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129 Cards in this Set
- Front
- Back
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The Following Disorders Can be treated with SSRIS (12)
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Major Depressive Episodes
OCD Panic Disorder Eating Disorders Dysthymia Social phobia PTSD Irritable Bowel Syndrome Migraine Headaches Autism premenstrual dysphoric disorder Depressive phase of a non-rapidly shifting manic depression |
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Special Uses of Bupoprion (2)
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Smoking Cessation
Depressive phase of manic depression Never give if risk of seizure |
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Special Uses of MAOIs (4)
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Atypical Major Depression
Panic Disorder Eating Disorder Social Phobia |
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Special Uses of TCAs (10)
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Melancholic Major Depression
OCD Panic Disorder Eating Disorder PTSD Irritable Bowel Syndrome Enuresis Neuropathic pain Migraine Headaches Insomnia |
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Criteria To consider prior to choosing an SSRI
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Patient's symptoms
Previous treatment or of family Medication side effect profile Comorbid conditions Risk of suicide (early paradox!) Hx mania (could cause switch!) |
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What neurotransmitters are affected by TCAs and how?
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They inhibit the reuptake of NE (norepinephrine) and 5HT (seratonin)
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TCA side effects
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Antihistaminic: Sedation
Antiadrenergic: orthostatic hypotension (most life threatening), tachycardia, arrythmias Antimuscarinic effects: Dry mouth, constipation, urinary retention, blurred vision, tachycardia Weight Gain Lethal in overdose even with 1 week supply! (assess suicide risk) Major Complications: 3C's Convulsions Coma Cardiotoxicities (don't give to pts with pre-existing conduction abnormality) |
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Treatment for TCA overdose
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Sodium Bicarbonate
Activated charcoal |
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EKG changes in TCA overdose
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Widened QRS (>100msec)
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MAOI mechanism of action and target neurotransmitters (4)
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They bind MAO-A and MAO-B enzymes to increase amount of transmitters in synapses. they affect NE, 5HT, dopamine and tyramine
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MAO-A Inhibitors preferentially target
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Serotonin + dopamine and tyramine
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MAO-B Inhibitors preferentially target
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epinephrine and norepinephrine + dopamine and tyramine
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MAOIs are good for what type of depression
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Refractory depression (also good for refractory panic disorder)
Atypical depression |
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MAOI common side effects (excluding hypertensive crisis and serotonin syndrome
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Common: orthostatic hypotension, drowsiness, weight gain, sexual dysfunction, dry mouth, sleep dysfunction
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What happens when SSRIs and MAOIs mix
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Serotonin Syndrome: lethargy, restlessness, confusion, flushing, diaphoresis, tremor, myoclonic jerks.
If bad: hyperthermia, hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, death |
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Why must pts taking MAOIs watch their diet?
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Hypertensive crisis: occurs if you eat tyramine rish foods or sympathomimetics
(no red chianti wine, cheese, chicken liver, fava beans, cured meats) due to a buildup of catecholamines Note that over the counter cold remedies can contain sympathomimetics! |
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Mechanism of action of SSRIs
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inhibit presynaptic serotonin pumps
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General SSRI side effects
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Sexual dysfunction (men hate it!)
GI disturbance Insomnia headache Anorexia / Weight loss or gain Serotonin syndrome with MAOIs |
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Give trade name, drug class, starting dose, and special considerations for:
Fluoxetine |
Paxil (SSRI) 20mg po qhs
longest half-life with active metabolites Causes weight loss Causes jitteriness Do not need to taper |
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Sertraline:
Trade Name, Class, and Relevant Info |
Zoloft
SSRI High Risk of GI complications Few other drug interactions more common sleep changes |
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Paroxetine:
Trade Name, Class, and Relevant Info |
Paxil
SSRI stimulates serotonin most specifically highest stimulant |
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Fluvoxamine:
Trade Name, Class, and Relevant Info |
Luvox
SSRI Only for OCD N + V common Many drug interactions |
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Citalopram:
Trade Name, Class, and Relevant Info |
Celexa
fewer drug interactions less sex side effects |
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Escitalopram:
Trade Name, Class, and Relevant Info |
Lexapro / Cipralex
S enantiomer of Citalopram less side effects more expensive |
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Venlafexine:
Trade Name, Class, and Relevant Info |
Effexor
SNRI Good for refractory depression and GAD, maybe ADHD Reacts with few drugs Do not give with BP probs (it elevates BP) Not for OCD Withdrawl causes flu and electric shock sensations |
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Duloxetine:
Trade Name, Class, and Relevant Info |
Cymbalta
SNRI Good for depression and neuropathic pain / fibromyalgia More dry mouth and constipation due to NE May have liver side effects if liver disease or ETOH |
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Bupoprion:
Trade Name, Class, and Relevant Info |
Wellbutrin
NDRI Good for lack of sexual side effects Good for adult ADHD Side effects increased seizures and psychosis and anxiety Contraindicated in pts with seizure or active eating disorders (metabolic seizures) or alcoholics (withdrawl seizures) and in those on MAOIs Good for smoking sensation |
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Trazodone:
Trade Name Class and Relevant info |
Desyrel
Serotonin Receptor Antagonist and Agonist Good for MDE with anxiety Really good for INSOMNIA No sexual side effects do not affect REM stage Side effects: Nausea, dizziness, orthostatic hypotension, cardiac arrhythmias, sedation Priapism in trazodone |
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Nefazodone:
Trade Name Class and Relevant Info |
Serzone
Serotonin Receptor Antagonist and Agonist Good for MDE with anxiety Really good for INSOMNIA No sexual side effects do not affect REM stage Side effects: Nausea, dizziness, orthostatic hypotension, cardiac arrhythmias, sedation Black box warning: rare but serious liver failure |
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Mirtazapine:
Trade Name Class and Relevant Info |
Remeron
A2 adrenergic receptor Good for refractory depression Good for people needing to gain weight No sexual side effects Few drug interactions Side effects: sedation, weight gain, dizziness, somnolence, tremor, dry mouth, constipation, rare agranulocytosis |
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Neurotransmitter activity of TCA (3) and associated side effects with each
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SNRI and Antihistamine- Fatigue and weight gain
A1 adrenergic antagonist- Dizziness and hypotension Anti-muscarinic- dry mouth and constipation All lower seizure threshold! |
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What are tertiary amines and what (3) properties do they have?
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A type of TCA with high anticholinergic activity, more sedating activity, greater lethality in overdose
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Amitriptaline: Trade Name Drug Class and distinguishing features
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Elavil
TCA (tertiary amine) Treats chronic pain, migraines, insomnia |
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Imipramine: Trade Name Drug Class and distinguishing features
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Tofranil
TCA (tertiery amine) Has IM form Useful in enuresis and panic disorder |
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Clomipramine: Trade Name Drug Class and distinguishing features
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Anafranil
TCA (tertiery amine) most serotonin specific Useful for OCD |
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Doxepin: Trade Name Drug Class and distinguishing features
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Sinequan
TCA (tertiary amine) useful for chronic pain Sleep aid in low doses |
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What are secondary amines and how do they differ from tertiary amines
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They are TCAs that are metabolites of their tertiary counterparts
As such they have less anticholinergic and less sedating effects |
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Notriptyline: Trade Name Drug Class and distinguishing features
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Pamelor or Aventyl
TCA (secondary amine) Least likely to cause orthostatic hypotension Useful for chronic pain |
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Desipramine: Trade Name Drug Class and distinguishing features
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Norpramin
TCA (secondary amine) more activating, least sedating Least anticholinergic |
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TCA general side effects (9)
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1. Highly protein bound so drug interactions
2. Antihistaminic (sedation) 3. Antiadrenergic (orthostatic hypotension, dizziness, tachycardia, arrhythmias, and ECG changes (wide QRS, QT and PR interval) 4. antimuscarinic (anticholinergic): Dry mouth, constipation, urinary retention, blurred vision, exacerbation of narrow angle glaucoma, tachycardia 5. Weight gain 6. Lethal in overdose (Agitation, tremors, ataxia, delirium, central hypoventilation, myoclonus, hyperreflexia, seizures and coma 7. Lower the threshold for seizures 8. Serotonergic effects (erectile or ejaculatory dysfunction in males and anorgasmia in females) |
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What is the mechanism of action of MAOIs?
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Prevent inactivation of biogenic amines:
Norepinephrine, serotonin, dopamine, and tyramine (intermediate between tyrosine and norepinephrine) |
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Name 3 medications used for resistant depression and their trade names.
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Phenelzine (Nardil)
Tranyocypromine (Parnate) Isocarboxazid (Marplan) |
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MAOI side effects
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1. Serotonin syndrome if mized with SSRI: lethargy, restlessness, confusion, flushing, diaphoresis, tremor, myoclonic jerks... may lead to hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, and death
Hypertensive crisis: avoid tyramine rich foods or sympathomimetics! leads to high BP, headache, sweating, nausea, vomiting, photophobia, chest pain, arrhythmias, death orthostatic hypotension (most common) drowsiness weight gain sexual dysfunction dry mouth sleep dysfunction parasthesias if low B6 leves rare liver toxicity and seizures start low and go slow |
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On what receptors do typical and atypical antipsychotics act upon, respectively?
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Typical: Dopamine (D2) receptors
Atypical: 5HT and Dopamine (D1-2) (atypicals act less on dopamine and thus have less side effects and do not cause hyperprolactinemia (except Risperdal) |
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How long do antipsychotics take to work?
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Immediate: calm and lower agitation
2-4 weeks: thought disorders helped |
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What are the main indications for antipsychotics?
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psychotic disorders
Mood disorders (w/ or w/o psychosis) violent behaviour autism Tourette's Somatiform disorders dementia OCD |
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Is there ever a reason to combine antipsychotics?
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No STOOPID!
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Indications for Anxiolytics (6)
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(always short-term)
Anxiety insomnia alcohol withdrawal (esp. DT) EPS and akathisia seizure disorders MSK disorders |
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Contraindications for Anxiolytics (4)
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Major depression (unless adjunct to other treatment)
history of drug/alcohol abuse pregnancy breast feeding |
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Mechanism of action of Benzos (and the exception of one!)
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potentiate binding of GABA to its receptors (thus causing inhibitory impulses)
Except buspirone (buspar) which is a partial 5HT type 1A receptor agonist |
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Benzodiazepine Side Effects and adverse events
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SEDATION!
Low dose withdrawl: tachycardia hypertension panic insomnia anxiety impaired memory and concentration perceptual disturbances High dose withdrawal: hyperpyrexia seizures psychosis death Other side effects drowsiness cognitive impairment reduced motor coordination memory impairment physical dependence tolerance Overdose: rarely fatal can kill if combined with alcohol, TCAs or CNS depressants |
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How do you treat Benzo withdrawal?
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anxiety, insomnia, dysperceptions and autonomic hyperactivity are symptoms
-taper with long-acting benzos! |
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How do you treat a benzo overdose?
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Flumazenil (Anexate)
specific antagonist at benzo receptor site |
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Buspirone:
Trade name primary use adantages Side effects |
BUSPAR (benzo)
non sedating not prone to abuse does not interact with or show cross-tolerance to other benzos, barbiturates or alcohol Does not alter seizure threshold Does not interact with alcohol Does not act as a muscle relaxant Side effects: dizziness drowsiness nausea headache nerousness extrapyramidal Sx? |
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What are the "Geriatric Benzos"?
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LOT =
Lorazepam Oxazepam Temazepam They are not metabolized by liver either so safe in liver disease |
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Clonazepam:
Trade name and drug class Appropriate use |
Rivotril (Long acting Benzo)
Akathisia GA seizure prevention panic disorder |
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Diazepam
Trade name and drug class Appropriate use |
Valium (Long acting Benzo)
GAD Seizure prevention muscle relaxant Alcohol withdrawal |
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Chlordiazepoxide
Trade name and drug class Appropriate use |
Librium (Long acting Benzo)
Sleep anxiety alcohol withdrawal |
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Flurazepam
Trade name and drug class Appropriate use |
Dalmane (Long acting Benzo)
Sleep |
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Alprazolam
Trade name and drug class Appropriate use |
Xanax (Short acting Benzo)
Panic disorder Warning: high dependency rate |
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Lorazepam
Trade name and drug class Appropriate use |
Ativan (short acting Benzo)
Sleep GA akathisia alcohol withdrawal Note: sublingual for super fast action! hoo ha! |
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Oxazepam
Trade name and drug class Appropriate use |
Serax (short acting Benzo)
Sleep GA Alcohol withdrawal |
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Temazepam
Trade name and drug class Appropriate use |
Restoril (short acting benzo)
Sleep |
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Triazolam
Trade name and drug class Appropriate use |
Halcion
rapid sleep but with rebound insomnia shortest halflife of all benzos |
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Zopiclone
Trade name and drug class Appropriate use |
Imovane (Azapirone benzo)
Sleep |
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How do you treat alcohol withdrawal? (3) Tx
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Diazepam 20mg PO/IV q1h PRN
Lorazepam 10mg PO/IV/SL for patients with liver disease, chronic lung disease, or the elderly Oxazepam also but specific dosage not given |
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Lithium mechanism of action?
(2 theories) |
1. alters G proteins and their ability to transduce signals
2. Li alters secondary messenger system responsible for G proteins (inhibits inositol monophosphatase) |
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Lithium Indications (2 main
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-acute mania and hypomania
-Depression in BAD patients (treat and prevent) -don't use for rapid cycling and mixed episodes (less effective) -don't use with antidepressants |
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What drug potentiates the action of antidepressants in depresssion and OCD?
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Lithium
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Lithium Side Effects
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WHATS GLIB D?
Weight Gain Hair loss Acne Tremor + weakness Sedation GI symptoms (incl. metalic taste) Long term thyroid and kidney SE Incoordination Bradycardia / dizziness Decreased Cognition Renal: Polyuria/dypsia reduced GFR fibrosis / sclerosis of glomerulae Endocrine: hypothyroidism Goiter Hyperparathyroidism |
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How do you monitor Lithium levels?
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1. 5 days after starting therapy
2. Once weekly for 2 weeks 3. Then every 6 months |
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Lithium Toxicity Effects (Severe only as Mild mimics SE)
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Coma with:
Hyperreflexia, muscle tremor, ECG changes and pulse irregularity, seizures, ATN |
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Treating Lithium Toxicity
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Mild: stop lithium
Severe: 1. reduce absorption with forced alkaline diuresis or dialysis 2. restore fluid and electrolyte balance |
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Lab Tests to order at beginning of treatment (and every admission): Name 6
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SMA10
CBC with differential TSH BUN / Creat PTH ECG if >45 or heart probs |
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Effects of anticonvulsants pharmacokinetic level
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-increase synthesis and release and effect on receptors
-decrease its breakdown and reuptake -decrease release of excitatory glutamate -inhibits carbonic anhydrase -acts on phosphokinase C |
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Valproic acid: Class and Indications
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Mood stabilizer
-treating acute manic phase BAD (oral loading leads to rapid level stabilization in blood) -maintenance therapy for relapses of BAD depression -augments Li monotherapy -good for rapid cycling and mixed episodes |
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Valproic Acid side effects
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Weight gain
Hair loss lethargy cognitive blunting tremors ataxia incoordination Teratogenic (neural tube defect/CVS/craniofacial malformations) GI disturbances Menstrual disturbances, PCOS, hyperandrogenism, insulin resistance Symptomatic transaminase elevation diplopia and nystagmus Gingival hyperplasia increased bone resorption suicidality |
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What tests to order for Valproic Acid
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CBC
LFTs HDL-LDL cholesterol Test monthly for 2 months then follow 2-3 times per year |
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Carbamazepine method of action
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enhances gaba function
may stabilize open sodium channels |
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Carbamazepine side effects
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sedation
hematological abnormalities agitation tremors headache auditory changes confusion Anticholinergic: blurred vision myadriasis cycloplegia opthalmoplegia dry mouth slurred speech constipation rash, unusual bruising, hair loss Stevens-Johnson syndrome |
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Carbamazepine interactions
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Increased metabolism with:
phenobarbital dilantin primidone Decreased metabolism of carb with: cimetidine propoxyphene calcium channel blockers it increases the clearance of: coumadin dilantin theophylline valproic acid |
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Carbamazepine lab workup and follow-up
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Same as valproid acid!
CBC Lytes LFTs ECG then CBC after 1 month then 2-3 times per year serum lytes every 6 months |
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Gabapentin class and mechanism of action
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mood stabilizer (rarely used now)
Increases GABA levels decreases glutamate levels |
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Gabapentin Indications
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For mood in seizure d/o
Adjunct for BAD |
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Gabapentin Side Effects
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weight gain
GI symptoms ataxia and tremor myalgia anticholinergic effects pruritis diplopia, nystagmus |
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Lamotrigine class and indications
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Anticonvulsant
acute BAD 1 depression acute BAD 2 depression (second line) maintenance BAD I and II |
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Lamotrigine SE
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N + V
sedation amnesia irritability insomnia switches to mania HA tremors incoordination dizziness breathlessness Steven Johnson's syndrome toxic epidermal necrolysis hypersensitivity suicidal thoughts and behavior aseptic meningitis |
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Lamotrigine
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Start low and go slow
25mg for first 2 weeks 50mg for 2nd 2 weeks 100mg for 3rd 2 weeks 200-400 for maintenance |
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Atypical Antipsychotics as mood stabilizers (Indications)
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Olanzapine, Quetiapine, Risperidone, Ziprasidone, Aripipazole
1st line acute mania 1st line maintenance BAD1 1st line for acute BD1 or 2 depression 2nd line maintenance of BDII |
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Lamotrigine SE
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N + V
sedation amnesia irritability insomnia switches to mania HA tremors incoordination dizziness breathlessness Steven Johnson's syndrome toxic epidermal necrolysis hypersensitivity suicidal thoughts and behavior aseptic meningitis |
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Lamotrigine
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Start low and go slow
25mg for first 2 weeks 50mg for 2nd 2 weeks 100mg for 3rd 2 weeks 200-400 for maintenance |
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Atypical Antipsychotics as mood stabilizers (Indications)
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Olanzapine, Quetiapine (best), Risperidone, Ziprasidone, Aripipazole
1st line acute mania 1st line maintenance BAD1 1st line for acute BD1 or 2 depression 2nd line maintenance of BDII |
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Name the regions that the ventral tegmental area projects and what each dysregulation leads to in terms of symptoms
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Mesolimbic: ↑ DA = + symptoms
Mesocortical: ↓ DA =- symptoms Nigrostriatal: ↓ DA =EPS Tuberoinfundibular: ↓ DA ↑ PRL (amenorrhea, galactorrhea, gynecomastia, infertility) |
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Kapur's Dopamine hypothesis in psychosis?
NMDA hypothesis modification? |
Increased dopamine in mesolimbic system inhibits the breaks (nucleus accumbens) of the thalamus
Decreased NMDA takes the breaks off of dopamine inhibiting the thalamus "takes the breaks off the breaks" |
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What receptors do typical and atypical antipsychotics block?
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Typical: block D2 receptors (helps positive Sx)
Atypical: block D2, 5-HT, etc Affects positive + negative with the bonus of less EPS! |
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Do patients respond better as individuals to certain antipsychotics?
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For atypicals yes
For typicals generally not But on the whole they are all about as effective |
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How long should you treat a patient after a psychotic episode?
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6 mo - 1 year. Sometimes longer. Sometimes for life (most).
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Should we treat patients with dementia with antipsychotics?
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No, it increases cardiac mortality
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Name 1 low potency typical antipsychotic, 3 medium, and 1 high
Also discuss EPS vs. Anticholinergic and Sedating effects |
Low
chlorpromazine (Largactil) Medium zuclopenthixol (Clopixol) perphenazine (Trilafon) loxapine (Loxapac) High haloperidol (Haldol) EPS = high potency Antichol + sedation = low potency |
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Chlorpromazine (Largactil) "The Movie Drug"
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Low potency typical
PO & IM Advantages: Very sedating No EPS at lower doses Can be used for severe agitation, esp. mania Can be helpful for intractable hiccups Disadvantage: α-blocker: orthostatic hypotension; can be given PO as long as BP>90/60 Severe sedation and very anticholinergic Not good for long term treatment |
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Haldol "Vitamin H"
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High Potency typical
PO, IM, liquid and IV Advantages Few drug interactions (pure D2) Frequently still used for agitation Only drug with real evidence for ICU delirium (IV with heart monitor) High doses can be effective in some treatment resistant patients Depot available Disadvantages More EPS than any other medication High risk of dystonia and akathesia in antipsychotic naïve patients |
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Clopixol (Zuclopenthol) "weekend drug"
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Medium potency typical
Accuphase, Depot, IM, PO Accuphase in non-naive patients gives 72h effect (don't do in naive though.. even though it would still work) |
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Perphenazine (Trilafon) "Catie Drug"
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Medium potency typical
PO, liquid Catie trial showed as effective as atypicals Weight neutral! |
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Loxapine (loxepac)
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Medium potency typical
PO, IM somewhat sedating less dystonia than haloperidol often seen in IM agitation cocktails |
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What is one serious cardiac complicaiton with all antipsychotics?
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QT prolongation (could cause Torsades des Pointes)
Decreased seizure threshold Anticholinergic (5 rhymes, urinary retention, constipation, seizures coma death) |
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Antidote for anticholinergic toxicity in antipsychotics?
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physostigmine (ACHe inhibitor or something)
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What causes neuroleptic malignant syndrome and what should you look for?
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massive DA blockade causes it
FEVER = Fever Encephalopathy Vitals unstable Elevated CPK, WBC, acidosis, myoglobinuria Rigidity |
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Risk factors for Neuroleptic Malignant syndrome?
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male
young high potency typicals depot NLP restraints dehydration |
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Treatment for Neuroleptic Malignant syndrome?
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stop antipsychotic
cool patient give fluids Dantrolene, Bromocriptine, Ativan |
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At what D2 receptor occupation do you get EPS symptoms?
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80% occupation of D2 receptors causes EPS
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What are the EPS parkinsian symptoms?
Timeline of onset? |
Tremor, Rigidity, Bradykinesia, Postural Instability (TRAP)
Can present within 30 days |
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Risk factors for EPS parkinsons?
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Elderly
Female High dose or increased dose olther neurological condition High potency NLP |
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Treatment for EPS parkinson's symptoms?
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lower dose
change meds (to mid or low or atypical antipsychotic) Anticholinergic meds (cogentin, kemadrin, benadryl) but watch for side effects |
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Acute Dystonic Reaction Risk factors for antipsychotic med patients?
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Asian male
Young high potency or rapid dose increase recent cocaine use |
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Acute dystonic reaction treatment?
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Anticholinergic meds (cogentin, kemadrin, benadryl) but watch for side effects EG cogentin IM 2mg max 2 doses / 24h
Benzodiazepine Treat for 2 weeks then release |
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Akathisia onset and risk factors for antipsychotics
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Onset early (10 days) or late (months)
Restless legs Risk factors are elderly women and high potency |
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Akathisia treatment
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lower dose
switch to atypical Benzos Antihistamines Propranolol |
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Tardive Dyskinesia onset and risk factors
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constant purposeless movements of face and mouth (sometimes limbs and trunk)
Late onset of months to years risk factors MOOD Sx! old female previous EPS long treatment Typicals (High potency in partic) |
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Tardive Dyskinesia treatment
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lowering/stop Rx often helpful
switch to atypical switch to clozapine tetrabenazine (dopamine depleting agent) anticholinergics can worsen the sx! |
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Advantages of atypicals over typical antipsychotics
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Less tight binding means fast off kinetics
Lower EPS + TD good positive symptom control better for negative and cognitive sx in some patients since 5HT blocking activity stops inhibition of dopamine in mesocortical region of brain and nigrostriatal (thus stopping EPS symptoms too) |
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Risperidone (Risperdal) advantages and disadvantages
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Atypical antipsychotic
Advantages PO, M-Tab and liquid Risperdal depot available Less EPS than Haldol at doses ≤ 6 mg Not very sedating Not anticholinergic Generic available Autism indication Disadvantages Significant hyperprolactinemia Mild-moderate weight gain More EPS than other atypicals |
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Paliperidone (Invega) advantages and disadvantages
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Atypical antipsychotic
Active metabolite of risperidone Advantages Less drug interactions, therefore may be useful in HIV patients on HAART Osmotic delivery “OROS” for more smooth plasma concentration (?clinical utility) Disadvantages Costly Little clinical experience |
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Olanzapine (Zyprexa) Advantages and Disadvantages
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Atypical Antipsychotic
Advantages PO, Zydis Better tolerated than other antipsychotics Little EPS Sedation useful for agitated patients Bipolar maintenance Fluoxetine + olanzapine in Bipolar depression Disadvantages Severe weight gain Moderately anticholinergic Sedation can be problematic for maintenance Worsens Type II diabetes |
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What is a good SSRI and atypical antipsychotic combination for bipolar depression?
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Olanzapine (Zyprexa) and Fluoxetine (Prozac)
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Quetiapine (Seroquel) Advantages and Disadvantages
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Atypical Antipsychotic
Advantages Virtually no EPS therefore useful in patients with Parkinson’s and Lewy Body Dementia Prolactin elevation is rare Bipolar depression indication Often used in low doses as anxiolytic Seroquel XR is dosed qd and can be titrated rapidly Disadvantages Very sedating Orthostatic hypotension Requires slow dose titration Bid dosing recommended (though may not be necessary for some) Mild-moderate weight gain |
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Ziprasidone (Zeldox) Advantages and Disadvantages
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Atypical Antipsychotic
Advantages Weight neutral Little worsening of diabetes Less sedating Not anticholinergic Disadvantages Must be taken bid with food QT prolongation New to Canada |
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Aripirazole (Abilify) mechanism of action, Advantages and disadvantages
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D2 Partial Agonist atypical antipsychotic
Advantages Maintenance in bipolar disorder The only drug approved for augmentation in depression Weight neutral Low risk of EPS Disadvantages Should not be combined with other antipsychotics Not available in Canada |
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Clozapine (Clozaril) Advantages
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30-50% of treatment resistant patients with schizophrenia will improve
Case reports of it being helpful in many other disorders when all else fails Virtually no EPS Virtually no Prolactin elevation Treats tardive dyskinesia May reduce suicidality in schizophrenia |
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Clozapine (Clozaril) Disadvantages
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1-2% dose independent risk of agranulocytosis, highest in 1st 6 months
Needs weekly CBC Lowers seizure threshold at higher doses Small risk of myocarditis Severe sedation Severe orthostatic hypotension Severe weight gain Severe sialorrhea (drooling) Severe constipation Needs very slow dose titration |
