2nd Gen Antipsychotics

Question 1

Risperidone (Risperdal)

Answer 1

Action: serotonin-dopamine antagonist

Half-life: 3 (fast metabolizers, 120 in poor metabolizers)

Side effects: EPS at high doses, postural hypotension, increased prolactin, weight gain, sedation, decreased concentration

Comments: present in breast milk

Question 2

Olanzapine (Zyprexa)

Answer 2

Action: serotonin-dopamine antagonist

Half-life: 31hr

Side effects: increased prolactin, orthostatic hypotension, anticholinergic side effects, weight gain, somnolence

Comments: get AAT levels (drug affects liver)

Question 3

Quetiapine (Seroquel)

Answer 3

Action: serotonin-dopamine antagonist

Half-life: 7hr

Side effects: orthostatic hypotension, somnolence, transient increase in weight

Comments: slit lamp eye exam at baseline and every 6 mo for those at risk for developing cataracts

Question 4

Ziprasidone (Geodon, Zeldox)

Answer 4

Action: serotonin-dopamine antagonist

Half-life: 7hr

Side effects: dose-related QT interval prolongation, postural hypotension, sedation

Comments: present in breast milk, baseline K and Mg levels

Question 5

Aripiprazole (Abilify)

Answer 5

Action: partial dopamine and serotonin-1A receptor agonist, and post-synaptic serotonin-2A antagonist

Half-life: 75hr

Side effects: headache, nausea, insomnia, somnolence

Comments: non-sedating, no risk of weight gain or diabetes

Question 6

Clozapine (Clozaril)

Answer 6

Action: serotonin-dopamine antagonist

Half-life: 5-15hr

Side effects: agranulocytosis, anticholinergic, weight gain, sedation, NMS

Comments: CBC w diff required weekly for first 6 mo, then Biweekly