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Behavioral Health > Atypical Antipsychotics > Flashcards

Atypical Antipsychotics Flashcards

1
Q

indications for atypicals

A

schizophrenia, schizoaffective d/o, mood d/o, agressive behavior, AIDS dementia, autism, tourette’s huntington’s adjunct for AHDH or ADD, psychosis due to head trauma, treatment resistent OCD

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2
Q

MOA for atypicals

A

serotonin-dopamine antagonists (more selective for the mesolimbic dopamine pathway, less for the nigrostriatal pathway where EPS SE originate)

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3
Q

risperidone

A

risperdal

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4
Q

olanzapine

A

zyprexa

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5
Q

quetiapine

A

seroquel

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6
Q

ziprasidone

A

geodon

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7
Q

clonazapine

A

clozaril

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8
Q

what are the atypicals used more often that typicals?

A 
greater tolerability and increased efficacy
EXCEPT clozaril (can cause agranulocytosis)
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9
Q

when can atypicals be used for schizophrenia and schizoaffective d/o

A

acute and chronic psychosis

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10
Q

why are atypicals better than typicals for schizophrenia and schizoaffective d/o?

A 
fewer relapses
require less frequent hospitaliztaions
fewer ER visits
less phone contact w/ mental health profesisonals
less treatment in day programs
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11
Q

which atypical should be AVOIDED unless absolutely necessary for the treatment of schizophrenia and schizoaffective d/o?

A

clozaril

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12
Q

what are some metabolic issues associated with atypicals?

A

weight gain, DM, hyperlipidemia

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13
Q

how should metabolic issues be monitored upon initial prescription of an atypical?

A

assess risk factors (age >45, BMI >27, FHx, ethnicity, gestational DM)
check a fasting glucose HDL and TG

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14
Q

monitoring of metabolic issues while chronically on an atypical

A

monthly monitoring of weight gain, polyphagia, polyuria and polydipsia
3 month FBS
12 month FBS, cholesterol and TG

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15
Q

important side effect of risperdal

A

MARKED increase in prolactin levels, especially if used with an SSRI

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16
Q

more common SE of risperdal

A

EPS (dose dependent), weight gain, anxiety, n/v, rhinitis, sexual dysfxn, dizziness, somnlonence

17
Q

metabolism of risperdal

A

CYP450

18
Q

important side effect of zyprexa

A

MORE weight gain than other atypicals, plateaus at 10 months and NOT dose related
Hyperlipemia, glucose intolerance, weight gain and liver toxicity

19
Q

common side effects of zyprexa

A

dry mouth, solmnolence, dizziness, constipation, dyspepsia, increased appetite, tremor, EPS (dose dependent), “periodic” elevated glucose and increased ALT, increased prolactin

20
Q

drug interactions with zyprexa

A

tagement (GERD) increases concentrations

tegretol and phenytoin (seizure) decreases concentrations

21
Q

important side effect of seroquel

A

LEAST likely to cause EPS REGARDLESS of dose - remember in a parkinson pt w/ dopamine induced psychosis
Also less weight gain

22
Q

more common side effects of seroquel

A

somnolence, postural hypotension, dizziness, modest weight gain

23
Q

drug interaction with seroquel

A

phenytoin decreases serum levels

24
Q

special action of geodon

A

consistent reports that it works like an antidepressant in non-schizophrenics

25
Q

common side effects of geodon

A

somnolence, HA, dizziness and nausea

26
Q

what side effects does geodon NOT cause

A

weight gain and increase in prolactin

27
Q

contraindication for geodon

A

if taking another med that prolongs QT

28
Q

when should clozaril be prescribed?

A

in those who FAILED standard treatment (2 other antipsychotics)

29
Q

what is the benefit if clozaril is given in a pt with severe tardive dyskinesia?

A

suppressed abnormal movements but symptoms will return after d/c of the med

30
Q

common side effects of clozaril

A

sedation, dizziness, syncope, tachycardia, hypotension, EKG changes, n/v, constipation, hypersalvation that is worse at night

31
Q

serious side effects of clozaril

A

leukopenia, granulocytopenia and aganulocytosis

32
Q

when can clozaril NOT be prescribed?

A

if WBC is

33
Q

monitoring for a pt on clozaril

A

WEEKLY CBC for the first 6 months and if all normal go out to every 2 weeks

34
Q

drug interactions with clozaril

A

NEVER used with another drug that can also cause agranulocytosis (tegretol, sulfonamides and phenytoin)
NOT used with paxil or prozac (increased levels)
CAUTION with lithium (decreases seizure threshold)

35
Q

What should be monitored if a patient is on zyprexa?

A

LFTs

36
Q

What exam should a patient get yearly if on seroquel?

A

Slit lamp

37
Q

Which atypicals are FDA approved for mania?

A

Seroquel and zyprexa

Behavioral Health (15 decks)

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