Antipsychotics

Question 1

1st Gen Antipsychotics- Available Low Potency Drugs

Answer 1

• Chlorpromazine (Thorazine)

- Thioridazine (Mellaril)

Question 2

1st Gen Antipsychotics- Available High Potency Drugs

Answer 2

• Haloperidol (Haldol)
• Fluphenazine (Prolixin)
• Pimozide (Orap)

Question 3

1st Gen Antipsychotics- Available Mid Potency Drugs

Answer 3

• Loxapine (Loxitane)
• Thiothixene (Navane)
• Trifluoperazine (Stelazine)
• Perphenazine (Trilafon)

Question 4

Low Potency 1st Gen Antipsychotics- Advantages

Answer 4

• LOWER EPS RISK (dopamine system side effects)
• highly sedating
• injectable
• inexpensive

Question 5

Low Potency 1st Gen Antipsychotics- Disadvantages

Answer 5

• STRONGER ANTICHOLINERGIC EFFECTS
• highly sedating
• risk of qTC prolongation
• risk of tardive dyskinesia

Question 6

High Potency 1st Gen Antipsychotics- Advantages

Answer 6

• WEAKER ANTICHOLINERGIC EFFECTS
• injectable/IV
• depot
• inexpensive

Question 7

High Potency 1st Gen Antipsychotics- Disadvantages

Answer 7

• HIGH EPS RISK

- high risk of dopamine system side effects (EPS & tardive dyskinesia)

Question 8

2nd Gen Antipsychotics- Available Drugs

Answer 8

• Clozapine (Clozaril)
• Risperidone (Risperdal)
• Quetiapine (Seroquel)
• Olanzapine (Zyprexa)
• Ziprasidone (Geodon)
• Aripiprazole (Abilify)
• Paliperidone (Invega)
• Asenapine (Saphris)
• Iloperidone (Fanapt)

Question 9

Clozapine (Clozaril)

Answer 9

• rqrs more time
• 1st 4 weeks = initial titration of clozapine
• at least 12 weeks of therapeutic dose (= 16 weeks total)
• it takes close to 6 mo. to evaluate a complete trial of medication
• many pts who are otherwise refractory improve on clozapine; compared to risperidone, more pts on clozapine remain discharged
• PROTECTS against suicide
• other reasons to use: recurrent suicidality or violence, substance abuse, persistence of positive sxs
• SE: AGRANULOCYTOSIS, sialorrhea (drooling), ANTICHOLINERGIC EFFECTS, highly sedating, wt. gain, lowers seizure threshold
• only antipsychotic shown to be MORE EFFICACIOUS

Question 10

Paliperidone (Invega)

Answer 10

• does not require hepatic metabolism
• 80% renally excreted, thus avoid with kidney problems
• dose-dependent EPS & prolactin elevation
• metabolite of risperidone
• long-acting injectable form (Sustenna)

Question 11

Quetiapine (Seroquel)

Answer 11

• lowest EPS risk
• moderate risk of wt gain
• common side effects include sedation and orthostatic hypotension

Question 12

Olanzapine (Zyprexa)

Answer 12

• pts more likely to be compliant
• high risk of wt gain and metabolic syndrome
• liver irritation, thus be careful in pts with hepatitis or taking other meds that irritate liver (statins, depakote, carbamazepine, naltrexone)

Question 13

Asenapine (Saphris)

Answer 13

• dopamine system side effects
• orthostasis, hypotension, syncope, qTC prolongation
• wt gain

Question 14

Depot Formulations

Answer 14

1st Gen:

• Haloperidol decanoate (Haldol)
• Fluphenazine decanoate (Prolixin)

2nd Gen:

• Risperidone depot (Risperdal consta)
• Paliperidone palmitate (Invega sustenna)

Side Effects:

• EPS
• TD
• metabolic syndrome
• prolonged qTC
• increased mortality in elderly
• NMS