Atypical Antipsychotics Flashcards
Schizophrenic patient with good response to Olanzapine but weight gain/metabolic syndrome:
First steps include recommending lifestyle modifications. If change in antipsychotic medication is needed, other atypical antipsychotics such as ziprasidone or ariprazole (less associated with weight gain) or typical antipsychotics might be considered; these medications would be cross-tapered.
What makes Atypical antipsychotics different than Typical?
- Atypical block both DA and Serotonin receptor and are associated with different side effects than traditional antipsychotics
- In particular, they are less likely to cause EPS, tar dive dyskinesia or neuroleptic malignant syndrome
- They may be more effective in treating negative Sx or schizophrenia than traditional antipsychotics
- They are also used to treat acute mania, bipolar disorder and as adjunctive medications in unipolar depression
- Sometimes used for personality disorders and certain psychiatric disorders in childhood
What are the six common Atypical Antipsychotics?
- Clozapine (Clozaril)
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Olanzapine (Zyprexa)
- Ziprasidone (Geodon)
- Aripiprazole (Abilify)
What are three newer, expensive Atypical Antipsychotics?
- Paliperidone (Invega)
- Asenapine (Saphris)
- Iloperidone (Fanapt)
What are the unique characteristics of Paliperidone (Invega)?
- Metabolite of risperidone
- Long-acting injectable form (Sustenna)
What are unique features of Clozapine (Clozaril)?
- Less likely to cause TD
- Only antipsychotic shown to be more efficacious
- Associated with tachycardia and hyper salivation
- More anticholinergic side effects than other atypical or high potency typical
- Myocarditis may develop
- There is a 1-2 percent incidence of agranulocytosis and 2-5 percent incidence of seizures
- MUST STOP clozapine if the absolute neutrophil count drops below 1500/uL
- Clozapine is the only antipsychotic shown to decrease risk of suicide
Risperidone (Risperdal):
- Can cause increased prolactin
- Some orthostatic hypotension and reflex tachycardia
- Has long-acting injectable form called Consta
Quetiapine (Seroquel):
Common side effects include sedation and orthostatic hypotension
Olanzapine (Zyprexa):
Common side effect is weight gain
Ziprasidone (Geodon):
Less likely to cause weight gain
Aripiprazole (Abilify):
- Unique mechanism of partial D2 agonism
- Can be more activating (akathisia) and less sedating
- Less potential for weight gain
What percent of treatment-resistant psychosis will respond to clozapine?
thirty percent
Halloo side effects
It typically has extrapyramidal side effect such as TD but does not typically cause agranulocytosis, which is associated with clozapine.
How do Alzheimer medications work? What are two common ones?
Work by reversible inhibition of acetylcholine esterase. Tacrine and donepezil.
What drugs have FDA approval for Tx of mania?
Quetiapine, Olanzapine, Aripiprazole, Risperidone, and Ziprasidone
