Atypical antipsychotics Flashcards
MOA of atypical?
Block both D2 and serotonin receptors
What is the benefit of atypical over typicals?
Less likely to cause EPS, tardive dyskinesia, or NMS
What other three uses to atypical have other than schizophrenia?
- acute mania (quetiapine, olanzapine, aripiprazole, risperidone, and ziprasidone)
- bipolar disorder
- adjunctive meds in unipolar depression
Which atypical has the most anticholinergic side effects?
Clozapine
*more than high potency atypicals as well, but these have a lower incidence of anticholinergic than the low potency; high potency = high risk of EPS)
What are three dangerous AE to look out for in clozapine?
- Agranulocytosis (1-2%)
- Myocarditis
- Seizures (2-5%)
*also: hypersalivation and tachycardia
When must clozapine be stopped?
when absolute neutrophil count drops below 1500/microliter
What are three positive things about clozapine?
- is most efficacious (30% of treatment resistant psychosis will respond)
- only antipsychotic shown to decrease suicidality
- less likely to cause tardive dyskinesia
Which two atypical cause highest incidence of weight gain?
- Olanzapine
2. Clozapine
Which two are least likely to cause weight gain?
- Ziprasidone
2. Aripiprazole
Which two can prolong the QT interval?
- Quetiapine
2. Ziprasidone
3 side effects of risperidone
- hyperprolactinemia
- orthostatic hypotension
- reflex tachycardia
How often must CBC be checked on patients starting clozapine?
Weekly for first 6 months
Which two have long acting injectable forms?
- Paliperidone
2. Risperidone
What other tests should be ordered in patients on atypical other than BG and triglycerides?
Liver function tests once a year
*monitor for metabolic syndrome with baseline weight, waist circumference, BP, fasting glucose, fasting lipids (triglycerides)
