Atypical antipsychotics

Question 1

Atypical antipsychotics - examples

Answer 1

• Risperidone
• Olanzapine
• Clozapine
• Quetiapine

Question 2

Atypical antipsychotics - indications

Answer 2

1) During agitation/violent behaviour to calm patients down to permit assessment
2) Schizophrenia (particularly when extrapyramidal side effects have complicated the use of typical antipsychotics)
3) Bipolar disorder - during acute episodes of mania or hypomania

Question 3

Atypical antipsychotics - how does it work/class

Answer 3

Dopamine D2 receptor antagonist

Question 4

Atypical antipsychotics - adverse effects

Answer 4

Common

• sedation
• metabolic disturbance: weight gain, diabetes, lipid changes
• can prolong QT interval (causing arrhythmias)

Less Common

• breast symptoms (in men and women)
• sexual dysfunction

Rare

agranulocytosis and myocarditis

Question 5

Atypical antipsychotics - contraindications

Answer 5

CAUTION
- CVD pxts

COMPLETELY AVOID

• Severe heart disease
• Hx of Neutropenia

Question 6

Atypical antipsychotics - interactions

Answer 6

Dopamine blocking anti-emetics
-Metocloperamide

Drugs that prolong QT interval:

• amiodorone
• macrolides
• SSRI

Question 7

Atypical antipsychotics - administration

Answer 7

Oral antipsychotic medications are best taken at bedtime

Question 8

Atypical antipsychotics - monitoring

Answer 8

Clozapine (intense monitoring due to risk of agranulocytosis)

Monitoring for metabolic and cardiovascular side effects is important for second-generation antipsychotics.
This includes measurement of:
- weight
- lipid profile
- fasting blood glucose
These are measured at baseline and intermittently during treatment.