Second Gen Antipsychotics

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Author:
jcu1
ID:
259116
Filename:
Second Gen Antipsychotics
Updated:
2014-01-29 16:34:17
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  1. clozapine and EPS (why)
    • very little amt
    • bc of low potency at D2
  2. Which antipsychotics may improve TD sx's
    • clozapine
    • quetiapine
  3. receptors blocked by clozapine and the clinical effect
    • alpha-1
    • alpha-2
    • H1
    • M1
    • hypotention, sedation, metabolic effects, bowel obstruction, enuresis, sialorrhea
  4. clozapine black box warnings
    • agranulocytosis
    • seizures
    • myocarditis
    • CV/resp rxns
    • death (in elderly pts with dementia)
  5. clozapine dosing
    • begin 12.5 - 25 mg qd
    • increase by 25 mg qd or 50 mg qod
    • target dose around 300 - 600 mg
    • max dose 900 mg
  6. missed clozapine doses
    if > 2 days missed, have to restart titration
  7. clozapine and smoking
    smoking decreases levels
  8. clozapine monitoring
    • WBC and ANC
    • every wk for 6 mo
    • every 2 wks for months 6-12
    • every 4 wks from 1 yr to infinity
  9. Risperidone doses > 6 mg
    • D2 binding similar to FGAs
    • most EPS among the atypicals
  10. receptors blocked by risperidone and clinical effect
    • alpha-1
    • H1
    • orthostatic hypotension
  11. olanzapine side effects
    most metabolic side effects
  12. receptors blocked by olanzapine and clinical effect
    • alpha-1
    • H1
    • M1
    • metabolic effects
    • anticholinergic effects (bc of this very little EPS)
  13. olanzapine and smoking
    smoking decreases levels (CYP 1A2 induction)
  14. Atypicals that have very little EPS effects
    • clozapine
    • olanzapine
    • quetiapine
  15. receptors blocked by quetiapine and the clinical effect
    • high alpha-1
    • low M1
    • H1
    • orthostasis, sedation, metabolic effects
  16. receptors blocked by ziprasidone and the clinical effect
    • weak effecs to M1, alpha-1, H1
    • little to now weight gain, minimal metabolic effects
  17. ziprasidone inhibits the reuptake of ___
    • NE and 5HT
    • activating at low doses (start at medium dose and quickly titrate up)
  18. how to take ziprasidone
    take with 500 calories of food
  19. aripiprazole receptors
    • partial agonist activity at D2 and 5HT1a
    • antagonist acticty at 5HT2a
  20. aripiprazole side effect and why
    • akathisisa
    • high degree of serotonergic properties
    • highly activating at low dose/AM dosing
  21. paliperidone clinical teaching
    • 9-OH risperidone (active metabolite of risperidone)
    • ER tablet shell found in stool
  22. Asenapine dosage form
    only sublingual
  23. Asenapine side effects
    • well tolerated
    • metabolic effects, sedation, orthostasis
  24. iloperidone receptor blocking and clinical effect
    • alpha-1
    • orthostasis
  25. lurasidone receptor affinity and clinical effect
    • minmal or no alpha-1, H1, or M receptor affinity
    • favorable metabolic profile
    • not sedating
  26. when to dose lurasidone and why
    • with evening meal
    • minimize akathisia/sedation

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