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Beth DeJongh, Pharm.D., BCPS, BCPP
Recertification Editorial Board Chair
Associate Professor of Pharmacy Practice
Concordia University Wisconsin School of Pharmacy

Second generation antipsychotics (SGAs) are a first-line treatment for schizophrenia and are often used as the primary treatment or augmentation in affective disorders.1-2 There are several SGAs available on the market and since 2009, six antipsychotics (lurasidone, asenapine, iloperidone, brexpiprazole, cariprazine, lumateperone) have been FDA-approved for treatment of schizophrenia. With the exception of clozapine, there is not sufficient evidence to indicate any of these antipsychotics are more effective than another in the general patient population, making it difficult to know which agent to try first. Several of these medications have similar mechanisms of action and appear similar, making it even more difficult for healthcare providers to differentiate these products. However, there are key differences in regard to their adverse effect profiles and tolerability3-6. Clinician familiarity with the specificity profile and adverse effect burden of newer SGAs may allow for prescribing according to each patient’s clinical profile. Pharmacists must understand the differences in receptor binding and potential for adverse effects to help provide patient-centered care based on comorbidities, past medical history, and vulnerability for specific adverse effects. The ability to differentiate antipsychotics based on their adverse effect profiles is important in clinical practice to help identify patients who may benefit most from the newer SGAS. Further, medication adherence may be improved if antipsychotics less likely to exacerbate comorbidities or cause additive adverse effects are selected4-6. This CPNP 2021 recertification session is designed to provide education on the differences among newer SGAs to aid in medication selection for patients.

Objectives for this session are:

  1. Analyze the relationship between receptor binding affinities and the adverse effect profiles of antipsychotics.
  2. Compare the advantages and disadvantages of newer second generation antipsychotics based on their adverse effect profiles.
  3. Select the most appropriate antipsychotic for a patient based on adverse effect potential and past medical history.

The CPNP Recertification Editorial Board is excited to announce Stephen R. Saklad, Pharm.D., BCPP as the speaker for this topic. Dr. Saklad has worked in psychiatric pharmacy for over forty years. He received his Doctor of Pharmacy degree from the University of Southern California. He completed a National Institute of Mental Health training fellowship in psychiatric pharmacy at the Nebraska Psychiatric Institute of the University of Nebraska Medical Center at Omaha. He then joined the faculty of the University of Texas (UT) at Austin College of Pharmacy and the clinical staff at San Antonio State Hospital (SASH). He is currently the Director of the UT Psychiatric Pharmacy Program. During his career, he provided clinical care, education, and research in a variety of settings and treatment roles at SASH. He team teaches didactic courses for second and third professional year pharmacy students. He is the course director for Advanced Pharmacotherapy Laboratory, a third professional year opportunity for students to develop their clinical presentation skills that is given across four campuses. He precepts and mentors third and fourth professional year pharmacy students at SASH.

Dr. Saklad has been a principal or co-investigator for several studies of the efficacy and adverse effects of Phase II, III, and IV psychotropic agents in schizophrenia, mood disorders, depression, and other serious and persistent mental illness, as well as their pharmacokinetics and interactions. He was the Director of UT Health Science Center San Antonio’s Advanced Pharmacotherapy Research with research facilities located at Laurel Ridge Treatment Center and President of Alamo Superior Research, LLC. He has been affiliated with the Behavioral Wellness (“Be Well”) Center, Department of Psychiatry, UT Health San Antonio since 2009. Dr. Saklad is also actively involved in CPNP and was a founding member when it was incorporated in 1998. He has served on CPNP’s Board of Directors, the Communications Committee, the Business Development Committee, and was the founding senior editor of the Mental Health Clinician.

View course information

References

  1. Hirschfeld RM, Bowden CL, Gitlin MJ, et al. APA Practice guideline for the treatment of patients with Bipolar Disorder (2nd edition). American Psychiatric Association. 2002.
  2. Lehman A, Lieberman J, Dixon L, et al. APA practice guideline for the treatment of patients with schizophrenia (2nd edition). American Psychiatric Association. 2004.
  3. Citrome L. Aripiprazole, brexpiprazole, and cariprazine: Not all the same. Current Psych 2018; 17(4): 25-34.
  4. Citrome L. A review of the pharmacology, efficacy and tolerability of recently approved and upcoming oral antipsychotics: an evidence-based medicine approach. CNS Drugs 2013; 27(11): 879-911.
  5. Corponi F, Fabbri C, Bitter I, et al. Novel antipsychotics specificity profile: A clinically oriented review of lurasidone, brexpiprazole, cariprazine, and lumateperone. Eur Neuropsychopharmacol 2019; 29(9): 971-985.
  6. Huhn M, Nikolakopoulou A, Schneider-Thoma J, et al. Comparative efficacy and tolerability of 32 oral antispychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet 2019; 394(10202): 939-951.
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