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42 Cards in this Set

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indications for atypical anti psychotics
~Positive sx; psychosis, manic excitation, severe agitation, Tourette's

~Negative sx: withdrawal, flat affect, anhedonia, poverty of speech, catatonia, and cognitive impairment
How many atypical antipsychotics are there?
9

*clozapine,
*risperidone
*olanzapine
*quetiapine
*ziprazidone
*aripiprazole
*paliperidone
*asenapine
*iloperidone
SE with atypicals
wt gain

sedation

hyperglycemia with ketoacidosis

agranulocytosis

Risk for EPS (rare)

Hyperprolactinemia
Therapeutic effect of atypicals related to blocade of
D2 and 5HT2a
MOA atypicals
Positive sx are decreased by the blockade of DA in the mesolimbic pathway. (not as strong as DA receptor antagonism of typicals therefore less EPS)

5HT inhibits DA. Negative sx are decreased when 5HT-DA antagonists (atypicals) block 5HT; therefore, DA increased in the mesocortical pathway
Benefits of atypicals over typicals
Have less clinically significant side effects

Effectively tx positive AND negative sx

Improved compliance
Clozapine
Clozaril (25-900mg/d)

***Must be in clozapine registry prior to starting

***Only drug for tx of resistant schizophrenia

****WBC monitoring REQUIRED d/t risk for agranulocytosis
during 1st 6mo: WEEKLY
during 2nd 6mo: q 2 weeks
then monthly if normal
Quetiapine
Seroquel (500-800)

***Yearly eye exam (risk of cataracts)

***Wt gain

Common SE: sedation and wt gain
Olanzapine
Zyprexa (5-20 mg/d)

***sig wt gain, and sedation

***risk of DM, hyperlipidemia, increased LFTs, mild prolactin elevation
Risperidone
Risperdal (2-6mg/d)

Atypical at lower doses and typical at higher doses

***doses greater than 6mg associated w/ a higher incience of EPS

***Greatest prolactin elevation among atypical psychotics

***less wt gain than clozaril or zyprexa
Ziprasidone
Geodon (40-160)

***REQUIRES QTc monitoring d/t rare prolongation of QTc interval

***Taking with food increases absorption twofold

***Avoid w/ other drugs known to prolong QTc & caution w/ pt at risk for hypoMg, hypoK, after MI or w/ CHF
Paliperidone
Invega (3-12 mg/d)

***extended-release risperidone

Common SE: orthostatic hypotension, hyperprolactinemia, GI upset, Dizzy, Headache
Aripoprizole
Abilify (5-30mg/d)

***Partial agonist of D2 receptors

***Wt gain, elevated lipids and blood glucose not problematic

Common SE: headache
agitation
anxiety
somnolence
gi problems
akathisia (usually dissipates & alleviate by short-term benzo)
Asenapine
Saphris
iloperidone
Fanapt
Baselines to obtain before starting Atypical
Weight
waist circumference
BP
Fasting plasma gluose
Fasting lipid profile
WBCs

Ask about personal/fam hx of
obesity
dyslipidemia
diabetes
hypertension
cardiovascular disease
psychotic sx can improve how fast on atypical
within one week but it may take several weeks for full effect on behavior
Wait how long to determine efficacy of atypical
4-6 weeks to determine efficacy
How long for complete response on atypical
4-5 months
Abilify MOA
partial agonist at D2 receptors

decreases DA output when DA concentrations are high, reducing + sx

Increases DA output when DA concentrations are low, reducing negative, cognitive and mood sx
generic for Seroquel
quetiapine
generic for fanapt
iloperidone
Generic for zyprexa
olanzapine
Generic for Geodon
ziprazidone
Generic for Saphris
asenapine
Risperidone main points to remember
Risperidal, Risperidal Consta (2-6mg/d)

Doses greater than 6 mg associated with increased incidence EPS

Greatest prolactin elevation of atypicals
Invega main points to remember
Paliperidone

Extended release risperidone

Greatest prolactin elevation of atypicals
Olanzapine main points to remember
Zyprexa (5-20mg/d)

Significant wait gain

Monitor Wt, BMI, waist circumference, BP, blood sugar, lipids, LFTs
Seroquel main points to remember
Quetiapine 50-800mg/d

Divided dosing

Cataract formation (rare) yearly eye exams

Sedation & wt gain can be problematic
Geodon main points to remember
Ziprasidone (40-160mg/d)

Take with food; increases absorption 2-fold

Prolonged QTc interval (rare) monitor EKG, not for pt after MI or w/ CHF or pt at risk for hypokalemia, hypomagnesia

Wt gain uncommon
Clozaril WBC schedule
Clozapine (25-900)

Only drug fro Treatment Resistant schizophrenia

Must be on Clozaril registry

Rare SE associated:
Agranulocytosis
Myocarditis
NMS

Monitor WBCs
Blood every week for 1st 6mo
every 2 weeks for 2nd 6 mo
If WBC & ANC normal then every month after 1st yr
Aripiprizole main points to remember
Abilify (5-30mg/d)

MOA: partial agonist @ D2 receptors

wt gain, elevated lipids, elevated blood glucose NOT a problem with Abilify

Akathisia usually dissipates & is alleviated by short-term benzo

Common SE:
Akathisia
headache
agitation
insomnia
anxiety
GI problems
Caffeine
can cause diminished antipsychotic effect (therefore may need to be on a higher dose)
Smoking
can cause reduced concentration of antipsychotics
Abilify dose range
Aripiperazole

5-30mg/d
Clozaril dose range
Clozapine

Tablet

25-900mg/d
Zyprexa dose range
Olanzapine

Tablet

5-20mg/d
Seroquel dose range
Quetiapine

Tablet

50-800mg/d
Risperidone dose range
Risperdal, Risperdal Consta

Tablet, Liquid, Injectable

2-6mg/d
Geodon dose range
Ziprasidone

Tablets, Injectable

40-160mg/d
Paliperidone dose range
Invega

Tablets

3-12 mg/d
Abilify dose range
Aripiprizole

Tablets

5-30 mg/d