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42 Cards in this Set
- Front
- Back
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indications for atypical anti psychotics
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~Positive sx; psychosis, manic excitation, severe agitation, Tourette's
~Negative sx: withdrawal, flat affect, anhedonia, poverty of speech, catatonia, and cognitive impairment |
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How many atypical antipsychotics are there?
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9
*clozapine, *risperidone *olanzapine *quetiapine *ziprazidone *aripiprazole *paliperidone *asenapine *iloperidone |
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SE with atypicals
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wt gain
sedation hyperglycemia with ketoacidosis agranulocytosis Risk for EPS (rare) Hyperprolactinemia |
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Therapeutic effect of atypicals related to blocade of
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D2 and 5HT2a
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MOA atypicals
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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 |
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Benefits of atypicals over typicals
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Have less clinically significant side effects
Effectively tx positive AND negative sx Improved compliance |
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Clozapine
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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 |
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Quetiapine
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Seroquel (500-800)
***Yearly eye exam (risk of cataracts) ***Wt gain Common SE: sedation and wt gain |
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Olanzapine
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Zyprexa (5-20 mg/d)
***sig wt gain, and sedation ***risk of DM, hyperlipidemia, increased LFTs, mild prolactin elevation |
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Risperidone
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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 |
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Ziprasidone
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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 |
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Paliperidone
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Invega (3-12 mg/d)
***extended-release risperidone Common SE: orthostatic hypotension, hyperprolactinemia, GI upset, Dizzy, Headache |
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Aripoprizole
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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) |
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Asenapine
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Saphris
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iloperidone
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Fanapt
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Baselines to obtain before starting Atypical
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Weight
waist circumference BP Fasting plasma gluose Fasting lipid profile WBCs Ask about personal/fam hx of obesity dyslipidemia diabetes hypertension cardiovascular disease |
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psychotic sx can improve how fast on atypical
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within one week but it may take several weeks for full effect on behavior
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Wait how long to determine efficacy of atypical
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4-6 weeks to determine efficacy
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How long for complete response on atypical
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4-5 months
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Abilify MOA
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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 |
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generic for Seroquel
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quetiapine
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generic for fanapt
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iloperidone
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Generic for zyprexa
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olanzapine
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Generic for Geodon
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ziprazidone
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Generic for Saphris
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asenapine
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Risperidone main points to remember
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Risperidal, Risperidal Consta (2-6mg/d)
Doses greater than 6 mg associated with increased incidence EPS Greatest prolactin elevation of atypicals |
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Invega main points to remember
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Paliperidone
Extended release risperidone Greatest prolactin elevation of atypicals |
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Olanzapine main points to remember
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Zyprexa (5-20mg/d)
Significant wait gain Monitor Wt, BMI, waist circumference, BP, blood sugar, lipids, LFTs |
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Seroquel main points to remember
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Quetiapine 50-800mg/d
Divided dosing Cataract formation (rare) yearly eye exams Sedation & wt gain can be problematic |
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Geodon main points to remember
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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 |
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Clozaril WBC schedule
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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 |
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Aripiprizole main points to remember
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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 |
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Caffeine
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can cause diminished antipsychotic effect (therefore may need to be on a higher dose)
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Smoking
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can cause reduced concentration of antipsychotics
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Abilify dose range
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Aripiperazole
5-30mg/d |
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Clozaril dose range
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Clozapine
Tablet 25-900mg/d |
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Zyprexa dose range
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Olanzapine
Tablet 5-20mg/d |
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Seroquel dose range
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Quetiapine
Tablet 50-800mg/d |
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Risperidone dose range
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Risperdal, Risperdal Consta
Tablet, Liquid, Injectable 2-6mg/d |
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Geodon dose range
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Ziprasidone
Tablets, Injectable 40-160mg/d |
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Paliperidone dose range
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Invega
Tablets 3-12 mg/d |
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Abilify dose range
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Aripiprizole
Tablets 5-30 mg/d |
