2nd gen Antipsychotics

Question 1

Clozapine

Answer 1

25 to 900 mg

Side effects: weight gain, hyperlipidemia, diabetes, Tachy, sleepy, drooling.

Rare: Agranulocytosis, NMS, hyperprolactinemia

Check ANC: weekly during the first 6 months, biweekly during the next 6 months, then monthly

If ANC is less than 500, stop the drug

Monitor for myocarditis and ask about family history of cardiovascular disease

There’s a dose-dependent seizure risk.

Question 2

Quetiapine

Answer 2

50 to 800mg

Side effects: cataracts, transient and asymptomatic elevated LFTs

Give it BID or TID

No prolactin elevation

Question 3

Olanzapine

Answer 3

5 to 20mg daily
Injection is 150 to 405mg biweekly or monthly

You have monitor them for 3 hours after the LAI to make sure they don’t get delirium sedation syndrome

Elevated LFTs, mild prolactin elevation

Question 4

Risperidone

Answer 4

2 to 8 mg
25 to 50 mg biweekly

galactorrhea, nausea, insomnia

Doses above 6mg are associated with EPS

It has less weight gain than some other 2nd gens

Question 5

Ziprasidone

Answer 5

40 to 200mg

10 to 20 mg for acute IM
Sleepy, QTc prolonged, skin reaction, drug reaction with eosinophilia and systemic symptoms (DRESS)

Requires QTc monitoring. Avoid giving with other drugs that prolong QTc.

Take with food to increase absorption.

Use cautiously in clients at risk for hypokalemia, hypomagnesemia, clients who had an MI, or clients with CHF

Question 6

Paliperidone

Answer 6

3 to 12 mg
39 to 234 mg monthly
273 to 819 every 3 months

Hyperprolactinemia

Question 7

Aripiprazole

Answer 7

5 to 30mg
200 to 400mg monthly

Side effects: agitation, anxiety, insomnia or somnolence, akathisia, GI upset

It’s a D2 partial agonist

Question 8

Iloperidone

Answer 8

12 to 24mg in divided doses

Side effects: sedation

Titrate slowly because of the alpha 1 antagonist properties

Might be helpful for PTSD arousal symptoms due to the alpha 1 blocking

Question 9

Asenapine

Answer 9

5 to 10mg BID, sublingual

Side effects: Akathisia, somnolence

Question 10

Lurasidone

Answer 10

40 to 160mg daily

Side effects: Akathisia, sedation, and nausea

Take with food to increase absorption.

Use a lower dose, and be cautious with people with renal or liver impairment

Question 11

Brexpiprazole

Answer 11

2 to 4mg

Akathisia, weight gain

Question 12

Cariprazine

Answer 12

1.5 to 6 mg

EPS, akathesia, restlessness, GI, somnolence

Question 13

Aripiprazole lauroxil

Answer 13

441 to 882 monthly IM

Akathisia