2nd Generation (A-typical) Antipsychotics

Question 1

name the 2nd generation (atypical) antipsychotics

(“Dali the atypical surrealist”)

Answer 1

“quite please only whispering is appropriate “

Quetiapine
(“Quite”)

Olanzapine
(“Only”)

Risperidone
(“whispering”)

Aripiprazole
(“appropriate”)

Clozapine
(“clozapine closet”)

Ziprasidone
(“black dress zipper”)
​

Question 2

2nd generation (atypical) antipsychotics MOA

Answer 2

-block dopamine D2 receptors in the CNS
(“Dali holding double rope”)

-Block serotonin 5HT-2A receptor
(“cut smiley cheese”)

Question 3

what can 2nd generation (atypical) antipsychotics be used for ?

Answer 3

-SGAs are useful in treatment of both positive and negative symptoms of Schizophrenia
(“Dali hearing both positive and negative voices”)

-can treat resistant depression
(“resisting bottle” from chateu tyramine)

-useful in managment of OCD adjunctive with SSRIs
(“obssesively neat museum coworker aligning the pictures”)

-can help manage tourette syndrome
( Dali holding “tourett’s marionette”)

Question 4

what are the side effects associated with 2nd generation (atypical) antipsychotics

Answer 4

-block H1 histamine receptors

• causes sedation
  (“passed out brown piece of shit in painting”)

-blocks α1 receptors
(“extinguished single candle on wall”)

• ​causes orthostatic hypotension
  (“passed out brown piece of shit in painting”)

-SGAs block muscarinic receptors and have Antimuscarinic effects especially Clozapine but in general less antimuscarinic effects than FGAs

• dry mouth
• ​constipation
• ​blurred vision
• ​urinary retention

(“antimuscarinic tea party painting hanging behind clozapine closet and partialy covered”)

-SGAs , especially Olanzapine and Clozapine can cause

• Weight gain
  (“fat face of brown piece of shit in painting”)
• ​ Hyperglycemia
  (“bunch of candy on floor of painting”)
• ​Dyslipidemia
  (“elevated butter” in painting)

​-SGAs can cause torsade de pointes
(“twisted torsades streamer all over the damn place”)

(coworker with “bee swatter” hitting bee paintings)

Question 5

Clozapine

(“Clozapine Closet”)

Answer 5

-can cause Agranulocytosis
(“melting sand timers”)

-can cause myocarditis and cardiomyopathy
(“surreal heart in melting painting”)

-clozapine reduces seizures threshold
(“shaking clock in melting painting”)

Question 6

what is the defining difference between 1st and 2nd generation antipsychotics ?

Answer 6

• the defining difference is that in 2nd generation drug therapy the incidence of Extra Pyramidal Symptoms is reduced [EPS via blocking D2 Receptors]
  (“kid with EXTRA pyramid hat is causing disturbance and is asked to leave the exhibition”)

EPS include (FGA>SGA)

• acute dystonia
• ​akathisia
• ​Parkinsonism

**Risperidone has the highest risk of causing EPS among SGAs**
(“whispering kid whisperes to EXTRA pyramid hat kid”)

-blocking D2 receptors leads to hyperprolactinemia [FGA>SGA]
(“disturbing kid has milk mustache”)
——————————————————————————-another difference is that the incidence of Neuroleptic Malignant Syndrome is also reduced but is still possible [FGA>SGA]

• NMS Includes mental status changes , rigidity , autonomic instability , fever
• ​NMS is associated with rhabdomyolysis