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Bonus Episode: Can You Answer These 3 Second Generation Antipsychotic Questions? · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  Welcome
• 0:06
  back,
• 0:06
  my
• 0:06
  friends,
• 0:06
  to
• 0:07
  a
• 0:07
  bonus
• 0:07
  episode
• 0:08
  of
• 0:08
  Pearls
• 0:09
  and
• 0:09
  prep.
• 0:09
  The
• 0:10
  place
• 0:10
  you
• 0:11
  go
• 0:11
  for
• 0:12
  pearls
• 0:12
  that
• 0:12
  prep
• 0:12
  you
• 0:13
  for
• 0:13
  your
• 0:13
  boards
• 0:13
  and
• 0:14
  prep
• 0:14
  you
• 0:14
  to
• 0:15
  practice
• 0:15
  npz.
• 0:16
  Here,
• 0:16
  your
• 0:16
  preceptor
• 0:17
  in
• 0:17
  your
• 0:17
  pocket.
• 0:18
  This
• 0:18
  is
• 0:18
  called
• 0:18
  SGA
• 0:19
  Trivia.
• 0:20
  Second
• 0:20
  generation
• 0:20
  antipsychotic
• 0:21
  trivia.
• 0:22
  We
• 0:22
  have
• 0:22
  three
• 0:22
  questions
• 0:23
  and
• 0:24
  three
• 0:24
  answers
• 0:25
  and
• 0:25
  I
• 0:25
  am
• 0:26
  really
• 0:26
  excited
• 0:27
  to
• 0:27
  to
• 0:27
  see
• 0:27
  if
• 0:27
  you
• 0:28
  can
• 0:28
  get
• 0:28
  all
• 0:28
  three
• 0:28
  of
• 0:28
  them
• 0:29
  correct.
• 0:29
  Maybe
• 0:30
  before
• 0:31
  I
• 0:31
  even
• 0:31
  explain
• 0:31
  it,
• 0:32
  you
• 0:32
  can
• 0:32
  hit
• 0:32
  pause
• 0:33
  in
• 0:33
  this
• 0:33
  podcast
• 0:34
  and
• 0:34
  think
• 0:35
  about
• 0:35
  the
• 0:35
  rationale
• 0:36
  as
• 0:36
  to
• 0:36
  why
• 0:36
  these
• 0:36
  answers
• 0:37
  are
• 0:37
  correct.
• 0:37
  Extra
• 0:38
  kudos
• 0:38
  to
• 0:38
  you
• 0:38
  if
• 0:39
  you're
• 0:39
  able
• 0:39
  to
• 0:39
  do
• 0:39
  that.
• 0:39
  Let's
• 0:40
  get
• 0:40
  right
• 0:40
  into
• 0:41
  it.
• 0:41
  Today,
• 0:41
  my
• 0:41
  friends,
• 0:42
  you
• 0:42
  have
• 0:42
  a
• 0:43
  45
• 0:43
  year
• 0:43
  old
• 0:44
  man.
• 0:45
  We're
• 0:45
  going
• 0:46
  to
• 0:46
  call
• 0:46
  him
• 0:46
  Eddie.
• 0:46
  Eddie's
• 0:47
  a
• 0:47
  fake
• 0:47
  person.
• 0:48
  He's
• 0:48
  a
• 0:48
  mock
• 0:49
  patient.
• 0:49
  Okay?
• 0:49
  He
• 0:50
  has
• 0:50
  schizophrenia
• 0:51
  and
• 0:51
  metabolic
• 0:52
  syndrome.
• 0:53
  His
• 0:53
  BMI
• 0:53
  is
• 0:53
  32.
• 0:54
  He
• 0:55
  has
• 0:55
  pre
• 0:55
  diabetes,
• 0:56
  he's
• 0:56
  got
• 0:56
  hypertension.
• 0:57
  Okay?
• 0:57
  He's
• 0:57
  currently
• 0:58
  on
• 0:58
  Zyprexa,
• 0:59
  very
• 0:59
  good
• 1:00
  symptom
• 1:00
  control.
• 1:01
  But
• 1:01
  he's
• 1:01
  telling
• 1:01
  you
• 1:01
  I
• 1:02
  want
• 1:02
  out.
• 1:03
  He's
• 1:03
  telling
• 1:03
  you
• 1:04
  he's
• 1:04
  gained
• 1:05
  40
• 1:05
  pounds
• 1:05
  on
• 1:06
  Zyprexa
• 1:06
  and
• 1:07
  he
• 1:07
  wants
• 1:07
  you
• 1:07
  to
• 1:07
  choose
• 1:08
  an
• 1:08
  antipsychotic
• 1:09
  that
• 1:09
  has
• 1:09
  a
• 1:09
  more
• 1:10
  favorable
• 1:11
  metabolic
• 1:11
  profile.
• 1:12
  So
• 1:12
  do
• 1:12
  you
• 1:13
  a,
• 1:13
  switch?
• 1:14
  Excuse
• 1:14
  me,
• 1:15
  do
• 1:15
  you
• 1:15
  A,
• 1:15
  continue
• 1:16
  the
• 1:17
  Zyprexa
• 1:17
  but
• 1:18
  just
• 1:18
  add
• 1:18
  metformin?
• 1:19
  Do
• 1:19
  you
• 1:19
  B,
• 1:20
  switch
• 1:20
  to
• 1:20
  Abilify?
• 1:21
  Do
• 1:22
  you
• 1:22
  C,
• 1:22
  switch
• 1:22
  to
• 1:24
  Seroquel?
• 1:24
  Do
• 1:24
  you
• 1:25
  D,
• 1:25
  switch
• 1:25
  to
• 1:26
  Risperdal?
• 1:27
  Well,
• 1:27
  let's
• 1:28
  start
• 1:28
  with
• 1:28
  a,
• 1:28
  continuing
• 1:29
  Zyprexa
• 1:30
  and
• 1:30
  adding
• 1:30
  Metformin.
• 1:31
  Well,
• 1:31
  aside
• 1:32
  from
• 1:32
  the
• 1:32
  fact
• 1:32
  that
• 1:33
  this
• 1:33
  is
• 1:33
  explicitly
• 1:34
  what
• 1:34
  your
• 1:34
  patient
• 1:34
  doesn't
• 1:35
  want
• 1:35
  you
• 1:35
  to
• 1:35
  do
• 1:35
  to
• 1:36
  continue
• 1:36
  the
• 1:36
  medication,
• 1:37
  this
• 1:38
  is
• 1:38
  not
• 1:39
  the
• 1:39
  correct
• 1:39
  answer.
• 1:40
  The
• 1:40
  man
• 1:40
  wants
• 1:40
  out
• 1:41
  of
• 1:41
  Zyprexa.
• 1:42
  We
• 1:42
  got
• 1:42
  to
• 1:42
  get
• 1:42
  him
• 1:43
  out
• 1:43
  of
• 1:43
  Zyprexa.
• 1:44
  Adding
• 1:44
  Metformin,
• 1:44
  although
• 1:45
  it
• 1:45
  might
• 1:45
  be
• 1:45
  helpful,
• 1:46
  it's
• 1:46
  really
• 1:47
  not
• 1:48
  the
• 1:48
  biggest
• 1:49
  change
• 1:49
  he's
• 1:49
  looking
• 1:50
  for
• 1:50
  here.
• 1:51
  And
• 1:51
  your
• 1:51
  girlfriend's
• 1:52
  like,
• 1:52
  well,
• 1:52
  fine,
• 1:54
  I'm
• 1:54
  not
• 1:54
  going
• 1:54
  to
• 1:54
  let
• 1:55
  him
• 1:55
  sleep
• 1:55
  on
• 1:55
  your
• 1:55
  bed
• 1:56
  anymore.
• 1:56
  And
• 1:56
  it's
• 1:57
  like,
• 1:59
  not
• 1:59
  really
• 1:59
  the
• 1:59
  same
• 2:00
  thing.
• 2:00
  I
• 2:00
  kind
• 2:00
  of
• 2:00
  want
• 2:00
  the
• 2:01
  dog
• 2:01
  out
• 2:01
  of
• 2:01
  the
• 2:02
  house.
• 2:02
  Well,
• 2:03
  no,
• 2:03
  I'll
• 2:03
  give
• 2:03
  him
• 2:04
  a
• 2:04
  tighter
• 2:04
  leash.
• 2:05
  Nah,
• 2:06
  no,
• 2:06
  you
• 2:07
  want
• 2:07
  the
• 2:07
  dog
• 2:07
  out
• 2:07
  of
• 2:07
  the
• 2:08
  house.
• 2:08
  Okay,
• 2:09
  I'm
• 2:09
  not
• 2:09
  speaking
• 2:09
  from
• 2:09
  personal
• 2:10
  experience.
• 2:10
  I
• 2:10
  love
• 2:11
  dogs.
• 2:11
  Just
• 2:12
  an
• 2:12
  analogy.
• 2:12
  He
• 2:12
  wants
• 2:13
  the
• 2:13
  dog
• 2:13
  out
• 2:13
  of
• 2:13
  the
• 2:13
  house,
• 2:14
  so
• 2:14
  get
• 2:14
  Zyprexa
• 2:15
  out
• 2:15
  of
• 2:15
  the
• 2:15
  way.
• 2:15
  What
• 2:16
  do
• 2:16
  you
• 2:16
  do
• 2:16
  with
• 2:16
  this?
• 2:16
  Do
• 2:16
  you
• 2:17
  switch
• 2:17
  them
• 2:17
  to
• 2:17
  Seroquel?
• 2:18
  Option
• 2:18
  C?
• 2:18
  Seroquel
• 2:20
  is
• 2:20
  not
• 2:20
  as
• 2:21
  much
• 2:21
  of
• 2:21
  a
• 2:21
  weight
• 2:22
  gainer
• 2:22
  as
• 2:23
  Zyprexa,
• 2:24
  but
• 2:24
  it
• 2:24
  is
• 2:24
  definitely
• 2:24
  an
• 2:25
  intermediate
• 2:25
  metabolic
• 2:26
  risk.
• 2:26
  I
• 2:26
  have
• 2:26
  seen
• 2:27
  patients
• 2:27
  experience
• 2:28
  significant
• 2:29
  weight
• 2:29
  gain
• 2:30
  on
• 2:30
  Seroquel.
• 2:32
  So
• 2:32
  it's
• 2:32
  definitely
• 2:33
  not
• 2:34
  a
• 2:34
  very
• 2:34
  good
• 2:34
  idea
• 2:35
  here.
• 2:35
  He's
• 2:35
  not
• 2:35
  going
• 2:35
  to
• 2:36
  be
• 2:36
  that
• 2:36
  happy
• 2:36
  with
• 2:36
  you.
• 2:36
  Do
• 2:37
  you
• 2:37
  switch
• 2:37
  to
• 2:37
  Risperidone?
• 2:38
  Well,
• 2:39
  Risperidone
• 2:40
  can
• 2:40
  also
• 2:40
  cause
• 2:41
  significant
• 2:41
  weight
• 2:41
  gain.
• 2:42
  BMI
• 2:42
  increases
• 2:43
  prolactin
• 2:43
  elevation.
• 2:45
  Not
• 2:45
  a
• 2:45
  very
• 2:46
  savvy
• 2:47
  move,
• 2:47
  my
• 2:47
  friends.
• 2:48
  So
• 2:48
  that
• 2:48
  leaves
• 2:49
  us
• 2:49
  with
• 2:49
  Abilify.
• 2:50
  Yes,
• 2:50
  switching
• 2:51
  to
• 2:51
  Abilify
• 2:51
  is
• 2:52
  the
• 2:52
  right
• 2:52
  answer.
• 2:52
  Abilify
• 2:53
  is
• 2:53
  definitely
• 2:53
  one
• 2:54
  of
• 2:54
  your
• 2:54
  more
• 2:55
  favorable
• 2:56
  second
• 2:56
  generation
• 2:56
  antipsychotics
• 2:57
  as
• 2:57
  it
• 2:58
  relates
• 2:58
  to
• 2:59
  weight
• 3:00
  gain.
• 3:00
  I
• 3:00
  have
• 3:01
  seen
• 3:01
  weight
• 3:01
  gain
• 3:01
  on
• 3:01
  Abilify,
• 3:02
  but
• 3:02
  remember
• 3:02
  from
• 3:03
  previous
• 3:03
  episodes,
• 3:04
  it
• 3:04
  is
• 3:04
  a
• 3:05
  rather
• 3:05
  weak
• 3:06
  antagonist
• 3:07
  of
• 3:07
  five
• 3:07
  HT2C
• 3:08
  receptors.
• 3:09
  In
• 3:09
  other
• 3:09
  words,
• 3:09
  unlike
• 3:10
  Zyprexa,
• 3:11
  unlike
• 3:11
  Seroquel,
• 3:12
  unlike
• 3:12
  Risperdal,
• 3:13
  it
• 3:13
  is
• 3:14
  a
• 3:14
  little
• 3:14
  more
• 3:14
  gentle
• 3:14
  on
• 3:15
  that
• 3:15
  receptor.
• 3:16
  So
• 3:16
  the
• 3:16
  weight
• 3:16
  gain
• 3:17
  is
• 3:17
  not
• 3:17
  as
• 3:17
  intense
• 3:18
  when
• 3:18
  it
• 3:19
  comes
• 3:19
  to
• 3:19
  Abilify.
• 3:20
  Can
• 3:20
  it
• 3:20
  still
• 3:20
  happen?
• 3:20
  Absolutely.
• 3:21
  I
• 3:21
  even.
• 3:22
  I
• 3:22
  definitely
• 3:23
  advise
• 3:23
  my
• 3:24
  patients
• 3:24
  that
• 3:24
  all
• 3:24
  bets
• 3:25
  are
• 3:25
  off.
• 3:25
  You
• 3:25
  could
• 3:25
  still
• 3:25
  experience
• 3:26
  some
• 3:27
  metabolic
• 3:27
  issues
• 3:27
  with
• 3:28
  this,
• 3:28
  but
• 3:28
  it
• 3:28
  is
• 3:28
  more
• 3:29
  of
• 3:29
  the
• 3:29
  weight
• 3:29
  neutral
• 3:30
  second
• 3:30
  generation
• 3:30
  antipsychotics.
• 3:31
  It's
• 3:32
  right
• 3:32
  up
• 3:32
  there
• 3:32
  with
• 3:32
  Gidon,
• 3:34
  which
• 3:34
  is
• 3:34
  also
• 3:35
  more
• 3:35
  weight
• 3:36
  neutral
• 3:36
  and
• 3:36
  metabolically
• 3:37
  friendly.
• 3:38
  Keep
• 3:38
  that
• 3:38
  in
• 3:38
  mind.
• 3:39
  The
• 3:39
  patient
• 3:40
  could
• 3:40
  really
• 3:40
  experience
• 3:41
  an
• 3:41
  improvement
• 3:42
  in
• 3:42
  their
• 3:42
  weight,
• 3:42
  their
• 3:43
  fasting
• 3:43
  glucose,
• 3:43
  their
• 3:44
  triglycerides,
• 3:44
  just
• 3:45
  by
• 3:45
  getting
• 3:45
  off
• 3:45
  of
• 3:45
  the
• 3:45
  Zyprexa.
• 3:46
  And
• 3:47
  at
• 3:47
  the
• 3:47
  right
• 3:47
  dose,
• 3:48
  Abilify
• 3:49
  can
• 3:50
  absolutely
• 3:50
  control
• 3:51
  the
• 3:51
  patient's
• 3:52
  psychotic
• 3:53
  symptoms.
• 3:53
  Don't
• 3:53
  forget,
• 3:53
  too.
• 3:54
  Abilify,
• 3:54
  through
• 3:55
  its
• 3:55
  dopamine
• 3:55
  partial
• 3:56
  agonism,
• 3:57
  might
• 3:57
  also
• 3:58
  work
• 3:58
  to
• 3:58
  help
• 3:58
  this
• 3:59
  guy's
• 4:00
  negative
• 4:00
  symptoms
• 4:01
  of
• 4:01
  schizophrenia,
• 4:02
  which
• 4:02
  are
• 4:02
  extremely
• 4:03
  debilitating.
• 4:04
  That's
• 4:04
  probably
• 4:04
  for
• 4:05
  another
• 4:05
  episode.
• 4:05
  But
• 4:06
  remember,
• 4:06
  my
• 4:06
  friends,
• 4:07
  schizophrenia
• 4:08
  is
• 4:08
  not
• 4:08
  just
• 4:08
  about
• 4:09
  those
• 4:09
  big,
• 4:10
  flashy
• 4:10
  hallucinations
• 4:11
  and
• 4:11
  delusions
• 4:12
  and
• 4:12
  disorganization.
• 4:13
  We're
• 4:13
  talking
• 4:13
  about
• 4:14
  people
• 4:14
  who,
• 4:15
  because
• 4:15
  of
• 4:15
  schizophrenia,
• 4:16
  don't
• 4:16
  have
• 4:17
  as
• 4:17
  much
• 4:17
  motivation.
• 4:18
  Their
• 4:18
  emotional
• 4:19
  expression
• 4:19
  is
• 4:20
  restricted.
• 4:21
  And
• 4:21
  that
• 4:21
  can
• 4:22
  be
• 4:22
  very
• 4:22
  difficult
• 4:22
  when
• 4:23
  you're
• 4:23
  trying
• 4:23
  to
• 4:23
  navigate
• 4:24
  intimate
• 4:25
  relationships
• 4:26
  or
• 4:26
  applying
• 4:26
  for
• 4:27
  a
• 4:27
  job.
• 4:27
  They
• 4:27
  don't
• 4:28
  talk
• 4:28
  as
• 4:28
  much,
• 4:28
  they're
• 4:29
  a
• 4:29
  little
• 4:29
  more
• 4:29
  withdrawn,
• 4:30
  they
• 4:30
  don't
• 4:30
  experience
• 4:30
  as
• 4:31
  much
• 4:31
  pleasure.
• 4:32
  Right.
• 4:32
  These
• 4:32
  are
• 4:32
  the
• 4:32
  negative
• 4:33
  symptoms
• 4:33
  that
• 4:33
  are
• 4:33
  often
• 4:34
  overlooked
• 4:35
  at
• 4:35
  the
• 4:35
  expense
• 4:36
  of
• 4:36
  the
• 4:36
  big,
• 4:36
  flashy
• 4:36
  ones.
• 4:37
  But
• 4:37
  finding
• 4:38
  the
• 4:38
  right
• 4:39
  antipsychotic
• 4:40
  that
• 4:40
  will
• 4:41
  not
• 4:41
  make
• 4:41
  your
• 4:41
  patient
• 4:42
  gain
• 4:42
  a
• 4:42
  hundred
• 4:42
  pounds
• 4:43
  and
• 4:44
  might
• 4:45
  have
• 4:45
  a
• 4:45
  range
• 4:45
  of
• 4:46
  other
• 4:46
  benefits
• 4:46
  like
• 4:47
  Abilify
• 4:47
  could
• 4:48
  certainly
• 4:48
  be
• 4:48
  a
• 4:48
  wonderful
• 4:49
  thing.
• 4:49
  So
• 4:49
  Abilify
• 4:50
  B
• 4:51
  is
• 4:51
  the
• 4:51
  answer.
• 4:52
  I
• 4:52
  hope
• 4:52
  you
• 4:52
  got
• 4:53
  that
• 4:53
  right.
• 4:53
  And
• 4:54
  if
• 4:54
  not,
• 4:54
  no
• 4:54
  worries.
• 4:55
  We're
• 4:55
  all
• 4:55
  learning
• 4:56
  every
• 4:56
  day.
• 4:56
  And
• 4:57
  guess
• 4:57
  what?
• 4:57
  Now
• 4:58
  you
• 4:58
  know
• 4:58
  a
• 4:58
  little
• 4:58
  more.
• 4:59
  And
• 4:59
  share
• 4:59
  the
• 5:00
  wisdom.
• 5:00
  Share
• 5:00
  the
• 5:00
  pearls,
• 5:01
  my
• 5:01
  friends.
• 5:02
  Question
• 5:02
  number
• 5:02
  two.
• 5:03
  This
• 5:03
  is
• 5:03
  a
• 5:03
  doozy.
• 5:04
  So
• 5:04
  your
• 5:04
  patient's
• 5:05
  coming
• 5:05
  to
• 5:05
  you
• 5:06
  and
• 5:06
  saying,
• 5:06
  hey,
• 5:07
  I
• 5:07
  have
• 5:08
  schizophrenia,
• 5:09
  I
• 5:09
  have
• 5:09
  psychosis,
• 5:10
  but
• 5:11
  I
• 5:11
  have
• 5:11
  a
• 5:11
  family
• 5:11
  history
• 5:11
  of
• 5:12
  sudden
• 5:12
  cardiac
• 5:12
  death,
• 5:13
  and
• 5:13
  I
• 5:13
  am
• 5:13
  concerned
• 5:13
  about
• 5:14
  cardiac
• 5:14
  safety.
• 5:15
  You
• 5:15
  need
• 5:15
  to
• 5:15
  find
• 5:16
  an
• 5:16
  antipsychotic
• 5:17
  that
• 5:18
  has
• 5:18
  a
• 5:18
  more
• 5:19
  favorable
• 5:20
  cardiac
• 5:21
  profile.
• 5:21
  Your
• 5:22
  patient
• 5:22
  is
• 5:23
  exclusively
• 5:24
  talking
• 5:24
  about
• 5:24
  sudden
• 5:24
  cardiac
• 5:25
  death.
• 5:25
  Okay,
• 5:26
  so
• 5:26
  which
• 5:26
  one
• 5:26
  do
• 5:27
  you
• 5:27
  choose?
• 5:27
  Do
• 5:27
  you
• 5:27
  choose
• 5:27
  A
• 5:28
  or
• 5:28
  Geodon?
• 5:30
  Do
• 5:30
  you
• 5:30
  choose
• 5:31
  B,
• 5:32
  Risperidol?
• 5:34
  Do
• 5:34
  you
• 5:34
  choose
• 5:35
  C,
• 5:36
  Abilify,
• 5:38
  or
• 5:39
  do
• 5:39
  you
• 5:39
  choose
• 5:39
  D,
• 5:41
  Lurazodone
• 5:42
  or
• 5:42
  Lituda?
• 5:43
  The
• 5:43
  answer
• 5:43
  is
• 5:44
  D,
• 5:45
  Latuda.
• 5:46
  I
• 5:46
  won't
• 5:46
  beat
• 5:47
  the
• 5:47
  dead
• 5:47
  horse
• 5:47
  on
• 5:47
  all
• 5:48
  these
• 5:48
  other
• 5:48
  potential
• 5:48
  answers,
• 5:49
  other
• 5:49
  than
• 5:50
  to
• 5:50
  say
• 5:50
  geodon
• 5:51
  is
• 5:51
  uniquely
• 5:51
  problematic.
• 5:52
  Also
• 5:53
  known
• 5:53
  as
• 5:53
  ziprazodone,
• 5:54
  Gidon
• 5:55
  is
• 5:55
  uniquely
• 5:55
  problematic
• 5:56
  as
• 5:56
  it
• 5:56
  does
• 5:57
  prolong
• 5:57
  the
• 5:57
  QT.
• 5:58
  And
• 5:58
  if
• 5:59
  you
• 5:59
  have
• 5:59
  a
• 5:59
  patient
• 5:59
  with
• 6:00
  abnormal
• 6:00
  EKGs
• 6:01
  or
• 6:01
  a
• 6:01
  history
• 6:01
  of
• 6:02
  QT
• 6:02
  prolongation,
• 6:03
  sudden
• 6:04
  cardiac
• 6:04
  death,
• 6:05
  there's
• 6:05
  concern
• 6:05
  about
• 6:06
  the
• 6:06
  patient's
• 6:07
  cardiac
• 6:07
  profile.
• 6:08
  You
• 6:08
  want
• 6:08
  to
• 6:08
  be
• 6:08
  a
• 6:09
  little
• 6:09
  more
• 6:09
  hesitant
• 6:09
  with
• 6:10
  Gidon,
• 6:10
  especially
• 6:11
  if
• 6:11
  they're
• 6:11
  on
• 6:12
  multiple
• 6:12
  medications
• 6:13
  that
• 6:13
  might
• 6:13
  prolong
• 6:13
  the
• 6:14
  qt.
• 6:14
  Right.
• 6:15
  And
• 6:15
  there's
• 6:15
  fancy
• 6:15
  websites
• 6:16
  out
• 6:16
  there.
• 6:16
  And
• 6:17
  it's
• 6:17
  very
• 6:17
  important
• 6:17
  you
• 6:18
  do
• 6:18
  your
• 6:18
  own
• 6:18
  due
• 6:18
  diligence
• 6:19
  to
• 6:19
  make
• 6:19
  sure
• 6:20
  that
• 6:20
  your
• 6:20
  patient
• 6:20
  isn't
• 6:21
  on
• 6:21
  a
• 6:21
  bunch
• 6:21
  of
• 6:21
  those
• 6:21
  medications.
• 6:22
  So
• 6:22
  you're
• 6:22
  not
• 6:23
  increasing
• 6:23
  the
• 6:23
  risk.
• 6:24
  You're
• 6:24
  having
• 6:24
  these
• 6:24
  discussions
• 6:25
  with
• 6:25
  your
• 6:25
  patients.
• 6:26
  Just
• 6:26
  a
• 6:26
  little
• 6:27
  refresher
• 6:27
  before
• 6:27
  we
• 6:28
  talk
• 6:28
  about
• 6:28
  why
• 6:28
  Latuda
• 6:29
  is
• 6:29
  the
• 6:29
  best
• 6:29
  choice
• 6:29
  here.
• 6:30
  QT
• 6:31
  interval
• 6:31
  on
• 6:31
  an
• 6:31
  EKG
• 6:32
  reflects
• 6:33
  the
• 6:33
  times
• 6:33
  required
• 6:34
  for
• 6:35
  ventricular
• 6:35
  repolarization,
• 6:37
  basically
• 6:37
  how
• 6:37
  long
• 6:38
  it
• 6:38
  takes
• 6:38
  for
• 6:38
  your
• 6:39
  heart's
• 6:39
  ventricles
• 6:40
  to
• 6:40
  reset
• 6:41
  electrically
• 6:41
  after
• 6:41
  each
• 6:42
  heartbeat.
• 6:42
  And
• 6:43
  when
• 6:43
  it's
• 6:43
  prolonged,
• 6:44
  you
• 6:44
  could.
• 6:44
  It
• 6:45
  could
• 6:45
  lead
• 6:45
  to
• 6:46
  the
• 6:46
  risk
• 6:46
  of
• 6:47
  torsade
• 6:47
  dep
• 6:47
  points,
• 6:48
  which
• 6:48
  is
• 6:49
  a
• 6:49
  life
• 6:49
  threatening
• 6:50
  ventricular
• 6:50
  arrhythmia
• 6:51
  that
• 6:51
  can
• 6:51
  throw
• 6:52
  you
• 6:52
  into
• 6:52
  V
• 6:52
  fib
• 6:52
  and
• 6:53
  sudden
• 6:53
  cardiac
• 6:53
  death.
• 6:54
  So
• 6:54
  this
• 6:54
  is
• 6:54
  a
• 6:54
  big
• 6:54
  deal,
• 6:55
  of
• 6:55
  course,
• 6:55
  and
• 6:57
  so
• 6:58
  we
• 6:58
  really
• 6:59
  want
• 6:59
  to
• 6:59
  make
• 6:59
  sure
• 6:59
  we
• 7:00
  choose
• 7:00
  the
• 7:00
  right
• 7:01
  antipsychotic
• 7:02
  in
• 7:02
  this
• 7:02
  case.
• 7:02
  And
• 7:02
  in
• 7:03
  this
• 7:03
  case
• 7:03
  it
• 7:03
  would
• 7:03
  be
• 7:03
  Latuda,
• 7:04
  which
• 7:05
  according
• 7:05
  to
• 7:05
  the
• 7:05
  American
• 7:05
  Psychiatric
• 7:06
  association
• 7:07
  guideline,
• 7:08
  has
• 7:08
  the
• 7:08
  lowest
• 7:08
  risk
• 7:09
  of
• 7:09
  QT
• 7:10
  prolongation.
• 7:11
  That's
• 7:11
  an
• 7:11
  interesting
• 7:12
  pearl.
• 7:12
  The
• 7:12
  most
• 7:13
  problematic
• 7:14
  would
• 7:14
  be
• 7:15
  Geodon,
• 7:15
  another
• 7:16
  medication
• 7:16
  too,
• 7:17
  called
• 7:17
  Phenapt,
• 7:18
  Iliperidone.
• 7:19
  Those
• 7:19
  are
• 7:19
  two
• 7:20
  big
• 7:20
  offenders.
• 7:21
  Latuda,
• 7:21
  though,
• 7:22
  and
• 7:22
  interestingly
• 7:23
  enough,
• 7:23
  Abilify
• 7:24
  has
• 7:25
  the
• 7:25
  lowest
• 7:25
  risk
• 7:25
  of
• 7:25
  QT
• 7:26
  prolongation.
• 7:27
  Very
• 7:27
  interesting.
• 7:28
  Remember
• 7:28
  that
• 7:29
  Geodon
• 7:29
  is
• 7:29
  kind
• 7:30
  of
• 7:30
  the
• 7:30
  one
• 7:30
  you
• 7:30
  want
• 7:30
  to
• 7:30
  avoid.
• 7:31
  It
• 7:31
  does
• 7:31
  have
• 7:32
  an
• 7:32
  FDA
• 7:32
  warning
• 7:33
  about
• 7:33
  QT
• 7:34
  prolongation
• 7:35
  in
• 7:35
  the
• 7:35
  product
• 7:36
  labeling.
• 7:36
  So
• 7:37
  you
• 7:37
  want
• 7:37
  to
• 7:37
  be
• 7:37
  very
• 7:38
  careful
• 7:39
  with
• 7:39
  that.
• 7:40
  And
• 7:40
  so
• 7:40
  it
• 7:40
  is
• 7:40
  very
• 7:41
  much
• 7:41
  contraindicated
• 7:42
  in
• 7:42
  this
• 7:42
  patient
• 7:42
  with
• 7:43
  a
• 7:43
  family
• 7:43
  history
• 7:43
  of
• 7:44
  sudden
• 7:44
  cardiac
• 7:45
  death.
• 7:46
  Hopefully
• 7:46
  you
• 7:47
  kind
• 7:47
  of
• 7:47
  tuck
• 7:47
  that
• 7:47
  pearl
• 7:47
  in
• 7:48
  your
• 7:48
  back
• 7:48
  pocket
• 7:48
  and
• 7:48
  remember
• 7:49
  that
• 7:49
  Latuda
• 7:49
  is
• 7:50
  where
• 7:50
  you
• 7:50
  want
• 7:50
  to
• 7:50
  go.
• 7:50
  Or
• 7:50
  maybe
• 7:51
  Abilify
• 7:52
  if
• 7:52
  you're
• 7:52
  having
• 7:52
  a
• 7:53
  concern
• 7:53
  for
• 7:53
  QT
• 7:54
  prolongation.
• 7:54
  Okay,
• 7:55
  now
• 7:55
  for
• 7:55
  question
• 7:56
  three.
• 7:56
  You
• 7:57
  have
• 7:57
  a
• 7:57
  45
• 7:58
  year
• 7:58
  old
• 7:58
  man
• 7:58
  with
• 7:59
  metabolic
• 7:59
  syndrome.
• 8:00
  He's
• 8:01
  also
• 8:01
  being
• 8:02
  switched
• 8:03
  from
• 8:03
  Zyprexa.
• 8:04
  He's
• 8:05
  a
• 8:05
  software
• 8:05
  engineer,
• 8:06
  but
• 8:06
  his
• 8:06
  main
• 8:06
  problem
• 8:07
  today
• 8:08
  is
• 8:08
  he
• 8:08
  has
• 8:09
  restlessness.
• 8:09
  He's
• 8:10
  unable
• 8:10
  to
• 8:10
  sit
• 8:10
  still
• 8:11
  during
• 8:11
  long
• 8:12
  work
• 8:12
  meetings.
• 8:13
  He
• 8:14
  has
• 8:14
  experienced
• 8:15
  this
• 8:15
  same
• 8:16
  problem
• 8:16
  years
• 8:16
  ago
• 8:17
  also
• 8:17
  on
• 8:17
  Haldol.
• 8:18
  He's
• 8:19
  coming
• 8:19
  to
• 8:19
  you
• 8:19
  saying,
• 8:19
  I
• 8:19
  want
• 8:20
  out
• 8:20
  of
• 8:20
  Zyprexa.
• 8:21
  I
• 8:21
  the
• 8:22
  one
• 8:22
  deal
• 8:22
  breaker
• 8:23
  is
• 8:23
  I
• 8:23
  cannot
• 8:23
  have
• 8:23
  that
• 8:24
  restlessness
• 8:24
  feeling
• 8:25
  because
• 8:25
  I'm
• 8:26
  a
• 8:26
  software
• 8:26
  engineer
• 8:27
  and
• 8:27
  in
• 8:27
  my
• 8:27
  work
• 8:27
  meetings
• 8:28
  it's
• 8:28
  really
• 8:28
  debilitating.
• 8:29
  I
• 8:29
  can't
• 8:29
  be
• 8:30
  restless
• 8:30
  again
• 8:30
  in
• 8:31
  my
• 8:31
  chair.
• 9:26
  So
• 9:26
  your
• 9:26
  first
• 9:26
  task
• 9:27
  is
• 9:27
  to
• 9:27
  ask
• 9:27
  yourself,
• 8:33
  what
• 9:28
  the
• 9:28
  hell
• 9:28
  is
• 9:29
  going
• 9:29
  on
• 9:29
  here?
• 9:29
  What
• 9:30
  is
• 9:30
  he
• 9:30
  talking
• 9:30
  about?
• 9:30
  He's
• 9:31
  talking
• 9:31
  about
• 9:31
  Akaesthesia,
• 9:32
  which
• 9:32
  I
• 9:32
  think
• 9:33
  the
• 9:33
  actual
• 9:33
  Greek
• 9:34
  translation
• 9:35
  is
• 9:36
  in
• 9:36
  an
• 9:37
  inability
• 9:37
  to
• 9:37
  sit
• 9:38
  or
• 9:38
  sit
• 9:38
  still.
• 9:39
  And
• 9:39
  so
• 9:40
  he's
• 9:40
  talking
• 9:40
  about
• 9:40
  Akasthesia.
• 9:41
  Knowing
• 9:41
  which
• 9:42
  medications
• 9:43
  of
• 9:43
  the
• 9:44
  SGAs
• 9:44
  are
• 9:45
  the
• 9:45
  greatest
• 9:45
  offenders
• 9:46
  for
• 9:46
  when
• 9:46
  with
• 9:47
  respect
• 9:47
  to
• 9:47
  akasthesia
• 9:48
  is
• 9:48
  something
• 9:49
  you
• 9:49
  should
• 9:49
  know
• 9:49
  about
• 9:50
  so
• 9:50
  you
• 9:50
  can
• 9:51
  navigate
• 9:51
  this
• 9:51
  properly
• 9:52
  and
• 9:52
  get
• 9:52
  him
• 9:53
  off
• 9:53
  of
• 9:54
  Zyprexa.
• 9:55
  And
• 9:55
  again,
• 9:55
  he
• 9:56
  has
• 9:56
  metabolic
• 9:56
  syndrome.
• 9:57
  So
• 9:57
  we
• 9:57
  talk
• 9:58
  about
• 9:58
  metabolic
• 9:59
  syndrome
• 9:59
  and
• 9:59
  he
• 9:59
  wanting
• 9:59
  to
• 10:00
  be
• 10:00
  switched
• 10:00
  from
• 10:01
  olanzapine
• 10:01
  or
• 10:02
  Zyprexa.
• 10:03
  We
• 10:03
  should
• 10:03
  be
• 10:03
  thinking,
• 10:04
  okay,
• 10:04
  let's
• 10:04
  gravitate
• 10:05
  towards
• 10:06
  the
• 10:06
  geodons,
• 10:07
  maybe
• 10:08
  abilify,
• 10:08
  right,
• 10:09
  because
• 10:09
  they're
• 10:09
  a
• 10:09
  little
• 10:10
  more
• 10:10
  metabolically
• 10:11
  friendly
• 10:11
  like
• 10:11
  we
• 10:12
  heard
• 10:12
  about.
• 10:12
  However,
• 10:13
  his
• 10:13
  deal
• 10:13
  breaker
• 10:14
  here
• 10:14
  is
• 10:14
  akasthesia.
• 10:15
  So
• 10:16
  which
• 10:16
  one
• 10:16
  of
• 10:16
  these
• 10:16
  would
• 10:16
  you
• 10:17
  choose
• 10:17
  for
• 10:17
  him
• 10:18
  given
• 10:19
  all
• 10:19
  of
• 10:19
  this
• 10:19
  information?
• 10:20
  Is
• 10:20
  it
• 10:20
  A,
• 10:20
  Abilify?
• 10:21
  Is
• 10:22
  it
• 10:22
  B,
• 10:23
  cariprazine?
• 10:24
  Is
• 10:24
  it
• 10:25
  C,
• 10:25
  Latuda?
• 10:26
  Is
• 10:26
  it
• 10:27
  D,
• 10:27
  Brexpiprazole?
• 10:29
  I'll
• 10:29
  let
• 10:29
  you
• 10:29
  think
• 10:29
  about
• 10:30
  that
• 10:30
  for
• 10:30
  a
• 10:30
  moment,
• 10:31
  my
• 10:31
  friends.
• 10:33
  The
• 10:33
  answer
• 10:33
  is
• 10:34
  D.
• 10:34
  Brexpiprazole
• 10:35
  demonstrates
• 10:36
  the
• 10:36
  lower
• 10:37
  risk
• 10:37
  of
• 10:37
  all
• 10:37
  of
• 10:37
  these
• 10:38
  choices
• 10:38
  compared
• 10:39
  to
• 10:40
  lurazidone
• 10:42
  and
• 10:43
  Abilify.
• 10:45
  And
• 10:45
  very
• 10:45
  interesting.
• 10:46
  Now
• 10:46
  how
• 10:46
  do
• 10:46
  we
• 10:46
  know
• 10:47
  this?
• 10:47
  When
• 10:47
  you
• 10:47
  open
• 10:48
  your
• 10:48
  textbooks,
• 10:48
  you've
• 10:49
  gotta
• 10:49
  compare
• 10:50
  these
• 10:50
  medications
• 10:50
  and
• 10:51
  it
• 10:51
  can
• 10:51
  be
• 10:51
  a
• 10:51
  little
• 10:51
  bit
• 10:52
  confusing.
• 10:52
  Sometimes
• 10:53
  your
• 10:53
  head
• 10:53
  can
• 10:53
  spin
• 10:54
  because
• 10:54
  there's
• 10:54
  so
• 10:54
  many
• 10:54
  different
• 10:55
  receptors
• 10:56
  and
• 10:56
  each
• 10:56
  of
• 10:56
  these
• 10:56
  meds
• 10:57
  has
• 10:57
  a
• 10:57
  different
• 10:57
  affinity
• 10:58
  for
• 10:58
  each
• 10:58
  receptor.
• 10:59
  I
• 10:59
  have
• 10:59
  fun
• 10:59
  with
• 10:59
  it.
• 11:00
  I
• 11:00
  love
• 11:00
  to
• 11:00
  see
• 11:00
  the
• 11:01
  unique
• 11:01
  signature
• 11:01
  of
• 11:01
  these
• 11:02
  meds.
• 11:02
  It
• 11:02
  makes
• 11:02
  me
• 11:02
  feel
• 11:03
  more
• 11:03
  empowered
• 11:03
  when
• 11:04
  I
• 11:04
  see
• 11:04
  a
• 11:04
  patient
• 11:04
  I
• 11:05
  am
• 11:05
  in
• 11:05
  a
• 11:05
  position
• 11:05
  to
• 11:05
  help
• 11:06
  and
• 11:06
  explain
• 11:07
  why
• 11:07
  I'm
• 11:07
  choosing
• 11:08
  one
• 11:08
  over
• 11:08
  the
• 11:08
  other.
• 11:08
  The
• 11:09
  worst
• 11:09
  thing
• 11:09
  in
• 11:10
  the
• 11:10
  world.
• 11:10
  When
• 11:10
  you
• 11:10
  eeny,
• 11:11
  meeny
• 11:11
  miny
• 11:11
  mow
• 11:12
  a
• 11:12
  medication
• 11:13
  as
• 11:13
  a
• 11:13
  new
• 11:13
  grad
• 11:14
  or
• 11:14
  as
• 11:14
  a
• 11:14
  student
• 11:15
  in
• 11:15
  a
• 11:15
  laboratory,
• 11:16
  you're
• 11:16
  going
• 11:17
  with
• 11:17
  the
• 11:17
  evidence
• 11:17
  and
• 11:18
  picking
• 11:18
  the
• 11:18
  right
• 11:18
  medication.
• 11:19
  But
• 11:19
  you
• 11:19
  can't
• 11:19
  really
• 11:20
  explain
• 11:20
  why
• 11:20
  you
• 11:20
  don't
• 11:21
  want
• 11:21
  to
• 11:21
  be
• 11:21
  one
• 11:21
  of
• 11:21
  those
• 11:21
  prescribers.
• 11:22
  You.
• 11:22
  You
• 11:22
  want
• 11:23
  to
• 11:23
  be
• 11:23
  one
• 11:23
  of
• 11:23
  those
• 11:23
  prescribers
• 11:24
  that
• 11:24
  fully
• 11:24
  understands
• 11:25
  and
• 11:25
  can
• 11:25
  articulate
• 11:26
  why
• 11:27
  you're
• 11:27
  choosing
• 11:28
  one
• 11:28
  medication
• 11:29
  over
• 11:29
  the
• 11:29
  other.
• 11:29
  Why
• 11:30
  is
• 11:30
  that?
• 11:30
  Because
• 11:30
  your
• 11:30
  patients
• 11:31
  oftentimes
• 11:32
  have
• 11:33
  tried
• 11:33
  a
• 11:33
  ton
• 11:33
  of
• 11:34
  different
• 11:34
  medications,
• 11:35
  and
• 11:35
  it
• 11:35
  helps
• 11:36
  to
• 11:36
  give
• 11:36
  them
• 11:37
  some
• 11:37
  reinforcement
• 11:38
  and
• 11:38
  added
• 11:39
  confidence
• 11:39
  and
• 11:39
  context
• 11:40
  as
• 11:40
  to
• 11:40
  why
• 11:40
  you're
• 11:41
  choosing
• 11:41
  this
• 11:41
  one
• 11:42
  versus
• 11:42
  another
• 11:42
  one.
• 11:43
  Now,
• 11:44
  in
• 11:44
  this
• 11:44
  case,
• 11:45
  there
• 11:45
  is
• 11:45
  a
• 11:45
  specific
• 11:46
  reason
• 11:46
  that
• 11:46
  we
• 11:47
  are
• 11:47
  choosing
• 11:47
  presence
• 11:48
  piprazole.
• 11:48
  The
• 11:49
  reason
• 11:49
  is
• 11:50
  that
• 11:51
  Brexpiprazole
• 11:53
  has
• 11:53
  a
• 11:54
  lower
• 11:54
  intrinsic
• 11:55
  activity
• 11:55
  at
• 11:56
  D2
• 11:56
  receptors.
• 11:57
  Okay,
• 11:57
  45%
• 11:58
  versus
• 11:59
  Abilify,
• 11:59
  which
• 12:00
  is
• 12:00
  60%.
• 12:01
  And
• 12:01
  that
• 12:01
  translates
• 12:02
  into
• 12:02
  a
• 12:02
  reduced
• 12:03
  aesthesia
• 12:03
  risk.
• 12:04
  Remember
• 12:05
  that
• 12:06
  Abilify
• 12:06
  is
• 12:07
  a
• 12:07
  partial
• 12:07
  agonist,
• 12:08
  and
• 12:08
  Priprazole
• 12:10
  is
• 12:10
  also
• 12:11
  a
• 12:12
  dopamine
• 12:12
  partial
• 12:13
  agonist.
• 12:13
  When
• 12:13
  they
• 12:13
  latch
• 12:14
  onto
• 12:14
  these
• 12:14
  receptors,
• 12:15
  they
• 12:15
  don't
• 12:16
  fully
• 12:16
  agonize
• 12:17
  the
• 12:17
  receptor
• 12:17
  like
• 12:18
  dopamine
• 12:18
  would.
• 12:18
  Dopamine
• 12:19
  is
• 12:19
  a
• 12:19
  full
• 12:19
  agonist.
• 12:20
  It
• 12:20
  would
• 12:20
  fully
• 12:20
  stimulate
• 12:21
  the
• 12:21
  receptor.
• 12:21
  An
• 12:21
  antagonist
• 12:22
  does
• 12:23
  not.
• 12:23
  It's
• 12:24
  0%
• 12:24
  stimulation
• 12:25
  of
• 12:25
  the
• 12:25
  receptor.
• 12:26
  It
• 12:26
  even
• 12:26
  blocks
• 12:27
  the
• 12:28
  effect
• 12:29
  trying
• 12:29
  to
• 12:29
  be
• 12:29
  exerted
• 12:30
  on
• 12:30
  that
• 12:30
  receptor.
• 12:31
  So
• 12:31
  Brexpriprazole
• 12:32
  gets
• 12:32
  onto
• 12:32
  that
• 12:33
  D2
• 12:33
  receptor
• 12:34
  and
• 12:34
  it
• 12:34
  has
• 12:34
  a
• 12:34
  45%
• 12:35
  affinity.
• 12:36
  Excuse
• 12:37
  me,
• 12:37
  intrinsic
• 12:37
  activity.
• 12:38
  So
• 12:39
  that
• 12:39
  means
• 12:39
  it
• 12:39
  is
• 12:40
  less
• 12:40
  inclined
• 12:41
  to
• 12:41
  cause
• 12:41
  aesthesia,
• 12:42
  because
• 12:42
  we
• 12:42
  know
• 12:43
  abilify
• 12:43
  is
• 12:44
  one
• 12:44
  of
• 12:44
  the
• 12:44
  biggest
• 12:44
  offenders,
• 12:45
  right?
• 12:46
  It's
• 12:46
  partially
• 12:47
  agonizing
• 12:47
  that
• 12:47
  receptor
• 12:48
  at
• 12:48
  60%.
• 12:49
  It's
• 12:50
  kind
• 12:50
  of
• 12:50
  this
• 12:50
  weird
• 12:51
  middle
• 12:51
  state
• 12:51
  between
• 12:52
  antagonizing
• 12:53
  the
• 12:54
  motor
• 12:54
  circuits
• 12:55
  when
• 12:55
  you
• 12:55
  fully
• 12:56
  antagonize
• 12:56
  them,
• 12:56
  like
• 12:56
  with
• 12:57
  Haldol,
• 12:57
  you
• 12:57
  have
• 12:57
  that
• 12:57
  motor
• 12:58
  rigidity
• 12:58
  when
• 12:59
  you're
• 12:59
  kind
• 12:59
  of
• 12:59
  in
• 12:59
  between.
• 12:59
  With
• 13:00
  a
• 13:00
  partial
• 13:00
  agonist,
• 13:01
  you
• 13:01
  have
• 13:01
  this
• 13:02
  kind
• 13:02
  of.
• 13:02
  I
• 13:02
  don't
• 13:02
  know
• 13:02
  whether
• 13:02
  I
• 13:03
  should
• 13:03
  sit
• 13:03
  in
• 13:03
  my
• 13:03
  chair
• 13:03
  or
• 13:04
  get
• 13:04
  up.
• 13:04
  It's
• 13:04
  a
• 13:04
  very
• 13:04
  uneasy
• 13:05
  feeling.
• 13:06
  Brexpriprazole
• 13:07
  lowers
• 13:07
  that
• 13:07
  threshold
• 13:08
  to
• 13:08
  45%
• 13:09
  intrinsic
• 13:10
  activity
• 13:11
  versus
• 13:12
  60%
• 13:12
  for
• 13:13
  Abilify.
• 13:13
  And
• 13:13
  I'm
• 13:13
  really
• 13:14
  harping
• 13:14
  on
• 13:14
  intrinsic
• 13:15
  activity
• 13:15
  here
• 13:16
  because
• 13:16
  I
• 13:16
  think
• 13:16
  it's
• 13:16
  such
• 13:17
  an
• 13:17
  important
• 13:17
  pharmacological
• 13:18
  principle,
• 13:19
  right?
• 13:19
  Intrinsic
• 13:20
  activity
• 13:21
  specifically
• 13:21
  refers
• 13:21
  to
• 13:22
  the
• 13:22
  maximal
• 13:22
  response
• 13:23
  a
• 13:23
  drug
• 13:23
  can
• 13:23
  produce
• 13:24
  when
• 13:24
  it
• 13:24
  binds
• 13:25
  to
• 13:25
  the
• 13:26
  receptor
• 13:27
  expressed
• 13:27
  as
• 13:27
  a
• 13:28
  percentage
• 13:28
  of
• 13:28
  a
• 13:28
  full
• 13:29
  agonist
• 13:29
  effect.
• 13:29
  That's
• 13:30
  why
• 13:30
  I
• 13:30
  mentioned
• 13:30
  dopamine,
• 13:31
  right?
• 13:31
  A
• 13:31
  hundred
• 13:32
  percent.
• 13:32
  We're
• 13:33
  not
• 13:33
  going
• 13:33
  full
• 13:33
  power
• 13:34
  onto
• 13:35
  this
• 13:35
  receptor
• 13:36
  like
• 13:36
  dopamine.
• 13:36
  It's
• 13:37
  partial.
• 13:38
  Abilify
• 13:39
  is
• 13:39
  60%
• 13:41
  versus
• 13:41
  40%.
• 13:42
  With
• 13:43
  brexpiprazole,
• 13:44
  you
• 13:44
  have
• 13:44
  less
• 13:44
  akesthesia.
• 13:45
  Pretty
• 13:46
  cool,
• 13:46
  pearl
• 13:46
  there.
• 13:46
  Actually,
• 13:47
  I
• 13:48
  think
• 13:48
  it's
• 13:48
  very
• 13:48
  useful
• 13:49
  because
• 13:49
  I
• 13:50
  know
• 13:50
  I've
• 13:50
  given
• 13:50
  Abilify
• 13:51
  a
• 13:51
  lot
• 13:51
  of
• 13:51
  times.
• 13:52
  I've
• 13:52
  prescribed
• 13:52
  it,
• 13:52
  and
• 13:53
  sure
• 13:53
  enough,
• 13:53
  especially
• 13:53
  if
• 13:54
  you
• 13:54
  increase
• 13:54
  the
• 13:54
  dose
• 13:55
  too
• 13:55
  quickly
• 13:56
  or
• 13:56
  even
• 13:56
  if
• 13:57
  you
• 13:57
  don't.
• 13:57
  Sometimes
• 13:58
  patients
• 13:58
  really
• 13:58
  complain
• 13:59
  of
• 13:59
  this
• 13:59
  restlessness.
• 14:00
  It's
• 14:00
  associated
• 14:01
  with
• 14:01
  increased
• 14:01
  suicidal
• 14:02
  ideations.
• 14:03
  It
• 14:03
  makes
• 14:03
  people
• 14:04
  very
• 14:04
  anxious.
• 14:04
  They
• 14:05
  often
• 14:05
  mistake
• 14:05
  it
• 14:06
  for
• 14:06
  increased
• 14:07
  anxiety.
• 14:07
  It's
• 14:08
  more
• 14:08
  of,
• 14:08
  like,
• 14:08
  a
• 14:08
  body
• 14:09
  restlessness
• 14:10
  that
• 14:10
  no
• 14:10
  doubt
• 14:10
  makes
• 14:11
  people
• 14:11
  anxious,
• 14:11
  but
• 14:11
  it's
• 14:12
  just
• 14:12
  highly
• 14:12
  unpleasant.
• 14:13
  It's
• 14:13
  very
• 14:13
  difficult
• 14:13
  to
• 14:14
  sleep.
• 14:14
  It's
• 14:14
  very
• 14:14
  difficult
• 14:15
  to
• 14:15
  function.
• 14:15
  It's
• 14:16
  hard
• 14:16
  to
• 14:16
  sit
• 14:16
  on
• 14:16
  a
• 14:16
  bus
• 14:17
  seat.
• 14:17
  It's
• 14:18
  hard
• 14:18
  to
• 14:18
  drive.
• 14:18
  It's
• 14:19
  hard
• 14:19
  to
• 14:19
  have
• 14:19
  a
• 14:20
  conversation
• 14:20
  because
• 14:20
  you're
• 14:21
  so
• 14:21
  restless
• 14:21
  you
• 14:21
  want
• 14:21
  to
• 14:22
  jump
• 14:22
  out
• 14:22
  of
• 14:22
  your
• 14:22
  skin.
• 14:23
  Okay,
• 14:24
  nice
• 14:24
  little
• 14:24
  pearl
• 14:25
  here.
• 14:25
  And
• 14:25
  remember,
• 14:26
  the
• 14:26
  ones
• 14:26
  we
• 14:26
  didn't
• 14:27
  choose,
• 14:27
  Vraylar,
• 14:27
  also
• 14:28
  known
• 14:28
  as
• 14:28
  cariprazine,
• 14:29
  actually
• 14:29
  shows
• 14:30
  a
• 14:31
  very
• 14:31
  high
• 14:31
  risk
• 14:31
  compared
• 14:32
  to
• 14:32
  placebo
• 14:32
  and
• 14:32
  the
• 14:33
  other
• 14:33
  SGAs.
• 14:34
  It's
• 14:34
  kind
• 14:35
  of
• 14:35
  similar,
• 14:35
  even
• 14:36
  worse
• 14:36
  than
• 14:36
  abilify
• 14:37
  in
• 14:37
  some
• 14:37
  ways.
• 14:37
  When
• 14:37
  it
• 14:38
  comes
• 14:38
  to
• 14:38
  akesthesia,
• 14:39
  definitely
• 14:40
  has
• 14:40
  more
• 14:40
  favorable
• 14:41
  metabolic
• 14:42
  properties,
• 14:42
  cariprazine
• 14:43
  or
• 14:43
  vailar.
• 14:44
  But
• 14:44
  the
• 14:44
  akesthesia
• 14:45
  risk
• 14:45
  is
• 14:45
  just
• 14:45
  not
• 14:46
  compatible
• 14:46
  with
• 14:47
  this
• 14:47
  particular
• 14:47
  patient's
• 14:48
  concern.
• 14:49
  Lurasidone
• 14:50
  or
• 14:50
  lituda.
• 14:51
  Also,
• 14:51
  maybe
• 14:52
  13
• 14:52
  to
• 14:52
  22%
• 14:53
  in
• 14:53
  clinical
• 14:53
  trials
• 14:54
  showed
• 14:55
  that
• 14:55
  it
• 14:55
  has
• 14:55
  an
• 14:55
  akesthesia
• 14:56
  risk
• 14:56
  or
• 14:57
  people
• 14:57
  complain
• 14:57
  of
• 14:58
  akasthesia.
• 14:59
  It
• 14:59
  is
• 14:59
  pretty
• 14:59
  good
• 14:59
  metabolically.
• 15:00
  Circling
• 15:01
  back
• 15:01
  to
• 15:01
  question
• 15:01
  number
• 15:02
  one,
• 15:02
  when
• 15:03
  we
• 15:03
  identified
• 15:03
  abilifying
• 15:04
  geodon
• 15:05
  as
• 15:05
  pretty
• 15:05
  favorable
• 15:06
  metabolically,
• 15:07
  I
• 15:07
  would
• 15:08
  add
• 15:08
  lurazidone
• 15:09
  to
• 15:09
  the
• 15:09
  more
• 15:09
  favorable
• 15:10
  metabolic
• 15:11
  properties.
• 15:11
  And
• 15:11
  just
• 15:11
  as
• 15:11
  a
• 15:12
  little
• 15:12
  bonus,
• 15:12
  remember
• 15:13
  that
• 15:13
  your
• 15:13
  patients
• 15:13
  have
• 15:13
  to
• 15:14
  eat
• 15:14
  with
• 15:15
  both
• 15:15
  geodon
• 15:15
  and
• 15:16
  lurazidone,
• 15:17
  Both
• 15:17
  geodon
• 15:18
  and
• 15:18
  latuda,
• 15:18
  also
• 15:18
  known
• 15:19
  as
• 15:19
  lurazidone.
• 15:20
  You
• 15:20
  have
• 15:20
  to
• 15:20
  eat,
• 15:21
  like
• 15:21
  300
• 15:22
  calories
• 15:22
  or
• 15:22
  so
• 15:22
  in
• 15:22
  the
• 15:23
  evening
• 15:23
  for
• 15:23
  them
• 15:24
  to
• 15:24
  be
• 15:24
  properly
• 15:24
  absorbed.
• 15:25
  It's
• 15:26
  kind
• 15:26
  of
• 15:26
  counterintuitive
• 15:26
  because
• 15:27
  you
• 15:27
  think
• 15:27
  they're
• 15:28
  metabolically
• 15:28
  friendly,
• 15:29
  and
• 15:29
  they
• 15:29
  are.
• 15:29
  So
• 15:29
  you're
• 15:30
  thinking,
• 15:30
  these
• 15:30
  are
• 15:30
  great
• 15:31
  medications
• 15:31
  to
• 15:32
  gravitate
• 15:32
  towards
• 15:33
  if
• 15:33
  my
• 15:33
  patient
• 15:33
  doesn't
• 15:33
  want
• 15:34
  to
• 15:34
  gain
• 15:34
  weight,
• 15:35
  and
• 15:35
  yet
• 15:35
  they
• 15:35
  have
• 15:36
  to
• 15:36
  eat
• 15:36
  with
• 15:36
  them.
• 15:36
  Just
• 15:37
  small
• 15:37
  meals,
• 15:37
  very
• 15:38
  small,
• 15:38
  300
• 15:38
  calories.
• 15:39
  So
• 15:39
  we're
• 15:39
  not
• 15:39
  asking
• 15:40
  anybody
• 15:40
  to
• 15:40
  have
• 15:40
  to
• 15:40
  pig
• 15:41
  out
• 15:41
  or
• 15:41
  binge
• 15:41
  on
• 15:42
  em.
• 15:42
  You
• 15:42
  just
• 15:42
  have
• 15:42
  to
• 15:43
  eat
• 15:43
  a
• 15:43
  little
• 15:43
  bit.
• 15:43
  So
• 15:43
  that's
• 15:44
  my
• 15:44
  little
• 15:44
  sprit
• 15:44
  pearl
• 15:45
  that
• 15:45
  I'm
• 15:45
  sprinkling
• 15:46
  on
• 15:46
  top
• 15:46
  today.
• 15:47
  Listen,
• 15:48
  my
• 15:48
  friends,
• 15:48
  I
• 15:48
  hope
• 15:48
  you
• 15:48
  really
• 15:49
  enjoyed
• 15:49
  this.
• 15:50
  The
• 15:50
  second
• 15:50
  generation
• 15:51
  antipsychotics
• 15:52
  are
• 15:52
  really
• 15:53
  fascinating
• 15:54
  and
• 15:54
  we
• 15:54
  could
• 15:54
  talk
• 15:54
  hours
• 15:55
  about
• 15:55
  all
• 15:55
  of
• 15:55
  them.
• 15:56
  The
• 15:56
  subtle
• 15:56
  nuances
• 15:57
  between
• 15:58
  them.
• 15:58
  Very
• 15:59
  interesting.
• 15:59
  You
• 15:59
  got
• 16:00
  the
• 16:00
  powerful
• 16:00
  heavy
• 16:01
  hitters
• 16:01
  like
• 16:01
  Zyprexa
• 16:02
  that
• 16:03
  really
• 16:03
  get
• 16:03
  the
• 16:03
  job
• 16:03
  done
• 16:04
  when
• 16:04
  you
• 16:04
  have
• 16:04
  acute
• 16:04
  psychosis
• 16:05
  and
• 16:05
  you
• 16:05
  need
• 16:06
  to
• 16:06
  really
• 16:06
  contain
• 16:07
  an
• 16:07
  agitated
• 16:08
  presentation
• 16:09
  in
• 16:10
  the
• 16:10
  inpatient
• 16:10
  space,
• 16:10
  Boy,
• 16:11
  Zyprexa
• 16:12
  is
• 16:12
  great.
• 16:12
  But
• 16:12
  if
• 16:13
  you're
• 16:13
  in
• 16:13
  the
• 16:13
  outpatient
• 16:14
  space
• 16:14
  and
• 16:14
  you're
• 16:15
  trying
• 16:15
  to
• 16:15
  keep
• 16:15
  things
• 16:15
  drama
• 16:16
  free,
• 16:16
  well,
• 16:17
  Zyprex
• 16:18
  is
• 16:18
  kind
• 16:18
  of
• 16:18
  like
• 16:18
  shooting
• 16:19
  a
• 16:19
  squirrel
• 16:19
  with
• 16:19
  the
• 16:19
  shotgun,
• 16:20
  right?
• 16:20
  It's
• 16:20
  very
• 16:20
  effective.
• 16:21
  But
• 16:21
  boy,
• 16:21
  can
• 16:22
  that
• 16:22
  cause
• 16:22
  weight
• 16:22
  gain.
• 16:23
  Sometimes
• 16:23
  you
• 16:23
  have
• 16:24
  to
• 16:24
  use
• 16:24
  it.
• 16:25
  Oftentimes
• 16:25
  you
• 16:26
  got
• 16:26
  to
• 16:26
  really
• 16:26
  go
• 16:26
  for
• 16:27
  the
• 16:27
  medications
• 16:27
  that
• 16:28
  can
• 16:28
  still
• 16:28
  get
• 16:29
  the
• 16:29
  job
• 16:29
  done
• 16:29
  and
• 16:30
  not
• 16:30
  give
• 16:30
  the
• 16:31
  patient
• 16:31
  diabetes
• 16:32
  and
• 16:32
  tons
• 16:33
  of
• 16:33
  weight
• 16:33
  gain.
• 16:34
  So,
• 16:34
  you
• 16:34
  know,
• 16:34
  I
• 16:34
  like
• 16:35
  to
• 16:35
  nerd
• 16:35
  out
• 16:35
  on
• 16:35
  this.
• 16:36
  Honest
• 16:36
  to
• 16:36
  God,
• 16:37
  all
• 16:37
  of
• 16:37
  these
• 16:37
  medications
• 16:38
  hold
• 16:38
  a
• 16:38
  special
• 16:39
  place
• 16:39
  in
• 16:39
  my
• 16:40
  heart
• 16:40
  because
• 16:41
  they
• 16:41
  all
• 16:41
  are
• 16:43
  uniquely
• 16:43
  virtuous
• 16:44
  in
• 16:44
  their
• 16:44
  own
• 16:44
  way.
• 16:45
  They
• 16:45
  like
• 16:45
  I
• 16:46
  could
• 16:46
  do
• 16:46
  a
• 16:46
  whole
• 16:46
  episode
• 16:47
  on
• 16:47
  Seroquel.
• 16:47
  Seroquel
• 16:48
  is
• 16:49
  absolutely
• 16:50
  magical
• 16:51
  in
• 16:51
  the
• 16:51
  right
• 16:51
  patient.
• 16:52
  Right?
• 16:53
  And
• 16:53
  you
• 16:54
  know,
• 16:54
  it's
• 16:54
  just
• 16:55
  again,
• 16:55
  we
• 16:56
  could
• 16:56
  talk
• 16:56
  for
• 16:56
  hours
• 16:56
  about
• 16:57
  this,
• 16:57
  but
• 16:58
  don't,
• 16:58
  please
• 16:59
  don't.
• 16:59
  I
• 16:59
  hope
• 17:00
  your
• 17:00
  takeaway
• 17:00
  from
• 17:00
  this
• 17:01
  is
• 17:01
  not
• 17:02
  that
• 17:02
  X
• 17:03
  drug
• 17:03
  is
• 17:03
  better
• 17:03
  than
• 17:04
  X
• 17:04
  drug,
• 17:05
  Y
• 17:05
  drug
• 17:05
  is
• 17:06
  better
• 17:06
  than
• 17:06
  than
• 17:06
  X
• 17:07
  than
• 17:08
  Z
• 17:08
  drug.
• 17:09
  It's
• 17:10
  not
• 17:10
  really
• 17:10
  the
• 17:10
  case.
• 17:10
  Your
• 17:11
  patient
• 17:11
  needs
• 17:12
  to
• 17:12
  be
• 17:12
  tailored
• 17:13
  to
• 17:13
  the
• 17:13
  medication
• 17:14
  that
• 17:15
  is
• 17:15
  most
• 17:15
  likely
• 17:16
  going
• 17:16
  to
• 17:17
  treat
• 17:17
  their
• 17:17
  symptoms
• 17:18
  and
• 17:19
  allow
• 17:19
  them
• 17:20
  to
• 17:20
  thrive
• 17:21
  with
• 17:21
  the
• 17:22
  absolute
• 17:23
  minimum
• 17:23
  number
• 17:23
  of
• 17:23
  side
• 17:24
  effects.
• 17:25
  And
• 17:25
  it's
• 17:25
  really
• 17:25
  important
• 17:26
  we
• 17:26
  know
• 17:26
  what
• 17:26
  those
• 17:26
  deal
• 17:27
  breaker
• 17:27
  side
• 17:27
  effects
• 17:28
  are.
• 17:28
  So.
• 17:29
  Hey
• 17:29
  my
• 17:29
  friends,
• 17:30
  don't
• 17:30
  forget
• 17:30
  to
• 17:30
  become
• 17:31
  Patreon
• 17:31
  members.
• 17:32
  You
• 17:32
  go
• 17:32
  into
• 17:32
  our
• 17:33
  show
• 17:33
  Notes
• 17:34
  for
• 17:34
  three
• 17:34
  bucks
• 17:34
  a
• 17:34
  month.
• 17:35
  You
• 17:35
  have
• 17:35
  tons
• 17:35
  of
• 17:36
  bonus
• 17:36
  knowledge,
• 17:37
  evidence
• 17:37
  based
• 17:39
  slide
• 17:39
  decks,
• 17:39
  beautiful
• 17:40
  visuals
• 17:41
  to
• 17:41
  really
• 17:41
  put
• 17:41
  this
• 17:42
  all
• 17:42
  together
• 17:43
  with
• 17:43
  great
• 17:43
  mnemonics.
• 17:44
  It's
• 17:44
  just
• 17:44
  three
• 17:44
  bucks
• 17:45
  a
• 17:45
  month.
• 17:45
  It's
• 17:45
  a
• 17:45
  steal
• 17:46
  if
• 17:46
  you're
• 17:46
  in
• 17:46
  school
• 17:47
  or
• 17:47
  you
• 17:47
  just
• 17:47
  want
• 17:47
  to
• 17:48
  sharpen
• 17:48
  your
• 17:48
  clinical
• 17:48
  sword.
• 17:49
  Highly
• 17:50
  recommend
• 17:50
  you
• 17:50
  become
• 17:50
  a
• 17:51
  Patreon
• 17:51
  member
• 17:51
  in
• 17:52
  the
• 17:52
  show
• 17:52
  notes.
• 17:52
  We
• 17:53
  love
• 17:53
  all
• 17:53
  of
• 17:53
  you,
• 17:53
  we
• 17:53
  appreciate
• 17:54
  all
• 17:54
  of
• 17:54
  you.
• 17:54
  Until
• 17:55
  next
• 17:55
  time.
• 17:55
  We
• 17:55
  will
• 17:55
  see
• 17:55
  you
• 17:56
  soon.
• 17:56
  Bye
• 17:56
  bye.