Assignment: Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Assignment: Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Assignment: Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Antipsychotics, also called neuroleptics, are the recommended medications for the initial treatment of schizophrenia spectrum and other psychotic disorders. Antipsychotics act by blocking the effect of dopamine in the central nervous system (CNS). The two main groups of antipsychotics are first-generation/ Typical and second-generation/Atypical antipsychotics. Atypical antipsychotics have a broader spectrum of receptor activity for Serotonin, dopamine, and GABA and are better at improving negative symptoms and cognitive dysfunction. The purpose of this assignment is to create a study guide for Olanzapine describing its indications, mechanism of action, dosing, side effects, and legal and ethical considerations.

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Drug Description

• Olanzapine (Zyprexa) is an Atypical antipsychotic.

It is FDA-approved for the following:

• Schizophrenia for persons above 13 years (Citrome et al., 2019).
• Bipolar I disorder in the acute treatment of manic or mixed episodes.
• Adjunct to Fluoxetine to treat depression associated with Bipolar I disorder and treatment-resistant depression (TRD) for persons above 10 years.
• To attenuate olanzapine-induced weight gain for schizophrenia and bipolar I disorder in combination with samidorphan (Rehan et al., 2022).
• Off-label uses include:
• Acute agitation
• Delirium
• Anorexia nervosa
• Chemotherapy-induced nausea and vomiting

 

 

 

 

 

 

 

 

Drug Classification

 

Appropriate dosing

• Oral: initially 5-10 mg/day; Maintenance: 10-20 mg/day.
• IM Injection short-acting- 10mg
• IM, extended-release dose: 210mg every 2 weeks; 300mg every 2 weeks; 405mg every 4 weeks (Citrome et al., 2019).

Considerations for dosing alterations:

• Hepatic and renal impairment: No dose alterations.
• Dosage adjustments, if needed, should be made at intervals of more than 24 hrs.

Considerations of use and dosing in specific specialty population

• Children 13-17 years: Olanzapine 2.5-5 mg/day PO initially; target dosage, 10 mg/day. The dose is adjusted by increments or decrements of 2.5-5 mg with a dosage range of 2.5-20 mg/day.
• Geriatrics: initially 2.5-5 mg/day orally; IM (extended-release): 150 mg every 4 weeks in patients predisposed to hypotension.
• Pregnancy and lactation: Not recommended. Neonates exposed to antipsychotics during the third trimester are at risk for EPS or withdrawal symptoms. Olanzapine enters breast milk (Meftah et al., 2020).
• Tobacco smokers: Require a 30% higher daily dose than non-smokers because of CYP1A2 induction.

Half-life:

• A drug’s elimination half-life refers to the time it takes for the concentration of the drug in the plasma or the total amount in the body to be reduced by half.
• Half-life is vital since it provides an accurate indication of the time that the drug’s effect will persist in a patient (Smith et al., 2018).
• This helps in deciding the appropriate dose and frequency of a prescribed drug.
• The half-life of Olanzapine is 21-54 hrs for immediate release and 30 days for extended-release.

Side effects/adverse reaction potentials

• Weight gain (dose-dependent) is the most common side effect of Olanzapine since it increases appetite causing hyperphagia leading to weight gain (Fitzgerald et al., 2021).
• Increased risk of metabolic effects is also a significant adverse effect. It can decrease insulin sensitivity, causing impaired glucose tolerance and hyperglycemia (Fitzgerald et al., 2021).
• Other common side effects include Orthostatic hypotension, hypertriglyceridemia, hypercholesterolemia, somnolence, extrapyramidal symptoms, xerostomia, weakness, dizziness, insomnia, constipation, dyspepsia, and hyperprolactinemia.

Contraindications

• Dementia-related psychosis since it increases the risk of death (Meftah et al., 2020).
• Documented hypersensitivity to Olanzapine.

Drug-to-drug interactions

• Concomitant use of high dose parenteral olanzapine with benzodiazepines is not recommended due to sedation and risk of severe cardiorespiratory depression (Citrome et al., 2019).

Overdose Considerations

• Overdosing can cause Olanzapine toxicity.
• Serum concentration of olanzapine >0.1 mg/L is toxic.
• Serum concentration>1 mg/L can be fatal (Meftah et al., 2020).
• There is no antidote to olanzapine.
• In acute overdosage, establish and maintain an airway and ensure adequate oxygenation and ventilation, including intubation.

Diagnostics and Labs Monitoring                

• Regular monitoring of blood glucose to assess for hypoglycemia (Fitzgerald et al., 2021).
• Complete blood count (CBC) monitoring to assess for neutropenia, leukopenia, and agranulocytosis.
• Monitor lipid levels at the beginning and periodically during treatment to evaluate for hyperlipidemia (Fitzgerald et al., 2021).
• Olanzapine should be discontinued at the first sign of blood dyscrasias or in absolute neutrophil count <1000/mm³.
• Monitoring of prolactin levels to assess for hyperprolactinemia.

Comorbidities considerations        

• It should be used cautiously in patients with obesity/overweight or diabetes mellitus due to weight gain and metabolic dysfunction (Fitzgerald et al., 2021).
• Use caution in patients with significant prostatic hypertrophy, narrow-angle glaucoma, or a history of paralytic ileus. Olanzapine demonstrates in vitro muscarinic activity.

Legal and ethical considerations

• Legal and ethical considerations when prescribing patients with Olanzapine include autonomy, beneficence, and nonmaleficence.
• The clinician should uphold autonomy by seeking patient consent to initiate treatment.
• Before obtaining consent, the clinician should educate the patient on the drug’s benefits and potential side effects.
• Beneficence should be upheld by evaluating if Olanzapine will promote the best outcomes in treating the target disease.
• Olanzapine should only be administered if it is established to improve health outcomes in the specific patient population.
• Nonmaleficence should be upheld by ensuring the benefits of Olanzapine outweigh the risks before initiating treatment.

Pertinent patient education considerations         

The patient should be educated on Olanzapine formulations (oral and IM).

• For tablets, the patient should be advised to store the drug at room temperature and free from direct sunlight and moisture.
• Patients should be educated on potential side effects and measures to take when they occur.

Conclusion

Olanzapine is an Atypical antipsychotic FDA-approved to treat schizophrenia, Acute Bipolar I disorder, depression related to Bipolar I disorder, and TRD. It is used in schizophrenia and Bipolar I but is limited to persons above 13 years.

It is contraindicated in elderly patients with dementia-related psychosis since it increases the risk of death. Olanzapine causes increased appetite, which causes weight gain, the most common side effect. Besides, it causes metabolic dysfunction leading to hyperglycemia. Thus, it should be avoided in patients with obesity and diabetes. Regular monitoring of blood glucose, serum lipid, CBC, and prolactin levels is recommended.

References

Citrome, L., McEvoy, J. P., Todtenkopf, M. S., McDonnell, D., & Weiden, P. J. (2019). A commentary on the efficacy of Olanzapine for the treatment of schizophrenia: the past, present, and future. Neuropsychiatric disease and treatment, 15, 2559–2569. https://doi.org/10.2147/NDT.S209284

Fitzgerald, I., O’Dwyer, S., Brooks, M., Sahm, L., Crowley, E., & Ní Dhubhlaing, C. (2021). Worth the Weight? Olanzapine Prescribing in Schizophrenia. A Review of Weight Gain and Other Cardiometabolic Side Effects of Olanzapine. Frontiers in psychiatry, p. 12, 730769. https://doi.org/10.3389/fpsyt.2021.730769

Meftah, A. M., Deckler, E., Citrome, L., & Kantrowitz, J. T. (2020). New discoveries for an old drug: a review of recent olanzapine research. Postgraduate Medicine, 132(1), 80–90. https://doi.org/10.1080/00325481.2019.1701823

Rehan, S. T., Siddiqui, A. H., Khan, Z., Imran, L., Syed, A. A., Tahir, M. J., Jassani, Z., Singh, M., Asghar, M. S., & Ahmed, A. (2022). Samidorphan/olanzapine combination therapy for schizophrenia: Efficacy, tolerance and adverse outcomes of regimen, evidence-based review of clinical trials. Annals of medicine and surgery (2012), p. 79, 104115. https://doi.org/10.1016/j.amsu.2022.104115

Smith, D. A., Beaumont, K., Maurer, T. S., & Di, L. (2018). Relevance of Half-Life in Drug Design. Journal of medicinal chemistry, 61(10), 4273–4282. https://doi.org/10.1021/acs.jmedchem.7b00969