Podcast
Questions and Answers
The maximum licensed dose for Flupentixol decanoate is lower than that of Haloperidol decanoate.
The maximum licensed dose for Flupentixol decanoate is lower than that of Haloperidol decanoate.
False
Olanzapine pamoate requires a loading dose at treatment initiation.
Olanzapine pamoate requires a loading dose at treatment initiation.
True
Aripiprazole can be injected in the gluteal region.
Aripiprazole can be injected in the gluteal region.
False
Paliperidone palmitate can only be administered in the gluteal region.
Paliperidone palmitate can only be administered in the gluteal region.
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The dosing interval for Risperidone microspheres can be every 2 weeks.
The dosing interval for Risperidone microspheres can be every 2 weeks.
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The test dose for Pipothiazine palmitate is 50 mg.
The test dose for Pipothiazine palmitate is 50 mg.
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Paliperidone palmitate (Trevicta) has a dosing interval of every 3 months.
Paliperidone palmitate (Trevicta) has a dosing interval of every 3 months.
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Zuclopenthixol decanoate is reported to have a low incidence of EPS compared to other long-acting injections.
Zuclopenthixol decanoate is reported to have a low incidence of EPS compared to other long-acting injections.
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Co-prescribing an LAI and an oral antipsychotic medication can lead to an unintentional low dose prescription.
Co-prescribing an LAI and an oral antipsychotic medication can lead to an unintentional low dose prescription.
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Zuclopenthixol decanoate has been shown to have the longest time to discontinuation among LAIs.
Zuclopenthixol decanoate has been shown to have the longest time to discontinuation among LAIs.
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Risperidone requires the use of an additional oral antipsychotic for three weeks after the first injection.
Risperidone requires the use of an additional oral antipsychotic for three weeks after the first injection.
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Olanzapine is associated with significant weight loss and mild metabolic effects among LAI SGAs.
Olanzapine is associated with significant weight loss and mild metabolic effects among LAI SGAs.
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Paliperidone typically decreases prolactin levels in patients receiving LAI SGAs.
Paliperidone typically decreases prolactin levels in patients receiving LAI SGAs.
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Antipsychotic depots are more effective than oral antipsychotic medications according to a Cochrane systematic review.
Antipsychotic depots are more effective than oral antipsychotic medications according to a Cochrane systematic review.
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LAI treatment guarantees adherence to antipsychotic medication.
LAI treatment guarantees adherence to antipsychotic medication.
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Only double-blind randomized controlled trials (RCTs) show a clear superiority of LAI over oral antipsychotic medications.
Only double-blind randomized controlled trials (RCTs) show a clear superiority of LAI over oral antipsychotic medications.
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Research indicates that every patient with schizophrenia prescribed LAIs shows improvement.
Research indicates that every patient with schizophrenia prescribed LAIs shows improvement.
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The proportion of patients receiving LAI antipsychotic medications is the same worldwide.
The proportion of patients receiving LAI antipsychotic medications is the same worldwide.
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American first-episode patients reject the idea of long-acting antipsychotic medications.
American first-episode patients reject the idea of long-acting antipsychotic medications.
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Delay in attending for an injection can signal potential non-adherence to LAI treatment.
Delay in attending for an injection can signal potential non-adherence to LAI treatment.
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LAI antipsychotic medications do not require a test dose before administration.
LAI antipsychotic medications do not require a test dose before administration.
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LAI antipsychotics should be administered to patients with a history of Neuroleptic Malignant Syndrome.
LAI antipsychotics should be administered to patients with a history of Neuroleptic Malignant Syndrome.
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Test doses are universally required for both First-Generation Antipsychotics (FGAs) and Second-Generation Antipsychotics (SGAs).
Test doses are universally required for both First-Generation Antipsychotics (FGAs) and Second-Generation Antipsychotics (SGAs).
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It is preferable to start with the highest effective therapeutic dose of LAI antipsychotics.
It is preferable to start with the highest effective therapeutic dose of LAI antipsychotics.
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Plasma drug concentrations from LAI antipsychotics can stabilize immediately after injection.
Plasma drug concentrations from LAI antipsychotics can stabilize immediately after injection.
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LAIs are appropriate for antipsychotic-naïve patients without prior oral medication assessment.
LAIs are appropriate for antipsychotic-naïve patients without prior oral medication assessment.
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Dose increases in LAI antipsychotics should only be made after careful assessment, ideally over a month or more.
Dose increases in LAI antipsychotics should only be made after careful assessment, ideally over a month or more.
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Steady-state plasma levels for LAI antipsychotics can be achieved in as little as one week.
Steady-state plasma levels for LAI antipsychotics can be achieved in as little as one week.
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Haloperidol is an example of a Long-Acting Injectable antipsychotic.
Haloperidol is an example of a Long-Acting Injectable antipsychotic.
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Study Notes
Long-acting Injectable Antipsychotics (LAIs)
- LAI antipsychotics are commonly prescribed in countries like the UK, Australia, and EU.
- Observational studies suggest LAIs are associated with fewer relapses and rehospitalizations.
- LAIs have been shown to be more effective than oral antipsychotics for people with schizophrenia.
- However, there is no clear superiority of LAIs over oral antipsychotics in research, likely due to study design limitations and sample bias.
- Continuous LAI treatment does not completely prevent relapse.
- LAIs are recommended when patients prefer convenience or to ensure adherence.
- Non-adherence can be easily detected with LAIs, allowing for prompt intervention.
- LAIs help differentiate between non-adherence and refractory illness.
- LAI usage varies globally, suggesting factors beyond adherence influence prescription.
- A US study suggests patient reluctance may not be a barrier to LAI usage.
Prescribing LAIs
- A test dose is recommended for LAI first-generation antipsychotics (FGAs).
- Dosage information is listed in Table 1.4.
- Tolerability and response to oral medication should be established before starting LAIs.
Advantages and Disadvantages of LAIs
- LAIs offer convenience and improved adherence, reducing relapse risk.
- LAI use allows for more regular monitoring of mental state and side effects.
- LAIs can result in prolonged adverse effects due to their long half-life.
- Co-prescribing an oral antipsychotic with an LAI can lead to unintentional high doses and increased side effects.
- LAIs may be less effective in patients with less severe illness.
Differences Between LAIs
- There is no clear superiority of one LAI over another in terms of efficacy.
- Zuclopenthixol decanoate shows promise in terms of shorter time to discontinuation and hospitalisation, but may have more side effects.
LAI Second-generation Antipsychotics (SGAs)
- Common LAI SGAs include aripiprazole, paliperidone, risperidone, and olanzapine.
- While comparable in efficacy, they differ in their side effect profiles, including weight gain, metabolic effects, extrapyramidal symptoms (EPS), and raised prolactin levels.
Important Considerations for LAIs
- Avoid LAIs in patients with a history of serious adverse effects like Neuroleptic Malignant Syndrome (NMS).
- Test doses might not be necessary for second-generation antipsychotics (SGAs).
- Prior treatment with oral medication is often preferred but not always necessary.
- Start with the lowest effective therapeutic dose.
- Data suggests low doses of LAIs might be as effective as higher doses.
Administration of LAIs
- LAIs can be administered at their licensed intervals.
- Longer intervals for LAI administration are preferred to minimize discomfort and pain.
- Plasma drug levels may decline gradually after injection.
- Peak plasma levels and therapeutic effects are delayed compared to oral medications.
Dosage Adjustment
- Adjust doses only after a sufficient period to assess therapeutic effect and steady-state plasma levels.
- Reduce dosages if adverse effects occur.
- Increase dosages incrementally and cautiously, preferably over a month or longer.
Considerations for Antipsychotic-Naïve Patients
- LAIs are not recommended for patients who have never been treated with antipsychotics.
- Use oral formulations first to assess tolerability.
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Description
This quiz covers the benefits and challenges of long-acting injectable antipsychotics (LAIs). Explore their effectiveness in preventing relapses in schizophrenia, global prescribing patterns, and the factors influencing patient adherence. Test your knowledge on how LAIs compare to oral antipsychotics and their role in clinical practice.
