Antipsychotics Flashcards
SGA - highest metabolic risk
Clozapine, olanzapine, quetiapine
SGA - moderate metabolic risk
Risperidone, paliperidone
SGA - lower metabolic risk
Aripiprazole, ziprasidone, lurasidone, and asenapine
SGA - lowest EPS risk
Quetiapine (recommended in patients with PD who needs antipsychotics)
SGA - highest hematologic effects
Clozapine (agranulocytosis)
SGA - highest QT prolongation risk
Ziprasidone
SGA - highest increased prolactin risk
Risperidone, Paliperidone
SGA - highest seizure risk
Clozapine (dose-dependent)
Antipsychotic MOA
blocks dopamine and serotonin receptors (less with FGA)
BBW for antipsychotics
Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death.
Dystonia
prolonged contraction of muscle during initiation of FGAs, including painful muscle spasm; can be fatal if airway is compromised. higher risk with younger males. May prophylactically treat with diphenhydramine, benztropine.
Akathisia
restlessness with anxiety and an inability to remain still. Treated with diphenhydramine, benztropine, benzodiazepines or propranolol.
Tardive dyskinesia
abnormal facial movement, primarily tongue or mouth. Higher risk with elderly females. Stop the drug and replace with SGA. TD can be irreversible.
Dyskinesia
abnormal movements
Clozapine monitoring
REMS: Baseline ANC must be 1500/mm2 or more to start the treatment. check ANC weekly x 6 months, then Q2W for 6 months, then monthly. Stop if ANC <1,000