Antipsychotics Flashcards
Clozapine
FDA approvals
Unique properties
Prominent Side effects
Starting dose
Atypical Antipsychotic
DSN-RAn
Trt-resist Schizo
Reduction risk in suicidal behavior for scz pts
Interactions at myriad of NT receptors
Gold standard for positive sypm efficacy
Orthostatis, sialorrhea, constipation, sedation, weight gain, hyperglycemia, TD, NEUTROPENIA, PARALYTIC ILEUS
Start: 25mg QHS
Olanzapine
FDA approvals
Unique properties
Prominent Side effects
Starting dose
Atypical antipsychotic (serotonin-dopamine antagonist)
DS-RAn
Schz
Scz maint
Agitation (IM)
Acute/Mixed Mania
Bipolar Dep.
Trt-R Dep
Weight gain, but good efficacy with schz, mania, and even dep.
METABOLIC, sedation, DRESS, TD, NMS
Start: 5-10mg QD
Quetiapine
FDA Approved:
Unique properties
Prominent Side effects
Starting dose
Atypical
DS-MM (Dopamin-Serotonin multimodal)
Schiz (Acute & maint)
Mania
Bipolar (maint & dep)
MDD
“3” (800 antipsych, 300 antidep, 50 sleep). Preferred pakinsons psychosis. Dosing differs in effects. No motor SE or PRL inc.
Sedation, Metabolic/weight gain, anticholinergics, orthostatic HypT, TD
Asenapine
FDA
Unique properties
Prominent Side effects
Starting dose
Atypical Antipsychotic
DSN-RAn
Schiz
Mania/mixed mania
Bipolar maint
Sublingual formulation. Possible antidepressant properties.
sedation, dizziness, akathesia, DIP, orthos, TD, ANAPHYLAXIS,
Start: 3.8mg Q24H
Risperidone
Unique properties
Prominent Side effects
Starting dose
Atyp
DS-RAn
Schz (13 +)
Mania/Mixed mania
Autism irritablitlity
Bipolar maint
Often preferred for pediatrics. High risk PRL ^
Weight gain, Sedation, DIP, Akathesia, PRL^, Tachycardia, TD, Nausea, constipation, dry mouth
Start: 1mg Qday & increase by 1mg/day
Paliperidone
FDA app
Unique properties
Prominent Side effects
Starting dose
Atypical (DS-RAn)
Schizo (12+)
Schizoaffective
Metabolite of risperidone - few drug interactions. Better tolerated than Risp, LAIs
DIP, PRL^, metabolic, Sedation, Tachycardia, orthos, TD, NMS
Ziprasidone
FDA apps
Unique properties
Prominent Side effects
Starting dose
Atypical (DS-RAn)
schizo (acute & maint)
agitation
Bipolar mania & maint
QTC prolongations, Little/No metabolic effect, short acting, must take w/food
Activation, dizziness, DIP, sedation, orthos, TD QTc prolongation, DRESS
Start: 20mg BID
Lurasidone
Unique properties
Prominent Side effects
Starting dose
Atypical (DS-RAn)
Schizo (13+)
Biploar dep.
Antidepressant actions (bipolar depression efficacy). Must take with food, Low/no weight gain, dosing at night mitigates sedation & motor SE
Dose-dependent sedation
Akathesia
Nausea
PRL^
TD
NMS
Start: 40-80mg QD w/food
Aripiprazole
FDA appz
Unique properties
Prominent Side effects
Starting dose
Atypical
Dopamine-Serotonin Partial Agonist (DS-RPA)
Schiz (13+) & maint
Mania Acute/mixed
Bipolar maint
MDD
Agitation (ASD)
Used more in dep; low motor SE, reduces PRL, low weight gain, 52h half life
Dizzines, akathesia, activation, N/V, constipation, headache, orthos, TD
Starting:
Schiz (10-15mg QD)
Depression (2-5mg QD)
Brexpiprazole
Unique properties
Prominent Side effects
Starting dose
Atypical
DS-RPA
Schiz (13+)
MDD
Agitation
Agitation in alzhiemers efficacy, adjunct treatment for derpession,
Akathesia, anxiety, weight gain, sedation, HA, TD, NMS
Start:
0.5mg - 1mg QD
Cariprazine
FDA
Unique properties
Prominent Side effects
Starting dose
Atypical
DS-RPA
Schizo (acute & maint)
Mania (acute/mix)
Bipolar dep
MDD (adjunct)
Good antidepressant effect, possible effect on negative symptoms & cognition, low DIP (some akathesia…titrate slow), low metabolic disturbance,
Akathesia, EPS, GI distress, Sedation, TD, NMS
Start:
schz (1.5 - 6mg QD)
Biplar mania (1.5mg QD)
Bipolar dep ( 1.5m QD)
Haldol
Unique properties
Prominent Side effects
Starting dose
Antipsychotic
D-RAn
Psychosis
Schizophrenia
Tics
Severe children behavior?
Effective, but may cause negative symptoms, less sedating
NIDS
Akathesia, DIP
TD
Galactorrhea (PRL ^)
Dizzynness/ sedation
Anticholinergic effects
Weight gain
Start: 1-15mg/day
