Antipsychotics and Mood Stabilizers Flashcards
Ziprasidone/Geodon
Sedating- Start at 80mg qhs
Cannot have SSRI with it- especially not Celexa or Lexapro because it can cause prolonged QT interval
No LAI form
Must take with 500 calories of food
Good for bipolar I and II
Low on weight gain and metabolic side effects
Aripiprazole/Abilify
Pros:
Non-sedating for most people
No effect on prolactin
Low on weight gain
Low risk of metabolic side effects
Has 2 LAI forms
Cons:
Akathisia/restlessness
TD
Takes 2 to 3 weeks to kick in
Brexipiprazole/Rexulti
Pros:
Adjunct for treatment resistant depression
Off label for agitation in dementia
Treatment-resistant Schizophrenia
Lower on ADRs than abilify
Cons:
$$$$$
Weight gain
Akathisia
Sedating
Not approved for bipolar yet but may work
Quetiapine/Seroquel
Pros:
Makes people sleepy who need it
Lower risk of EPS than other second generation antipsychotics
Cons:
Not for diversion clients- can be sold on the street
Can cause weight gain
Metabolic side effects
Trifluoperazine/Stelazine
downsides-
2nd line (as a 1st gen antipsychotic)-
TD
akathisia
Galactorrhea or amenorrhea
Rash
Priapism
Pros
good for aggression
good for autonomic and motor hyperactivity
low on weight gain
Lurasidone/Latuda
Pros:
Low on weight gain
Low on metabolic ADRs
Sedating
Cons:
Good for Bipolar II, not monotherapy for Bipolar I or actively manic people
Need to take with 350 calories of food
Can raise PROLACTIN
Olanzapine/Zyprexa
Pros:
Has an ODT form for people who cheek meds
Good for very psychotic and aggressive people- molecularly similar to clozapine
Sedating
Cons
LAI is available but has 3 hour post-injection monitoring window, so some clinics don’t offer it
Weight gain
Metabolic ADRs
Carbamazepine/Carbatrol
Pros-
Even if you max out the dose, can check carbamazepine level and then raise the dose further if safe
Cons
Can cause rash leading to SJS
Interaction with hormonal birth control
Oxcarbazepine/trileptal
Pros
QHS dosing can be done
Low on ADRs compared to the atypical antipsychotics
Cons
Only good for bipolar II, not bipolar I monotherapy (not that strong)
Interacts with hormonal birth control
Can cause ataxia- clumsiness and dizziness, hands dropping things (because it causes hyponatremia)
Can cause a rash leading to SJS
Lamotrigine
Pros
Good for bipolar I and II
Cons
Need to ramp up and ramp down- not good for people with a history of stopping meds abruptly
Can cause a rash that can be benign with normal labs, peaking in days (10%) or leading to SJS (rare)
Haloperidol/Haldol
Pros
Has an LAI- every 2 weeks x 1 month and then monthly
Good for very psychotic people
Cons
High TD and EPS risk
Risk of sexual ADRs
Elevates PRL- galactorrhea, amenorrhea
Risperidone/Risperdal
Pros-
Good for aggression
Good for cognitive symptoms
Good for irritability in autism
Good for children with behavioral disturbances
Cons-
may elevate prolactin (sore nipples, nipple discharge, breast enlargement)
TD
sedation
weight gain
contraindicated in afib- increases stroke risk
Fluphenazine/Prolixin
Pros-
Rapid onset LAi
good for aggressive patients
good for motor and autonomic hyperactivity
Cons-
Can cause TD, EPS
Can elevate prolactin
Not good for peds and elderly
Trileptal/Oxcarbazepine
Pros
Can be dosed QHS at low doses (600mg qhs) or BID
Good for treatment resistant bipolar disorder
Can try it for a patient who isn’t tolerating carbamazepine
fewer ADRs than carbamazepine
Cons
Risk of SJS
Risk of hyponatremia (dizziness, clumsiness are signs of that)
Lumateperone/Caplyta
PROs
Low on EPS and akathisia
Low on metabolic ADRs and weight gain
Sedating
Good for- aggression
Positive and negative symptoms
Cognitive symptoms
Unstable mood
CONS
Dry mouth
Constipation
TD
Expensive
No dose adjustment possible
