Antipsychotics Flashcards
Aripiprazole/Abilify
Atypical- Dopamine receptors
Use: Schizophrenia
- Acute/mixed mania (10+) Bipolar
- SSRI adj
- Autism irritability
- Tourette’s
- Acute agitation r/t schizophrenia or bipolar
- Depression adjunct
bipolar depression
- behavior disturbance dementia
● impulse control, irritability
● Good adjunct if irritable
Dose: Max 30 mg
- 15-30 mg for Schizophrenia/Bipolar
- 2-10 SSRI adjunct
- 5-15 Autism
TAB: 2, 5, 10, 15, 20, 30
13+- 1 mg BID, then 2.5 mg BID
Side effects
- Activating @ higher dose
● >15 mg rarely more effective
● 4-6 weeks efficacy
● SE: dizziness, insomnia, akathisia, orthostatic
hypotension
● CYP 450 3A4
Olanzapine/Zyprexa
Atypical- Dopamine and serotonin receptor antagonist
Use: Schizophrenia
- Acute mania
- Bipolar
- Acute agitation
- Bipolar depression (combo with fluoxetine)
- Behavior disturbance dementia
Dose: Start 5 mg, (2.5 non-smoker, elderly), max 20 mg doses
- Tab 2.5, 5, 7.5, 10, 15, 20
Side effects:
- Hepatic- lower dose, no removed dialysis
● sedation, weight gain, Neuroleptic Malignant Syndrome, dizziness
● Augment for bipolar & tx resistant dep.
● Antagonize levodopa/dopamine agonist
● NO glaucoma
Lurasidone/Latuda
Atypical- Dopamine and serotonin receptor antagonist
Use: Schizophrenia
- Bipolar depression
- Acute mania
- Bipolar maintenance
- bx disturbance in
dementia
- children & adolescent impulse control
● Reduce positive sx, improve neg sx
Dose: Start 20 mg daily, max 160mg
- 20-60mg for Bipolar
- 40-80 for schizophrenia
- TAB: 20, 40, 60, 80, 120
13+ preferred
Side effects:
- Taper /cross taper off
● Renal & hepatic adjustment
● Sudden d/c= rebound effect
● Caution cardiac, no angioedema hx
● Metabolic friendly
● No ketoconazole or rifampin
Quetiapine/Seroquel and Seroquel XR
Atypical- dopamine, serotonin
Use: Schizophrenia
- Acute mania
- Bipolar maintenance
- Bipolar depression
- Depression
- Mixed mania
- bx disturbance r/t
dementia
- parkinsons (hallucinations and delusions)
- lewy body behavioral symptoms
- severe tx-resistant anxiety
Dose: Start 25-50 mg bid/TID max 800
- 400-800 mg/day in 1 (XR) or 2 (IR) doses for schizophrenia
- 400-800 mg/day in 1 (XR) or 2 (IR) doses for bipolar mania
- 300 mg bedtime for bipolar depression
● High anxiety, racing thoughts- 25mg
bid, 100mg hs
● XR- help with drug cravings
Age 13+ schiz
Age 10+ mixed/mania
- Tabs in 25, 50, 100, 200, 300, 400
- XR: 50, 150, 200, 300, 400
Side effects:
- sedation, dizziness, orthostasis,
cataracts, dry mouth, constipation, weight gain
● Lower dose hepatic
Risperidone/Risperdal
Atypical- Dopamine, serotonin, norepinephrine receptor antagonist
Use: Schizophrenia
- Acute mania
- Autism-related
irritability
- bipolar maintenance
- bipolar depression
- bx disturbance dementia
- children & Adolescent impulse control
- aggression
● Long term maintenance bipolar and
behavior disorder
Dose: Start 1 mg divided daily-BID, max 16 mg
- Tabs: 0.25, 0.5, 1, 2, 3, 4
- Solution: 1 mg/ML
- Kids: 0.5-2 mg
Side effects:
- >4mg rarely effective (target 2-6 mg)
● adjust for renal and liver diseases
● gynecomastia, hypotension and
prolonged QT, dizzy, insomnia, sedating
Ziprasidone/Geodon
Atypical- Dopamine and serotonin receptor antagonist
Use: Schizophrenia
- Acute agitation in
schizophrenia
- Acute mixed mania
- bipolar maintenance
● Weight neutral
● Activating low dose, sedating high dose
● Good for cognitive sx, unstable mood
Dose: start 10-20 mg bid, max 160 mg, take with food
- Capsules in 20, 40, 60, 80
- > 40mg rarely more effective
● Take with food 300 calories
● SE of QT prolongation, nausea, dry mouth,
orthostatic hypotension
● No arrhythmia, CHF
Carprazine/Vraylar
Atypical- Dopamine, serotonin, norepinephrine receptor antagonist
Use: Schizophrenia
- Acute mania
- Bipolar
- Tx resistant depression
- bx disturbances in
dementia
- children, & adolescent impulse control
● Reduce positive sx, improve negative
● Helps unstable mood in depression and
mania
Dose: Start 1.5 mg daily, max 6 mg
- Mania- 3-6
- Schizophrenia- 1.5-6
- Capsules in 1.5, 3, 4.5, 6
Side effects:
- d/c if ANC <1000 or unexplained decr. In WBC
● Long half life
● SE: GI, EPS, akathisia
● May antagonize levodopa, dopamine agonist
● Avoid severe renal/hepatic
Brexipiprazole/Rexulti
Atypical- Dopamine partial agonist
Use: Schizophrenia
Tx-resistant depression
- Acute mania
- Bipolar
● Good adjunct if irritable
● Cognitive improvement
Dose: Start 0.5-1mg daily, max 3mg
- Tabs in 0.25, 0.5, 1, 2, 3, 4 mg
Side effects:
- adjust for renal and hepatic (max 2 mg)
● Caution cardiac
● SE of weight gain
● CYP 450 3A4- take ½ dose of rexulti
Paliperidone/Invega (Sustenna)
Atypical- dopamine and serotonin receptor antagonist
Use: Schizophrenia (12+)
- Schizoaffective
- psychotic disorder
- Bipolar,
Behavior disturbance and impulse control
Dose: Start 6mg am, max 9 mg
- Tabs 1.5, 3, 6, 9
Side effects:
- Neuroleptic Malignant Syndrome, prolactin, EPS, tachycardia,
orthostatic hypotension
● Renal- see Stahl’s, caution cardiac- QTC,
CHF
Asenapine/Saphris
Atypical- Dopamine, serotonin, norepinephrine receptor antagonist
Use: Schizophrenia
- acute/mixed mania
- Adjunct to lithium or valproate in adults
Dose: Start 2.5mg, max 20 divided
- Sublingual 2.5, 5, 10
Ages 10+
Side effects:
- Neuroleptic malignant syndrome, oral ulcers, akathisia
● Must be sublingual, does not absorb in GI tract
● No food/drink for 10 minute
● CYP 450, 2D6, 1A2
Clozapine/Clozaril
Atypical
Use: Tx resistant schizophrenia
- tx- resistant bipolar disorder
Rarely used. See stahl’s
neutropenia is a major side effect
Haloperidol/Haldol
1st generation/typical- dopamine receptor antagonist
Use: Manifestations of psychotic disorders
- Tics in Tourette’s
- 2nd line behavior problems
children
- 2nd line short term tx hyperactive child
- Bipolar disorder
- Behavioral disturbances
in dementias
- Delirium (with lorazepam)
Dose: Start 0.5-2mg BID-TID for moderate sx
- 3-5mg BID-TID for severe sx
-Max 100mg (psychosis)
Tabs in 0.5, 1, 2, 5, 10, 20
Side effects:
- akathisia, EPS, parkinsonism, dizziness,
sedation, dry mouth, constipation, decreased
sweating
● Avoid Parkinson’s
● Caution renal, hepatic, cardiac
Fluphenazine/Prolixin
1st generation/typical- dopamine 2 antagonist
Use: Psychotic disorders and bipolar
Dose: Start 2.5-10mg divided every 6-8hrs, max 40 mg (psychosis)
- Tabs in 1, 2.5, 5, 10mg
- Solution in 2.5mg/5mL, 5mg/ML
- Injection in 2.5mg/mL
Side effects:
- Taper- rebound effect
● Caution: seizures, diuretics, ETOH
● Akathisia, priapism, EPS, parkinsonism,
TD, dizziness, sedation, hypotension,
tachycardia, syncopy, photosensitivity, heat
exposure
● Caution with renal/hepatic. NO cardiac hx
Perphenazine/Trilafon
1st generation/Typical- dopamine receptor antagonist
Use: Schizophrenia, Nausea/vomiting, other psychotic disorders, bipolar disorder
Dose: start 4-8mg TID
- Max 64mg
-Tab: 2, 4, 8, 16
Side effects:
- anticholinergic, hypotension, tachycardia,
syncope, photosensitivity, heat exposure
● Caution: respiratory d/o, ETOH, seizures,
urinary retention
● NO Parkinsons, Lewy Body
Chlorpromazine/Thorazine
1st generation/Typical- Dopamine receptor antagonist
Use: Schizophrenia
- Mania
- Combative/explosive
hyperexcitable behavior in children
- Hyperactive with conduct d/o (impulsive,
attention, aggressive, mood lability, poor
frustration tolerance)
- psychosis
- Bipolar D/O
● Short term relief daytime agitation
Dose: 200mg- max 800mg
Tab: 10, 25, 50, 100, 200
Capsules in 30, 75, 150
Kids over the age of 1 check stahl’s
Can be sedating with a low dose
Side effects:
- Neuroleptic Malignant Syndrome
● Akathisia, Tardive Dyskinesia, dizziness, anticholinergic,
hypotension, tachycardia, urinary retention
● Avoid caution/hepatic impairment
● Taper off
● Increase antihypertensive, alcohol & diuretics
may increase hypotension, reduce
anticoagulants
