atypical antipsychotics Flashcards
Atypical Antipsychotics and limbic pathways
mesolimbic- decrease dopanibe, decrease positive symptoms
mesocortical: decrease serotonin, increase dopamine and decrease negative symptoms
nigorstriatal: decrease serotonin, increase dopamine and decrease risk of EPS
tuberinfundibular: decrease serotonin and prolactin, increase dopamine and decrease feminization effects
Atypical antipsychotics are
dopamine and serotonin antagonists. They treat positive
how do atypical treat positive symptoms
by blocking dopamine in the mesolimbic pathway
how do atypical treat negative symptoms
blocking serotonin and increasing dopamine in the mesocortical pathway
how do atypical reduce negative side effects
they block serotonin and increase dopamine in the other pathways like nigrostrital and tuberindfindibular
clozapine
brand: clozaril
chem class: Dibenzodiazepine
dosage:75-900mg/day ( common 300mg/day)
olanzapine
brand: zyprexa
chem class: thienobenzodiazepine
dosage:5-20mg/day
whats needed before trying clozapine
trying 3 other medications including typical and atypical. start at low dose, monitor blood pressure for 5min, 15min, 1hr then blood work done regularly for 6 months.
what happens if blood work isn’t done on a patient taking clozapine
drug is not dispensed, needs to start from beginning
a threatening side effect of clozapine
constipation can be life threatening
why is clozapine not given as an injection
because injections work much faster and we wouldn’t be able to reverse the effects
olanzapine briefly
offered PO and injection
highly effective, huge weight gain and metabolic syndrome is very common
metabolic syndrome
health effect from weight gain and its effect on the body so proactively they prescribe methphormin which is usually used in diabetes
agranulocytosis
decrease in wbc count thats life threatening and clozapine is associated with it which is why there’s lots of protocols put in place
list the 7 second gen atypical antipsychotics
risperidone
asenapine
paliperidone
ziprasidone
Q RAPZ PL
quetiapine
primozide
lurasidone
risperidone
brand: risperidal
chem class:benzisoxazole
oral dose: 0.5-16
also used for tick disorders
paliperidone
brand: Invega
chem class: benzisoxazole
oral dose: 3-12mg/day
ziprasidone
brand: Zeldox
chem class:benzothiazolyl piperazine
oral dose: 40-160mg
asenapine
brand: saphris
chem class: unknown
oral dosage: 5-20mg
quetiapine
brand: Seroquel
chem class: Dibenzothiazepene
oral dose: 50-800mg/day
low dose for insomnia 25-100mg
high dose for antipsychotic ex 800mg
lurasidone
brand:
chem class:
oral dose:
pimozide
brand: orap
chem class: diphenylbutylpiperidine
oral dose:
aripiprazole
brand: abilify
chem class: dihydrocarbostyril
oral dose: 10-30mg
brexipiprazole
brand: Rexulti
class: dihydrocarbostyril
oral dose: 1-3mg
3rd gen & metabolic side effects
they have fewer metabolic side effects
which drugs are short acting injectable drugs
chlorpromazine
methotrimeprazine
laxopine
olanzapine
zuclopenthixol acetate
halpperidol
ziprasidone
things to remember for short acting injectables
Monitor VS and for respiratory depression after injection especially when used in combination with a benzo
administration considerations for oral meds
- low dose with monitoring upon trying a new drug
- pt has to be carefully monitored for side effects
- slowly tritrate over period of time till therapeutic effects are reached
- DO NOT CRUSH OR CHEW SUBSTAINSITATED RELEASE CAPSULES, this can speed up absorption and may trigger toxicity: this is to avoid diaxonrinuRION AYNSEOM
- titrated down over a 6-8 week period
