Atypical Antipsychotics Flashcards by Sarah Giammarese

indications for atypicals

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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MOA for atypicals

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

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risperidone

risperdal

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olanzapine

zyprexa

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quetiapine

seroquel

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ziprasidone

geodon

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clonazapine

clozaril

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what are the atypicals used more often that typicals?

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

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

acute and chronic psychosis

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

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

clozaril

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what are some metabolic issues associated with atypicals?

weight gain, DM, hyperlipidemia

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

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

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monitoring of metabolic issues while chronically on an atypical

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

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important side effect of risperdal

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

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more common SE of risperdal

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

metabolism of risperdal

CYP450

important side effect of zyprexa

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

common side effects of zyprexa

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

drug interactions with zyprexa

tagement (GERD) increases concentrations

tegretol and phenytoin (seizure) decreases concentrations

important side effect of seroquel

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

more common side effects of seroquel

somnolence, postural hypotension, dizziness, modest weight gain

drug interaction with seroquel

phenytoin decreases serum levels

special action of geodon

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

common side effects of geodon

somnolence, HA, dizziness and nausea

what side effects does geodon NOT cause

weight gain and increase in prolactin

contraindication for geodon

if taking another med that prolongs QT

when should clozaril be prescribed?

in those who FAILED standard treatment (2 other antipsychotics)

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

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

common side effects of clozaril

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

serious side effects of clozaril

leukopenia, granulocytopenia and aganulocytosis

when can clozaril NOT be prescribed?

if WBC is

monitoring for a pt on clozaril

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

drug interactions with clozaril

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)

What should be monitored if a patient is on zyprexa?

LFTs

What exam should a patient get yearly if on seroquel?

Slit lamp

Which atypicals are FDA approved for mania?

Seroquel and zyprexa