BookJonathan M Meyer, Stephen M Stahl ; with illustrations by Nancy Munter.
Summary: "The use of antipsychotics to treat schizophrenia is fraught with many layers of complexity, as prescribers try to tailor the pharmacodynamic properties of an agent to a specific patient based primarily on subjective response. Variations in drug metabolism related to genetic polymorphisms, or to medication or environmental exposures (e.g. smoking), and variable adherence with oral medications lead to scenarios that confound even seasoned clinicians. Excluding the realization that up to one-third of schizophrenia patients may not respond adequately to non-clozapine antipsychotics, 60 years of antipsychotic research has demonstrated that dose is a poor correlate of response likelihood, whereas plasma drug levels represent the best clinically available tool that quantifies the relationship between drug exposure and central nervous system (CNS) activity.[1] The classic equation by psychopharmacologist Sheldon Preskorn illustrates the variables involved in clinical drug response (Figure 1.1)"-- Provided by publisher.
Contents:
Sampling times for oral and long acting injectable agents
The therapeutic threshold and the point of futility
Level interpretation including laboratory reporting issues, responding to high plasma issues, responding to high plasma levels, special situations (hepatic dysfunction, renal dysfunction and hemodialysis, bariatric surgery)
Tracking oral antipsychotic adherence
What is an adequate antipsychotic trial-using plasma levels to optimize psychiatric response and tolerability
Important concepts about first generation antipsychotics
Haloperidol and haloperidol decanoate
Fluphenazine and fluphenazine decanoate
Perphenazine and perphenazine decanoate
Zuclopenthixol and zuclopenthixol decanoate; flupenthixol and flupenthixol decanoate
Chlorpromazine, loxapine, thiothixene, trifluoperazine
Important concepts about second generation antipsychotics
Clozapine
Risperidone oral and long acting injectable, paliperidone oral and long acting injectable
Olanzapine and olanzapine pamoate
Aripiprazole, aripiprazole monohydrate and aripiprazole lauroxil
Amisulpride, asenapine, lurasidone, brexpiprazole, cariprazine.