NEURO: ANTIPSYCHOTICS, 1ST GENERATION ATYPICAL - CLOZAPINE

Question 1

ANPAT CLOZAPINE: INDICATIONS

Answer 1

• Urgent tx for psychomotor agitation
• Schizophrenia
• Bipolar Disorder

Question 2

ANPAT CLOZAPINE: MOA

Answer 2

• Block post synaptic dopamine-D2 receptors
• Features that distinguish 2nd gen AntiPsych from 1st Gen, improved efficacy in tx resistant schizophrenia and a lower risk of extrapyramidal side effects
• Possible mechanisms for these differences = higher affinity for other receptors (particularly 5-HT2A) and a character of looser binding to the D2 receptors

Question 3

ANPAT CLOZAPINE: ADVERSE EFFECTS

Answer 3

• Some degree of sedation
• Extrapyramidal effects = more common with 1st gen AntiPsych
• Metabolic disturbance = weight gain, DM, lipid changes
• Prolong QT interval = arrhythmias
• Risperidone = particular effects on dopaminergic transmission in the TUBEROHYPOPHYSEAL PATHWAY - regulates the secretion of Prolactin
• Breast Symptoms and sexual dysfxn
• Agranulocytosis
• Myocarditis

Question 4

ANPAT CLOZAPINE: WARNINGS

Answer 4

• Cardiovascular Dx patients

- Not used in patients with severe heart disease and neutropenia

Question 5

ANPAT CLOZAPINE: INTERACTIONS

Answer 5

• Sedation may be more pronounced when used with other sedating drugs
• Should not be combined with other dopamine blocking antiemetics and drugs that prolong the QT interval ( amiodarone, quinines, macroclides, SSRIs)

Question 6

ANPAT CLOZAPINE: OTHER EXAMPLES

Answer 6

• Quetiapine
• Olanzapine
• Risperidone
• CLOZAPINE