
|
Definition
blocks dopamine 2 recptors, reducing + sx's of psychosis and improving other behaviors
combination of dopamine D2, histamine H1, and cholinergic M1 blockade in the vomiting center may reduce nausea and vomiting. |
|
|
Term
chlorpromazine (thorazine)
conventional antipsychotic, neuroleptic, phenothiazine, dopamine 2 antagonist, aniemetic
BEST AUGMENTING COMBOS |
|
Definition
addition of a mood-stabilizing anticonvulsant such as valproate carbamazepine, or lamotrigine may be helpful in both schizophrenia and bipolar mania
augmentation with lithium in bipolar mania may be helpful
addition of a benzodiazepine, especially short-term for aggitation |
|
|
Term
chlorpromazine (thorazine)
conventional antipsychotic, neuroleptic, phenothiazine, dopamine 2 antagonist, aniemetic
TEST PRIOR TO STARTING |
|
Definition
| wt, ht, bmi, fasting plasma glucose, ldl cholesterol, and triglycerides |
|
|
Term
chlorpromazine (thorazine)
conventional antipsychotic, neuroleptic, phenothiazine, dopamine 2 antagonist, aniemetic
MONITOR AFTER STARTING |
|
Definition
wt, ht, bmi, fasting triglycerides monthly for several months in patients at high risk for metabolic complications and when initiating or switching antipsychotics
bp in elderly
elevated prolactin levels
pts with hx of drug induced leucopenia/neutropenia should have cbc frequently in beginning of tx and during first few months. |
|
|
Term
chlorpromazine (thorazine)
conventional antipsychotic, neuroleptic, phenothiazine, dopamine 2 antagonist, aniemetic
SIDE EFFECTS |
|
Definition
|
|
