Reference no: EM133425487

Roger is an 18 y/o WM who is brought into the emergency department after being picked up by EMS. He was walking around the local mall and hiding behind objects in stores "looking suspicious" according store owners. The police interviewed Roger and determined he must be suffering from sort of mental illness since he stated he was "on a mission to find spies" and that the "CIA was sending messages via the store music". Roger is a college freshman, and according to his roommate, he has been acting strange for several weeks. Roger's roommate states that he has always been a straight "A" student and was not one to get into trouble or experiment with drugs or alcohol. Roger's drug screening was negative, and his PMH was non-contributory. All labs and vitals are WNL. EKG revealed a QTc of 494 msec. Roger is somewhat agitated and diagnosed with new onset schizophrenia. He has been acutely managed with lorazepam 2mg IV + haloperidol 5mg IV. The physician is requesting your assistance with selecting a maintenance regimen.

What medications would you avoid and why?

Which atypicals have the highest risk of metabolic effects? The lowest?

What non-injectable antipsychotic would you recommend for Roger and why? (Provide initial starting dose)

What are the metabolic monitoring parameters that should be assessed at baseline prior to starting Roger on antipsychotic therapy?

If you were told that Roger was "cheeking" his medications, how would that alter your recommendation?

Roger gets stabilized on a dose of risperidone 4mg daily but has difficulty remembering to take his medication regularly. What long acting injectable would you recommend? Provide name (brand & generic), route, and dosing frequency.

Does Roger need a loading dose or PO overlap with the LAI you selected?