atypical antipsychotics

Question 1

Atypical Antipsychotics and limbic pathways

Answer 1

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

Question 2

Atypical antipsychotics are

Answer 2

dopamine and serotonin antagonists. They treat positive

Question 3

how do atypical treat positive symptoms

Answer 3

by blocking dopamine in the mesolimbic pathway

Question 4

how do atypical treat negative symptoms

Answer 4

blocking serotonin and increasing dopamine in the mesocortical pathway

Question 5

how do atypical reduce negative side effects

Answer 5

they block serotonin and increase dopamine in the other pathways like nigrostrital and tuberindfindibular

Question 6

clozapine

Answer 6

brand: clozaril
chem class: Dibenzodiazepine
dosage:75-900mg/day ( common 300mg/day)

Question 7

olanzapine

Answer 7

brand: zyprexa
chem class: thienobenzodiazepine
dosage:5-20mg/day

Question 8

whats needed before trying clozapine

Answer 8

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.

Question 9

what happens if blood work isn’t done on a patient taking clozapine

Answer 9

drug is not dispensed, needs to start from beginning

Question 10

a threatening side effect of clozapine

Answer 10

constipation can be life threatening

Question 11

why is clozapine not given as an injection

Answer 11

because injections work much faster and we wouldn’t be able to reverse the effects

Question 12

olanzapine briefly

Answer 12

offered PO and injection
highly effective, huge weight gain and metabolic syndrome is very common

Question 13

metabolic syndrome

Answer 13

health effect from weight gain and its effect on the body so proactively they prescribe methphormin which is usually used in diabetes

Question 14

agranulocytosis

Answer 14

decrease in wbc count thats life threatening and clozapine is associated with it which is why there’s lots of protocols put in place

Question 15

list the 7 second gen atypical antipsychotics

Answer 15

risperidone
asenapine
paliperidone
ziprasidone

Q RAPZ PL

quetiapine
primozide
lurasidone

Question 16

risperidone

Answer 16

brand: risperidal
chem class:benzisoxazole
oral dose: 0.5-16

also used for tick disorders

Question 16

paliperidone

Answer 16

brand: Invega
chem class: benzisoxazole
oral dose: 3-12mg/day

Question 16

ziprasidone

Answer 16

brand: Zeldox
chem class:benzothiazolyl piperazine
oral dose: 40-160mg

Question 16

asenapine

Answer 16

brand: saphris
chem class: unknown
oral dosage: 5-20mg

Question 16

quetiapine

Answer 16

brand: Seroquel
chem class: Dibenzothiazepene
oral dose: 50-800mg/day

low dose for insomnia 25-100mg
high dose for antipsychotic ex 800mg

Question 17

lurasidone

Answer 17

brand:
chem class:
oral dose:

Question 17

pimozide

Answer 17

brand: orap
chem class: diphenylbutylpiperidine
oral dose:

Question 17

aripiprazole

Answer 17

brand: abilify
chem class: dihydrocarbostyril
oral dose: 10-30mg

Question 17

brexipiprazole

Answer 17

brand: Rexulti
class: dihydrocarbostyril
oral dose: 1-3mg

Question 17

3rd gen & metabolic side effects

Answer 17

they have fewer metabolic side effects

Question 17

which drugs are short acting injectable drugs

Answer 17

chlorpromazine
methotrimeprazine
laxopine

olanzapine
zuclopenthixol acetate

halpperidol
ziprasidone

Question 18

things to remember for short acting injectables

Answer 18

Monitor VS and for respiratory depression after injection especially when used in combination with a benzo

Question 19

administration considerations for oral meds

Answer 19

• 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