2nd gen antipsychotics

Question 1

What is the main distinguishing factor for a second generation AP

Answer 1

Blockade of the 5HT2A receptor

Question 2

Targets of the 2nd gen APs

Answer 2

D2 inhibition

5HT2A inhibition

All have sig. H1 inhibition - especially clozapine and quetiapine

antihistamine - all Ms

antiadrenergic - alpha1

Question 3

What are the side effects of the SGAs

Answer 3

Ortho Hypo AND reflex tachycardia

Antimuscarinic- especially clozapine

CNS depression
Sedation
Dementia

Weight GAIN- (fat judy)
Dyslipidemia, hypercholesterolemia
Insulin resistance/Diabetes.
- these metabolic effects are strongest with Clozapine and Olanzapine, lowest with Ziprasidone (skinny lady)

Potentially LETHAL SEs:

• Long QT syndrome and Torsades
• Agranulocytosis and Neutropenia
• Myocarditis and cardiomyopathy

AND STILL ALL THE ONES FROM FGAs. They just occur at lower rates. - The lowest rates are with clozapine which has the weakest D2 binding.

Extra pyramidals
Neuroleptic malignant syn
Rhabdomyolysis
Hyperprolactinemia - especially with rhisperidone. 
Lowered Seizure threshold

Question 4

List the SGAs

Answer 4

Quetiapine
Olanzipine
Risperadone
Aripiprazole
Zipasidone
Clozapine

Question 5

What are the UNIQUE SEs to Clozapine

Answer 5

• strongest antimuscarinic AP
• most potent drop in seizure threshold
• strongest dyslipidemia and metabolic effects.

LIFE THREATENING:

• Agranulocytosis and Neutropenia - needs routine WBC counts
• Myocarditis and Cardiomyopathy

Question 6

Which SGA causes the most hyperprolactinemia

Answer 6

Risperidone

Question 7

What is unique about Aripiprazole?

Answer 7

It is a Partial agonist of D2, not pure antagonist