A.28. 2nd generation ("atypical") antipsychotic agents

Question 1

characteristics of atypical antipsychotic agents

Answer 1

1. 5-HT blockade is the dominant mechanism of most
2. beneficial effects on both positive and negative symptoms
3. metabolic syndrome is a common side effect
4. reduced risk to develop EPS, hyperprolactinemia and NMS (compared to typical)

Question 2

what are tiapride and cariprazine?

Answer 2

atypical antipsychotic, D2/D3 antagonist

cari - D3> D2

Question 3

when is tiapride used?

Answer 3

alcohol psychosis

Question 4

dose of tiapride

Answer 4

200-300 mg (acute)

Question 5

what are the indications for cariprazine?

Answer 5

schizophrenia, bipolar disorder (manic episode)

Question 6

what is important to remember in cariprazine?

Answer 6

it’s a Hungarian development

Question 7

list the atypical antipsychotic agents (2nd generation)

Answer 7

clozapine 
olanzapine
risperidone 
aripiprazole 
quetiapine

Question 8

list the first-line atypical antipsychotic agents

Answer 8

olanzapine
risperidone
aripiprazole
quetiapine

Question 9

what is the atypical antipsychotic agent that is used as 3rd choice schizophrenia (non-responder)?

Answer 9

clozapine

Question 10

low 5-HT₂ₐ blocking

Answer 10

quetiapine

Question 11

which agent has mostly low blocking effect of everything but high sedation effect

Answer 11

quetiapine

Question 12

strong muscarinic, serotonin and 𝝰 blockage

Answer 12

clozapine

Question 13

Do all agents have histamine blockage?

Answer 13

yes

Question 14

does clozapine cause Parkinson’s?

Answer 14

no never!

also no TD

Question 15

SE of clozapine

Answer 15

bone marrow supression--> agranulocytosis 
increased salivation , hypotension 
seizures 
myocarditis 
weight gain, metabolic effects

Question 16

whIch agents improve negative symptoms?

Answer 16

olanzapine and risperidone

Question 17

dose for olanzapine

Answer 17

acute: 10mg IM

Question 18

SE of olanzapine

Answer 18

weight gain, metabolic effects

Question 19

which agent has a significant risk for EPS?

Answer 19

risperidone

Question 20

what is the T1/2 of aripiprazole ?

Answer 20

long-acting, T1/2 up to 3 days

Question 21

partial agonist for D₂ receptor?

Answer 21

aripiprazole

Question 22

partial agonists of 5-HT₁ₐ receptors

Answer 22

QA
Quetiapine
Aripiprazole

Question 23

general considerations of 2nd gen’ AP agents

Answer 23

• all antipsychotics have a pro-convulsive effect (↓ the seizure threshold)
• AP causing sedation or hypotension, must be titrated in order to avoid collapse and strong sedation

Question 24

which agent doesn’t cause sedation?

Answer 24

Aripiprazole