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Questions and Answers
The missing word in the statement 'Every prime number is an _____ number' is 'even'.
False
The value of the expression $6(2 + 3)$ equals $30$.
False
In every triangle, the sum of the angles is equal to $180$ degrees irrespective of the shape.
True
The statement 'All even numbers are divisible by $5$' is true.
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The square root of $49$ is $7$, which makes the statement 'The square root of $49$ is odd' true.
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A dosage of 150mg of paliperidone LAI for 1-monthly administration is equivalent to 350mg for 3-monthly administration.
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To ensure an even distribution of the suspension, a loose wrist should be maintained for at least 10 seconds.
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The equivalent dose of 75mg of paliperidone LAI for a 3-monthly administration is 263mg.
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The dosing table for paliperidone LAI indicates a direct relation where higher monthly doses correspond to lower quarterly doses.
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For the 1-monthly administration of paliperidone LAI, a dose of 50mg is equivalent to a 3-monthly dose of 175mg.
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Paliperidone palmitate is available only as a monthly long-acting injection.
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The peak concentration of paliperidone is observed, on average, 28% higher in the gluteal muscle compared to the deltoid muscle.
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The two initiation doses of paliperidone should be administered via the intravenous route.
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Improvement in psychotic symptoms may be observed as quickly as day 4 after administration of paliperidone.
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The maintenance dose of paliperidone palmitate should be higher than the equivalent dose of oral paliperidone or risperidone.
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No test dose is required for paliperidone palmitate administration.
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Patients should receive at least 12 injections a year to minimize the risk of relapse.
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The second initiation dose of paliperidone can only be given on day 8 after the first dose.
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Paliperidone LAI has been shown to decrease prolactin levels compared to haloperidol depot.
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The average monthly dose of haloperidol used in practice is approximately 75 mg.
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Paliperidone 3-monthly is indicated for patients who have been stable on paliperidone 1-monthly for less than four months.
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Paliperidone 3-monthly has a superior tolerability profile compared to the 1-monthly formulation.
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In studies, aripiprazole showed clinically meaningful improvements in quality of life compared to paliperidone.
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The bioavailability of Paliperidone palmitate is 28%.
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Both paliperidone and aripiprazole LAIs improved quality of life in patients with psychosis and substance use disorders.
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For switching to paliperidone 3-monthly, the last two doses of paliperidone 1-monthly should be adjusted to ensure a correct maintenance dose.
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Study Notes
Paliperidone Palmitate Long-Acting Injection
- Paliperidone palmitate, a long-acting injection, is available in monthly and 3-monthly formulations.
- It is the ester prodrug of paliperidone, which is the main active metabolite of risperidone.
- The ester is broken down in the muscle by esterases and then absorbed into the bloodstream.
Paliperidone LAI 1-monthly
- The average peak concentration is 28% higher after an injection into the deltoid muscle compared to the gluteal muscle.
- The two initial doses (deltoid) help achieve therapeutic levels quickly, with improvement in symptoms seen as early as day 4.
- The manufacturer recommends administering maintenance doses up to 7 days before or after the monthly time point.
Paliperidone LAI 1-monthly Administration
-
Initiation:
- Day 1: 150mg IM (deltoid only)
- Day 8 (± 4 days): 100mg IM (deltoid only)
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Maintenance:
- 50-150mg IM (deltoid or gluteal)
Key Points
- No test dose is needed for paliperidone palmitate, but patients should be stable on or have previously responded to oral paliperidone or risperidone.
- The median time to reach maximum plasma concentrations is 13 days.
- Patients receiving fewer than 12 injections per year have an increased risk of relapse.
- Correct dosing is crucial to the effectiveness of paliperidone LAI.
Paliperidone LAI Comparison with Haloperidol Depot
- Paliperidone LAI and haloperidol depot were equally effective in preventing relapse.
- Paliperidone caused more weight gain, increased prolactin levels, and showed a trend towards higher tardive dyskinesia.
- The average dose of haloperidol used was around 75 mg a month, which is uncommon in clinical practice.
Paliperidone LAI 3-monthly
- It is indicated for clinically stable patients on paliperidone LAI 1-monthly (preferably for at least four months) who do not require dose adjustments.
- The last two monthly doses should remain unchanged before switching to the 3-monthly dose to ensure the maintenance dose is correct.
- It has a similar tolerability profile to the 1-monthly preparation and is non-inferior in terms of relapse rate.
- It offers advantages for patients, including fewer injections and less focus on illness.
- It does not impact interaction frequency with healthcare professionals, but regular contact should be maintained.
Paliperidone LAI and Aripiprazole LAI Comparisons
- Two studies compared monthly paliperidone LAI with aripiprazole LAI.
- The first study, a randomized trial, found aripiprazole superior in improving quality of life in the short term, but the aripiprazole group included more younger patients.
- The second study compared the two LAIs in patients with psychosis and substance use disorders.
- Both LAIs improved quality of life and reduced substance cravings, with aripiprazole showing slightly better results, although the difference was not considered clinically meaningful.
Dose Equivalence
-
Paliperidone LAI 1-monthly:
- 50 mg = Risperidone oral 2 mg/day
- 75 mg = Risperidone oral 3 mg/day
- 100 mg = Risperidone oral 4 mg/day
- 150 mg = Risperidone oral 6 mg/day
-
Paliperidone LAI 3-monthly:
- 175 mg = Paliperidone LAI 1-monthly 50 mg
- 263 mg = Paliperidone LAI 1-monthly 75 mg
- 350 mg = Paliperidone LAI 1-monthly 100 mg
- 525 mg = Paliperidone LAI 1-monthly 150 mg
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Description
This quiz covers the essentials of Paliperidone Palmitate, a long-acting injection used in psychiatric treatment. It includes information on dosages, administration methods, and pharmacokinetics, crucial for healthcare professionals. Test your knowledge on this important medication and its clinical application.
