Atypical Antipsychotics

Question 1

What are three examples of atypical antipsychotics?

Answer 1

Aripiprazole (Abilify)
Olanzapine (Zyprexa)
Risperidone (Risperidal)

Question 2

Atypical antipsychotics have what six clinical uses?

Answer 2

BPD

Depressive disorders

Mania

OCD (off-label)

Psychosis associated with dementia CAUTION

Schizophrenia and other causes of psychosis

Question 3

The MOA of atypical antipsychotics is not fully understood, but what is our understanding regarding how they work?

Answer 3

Block serotonin in the brain cortex making serotonin unable to stop dopamine release. More dopamine reaches the front of the brain which helps reduce negative symptoms of Schizophrenia.

**Think of it like removing a brake (Serotonin) that was stopping a helpful chemical (dopamine) from reaching an important part of the brain.

Question 3

Movement disorders
Involuntary muscle control
Dry mouth, blurred vision, other anticholinergic effects
Issues with blood pressure and heart rate
Neuroleptic malignant syndrome

These are all serious side effects associated with what type of medications? This is why atypical antipsychotics are used more commonly.

Answer 3

Typical antipsychotics

Question 4

There are many adverse effects of atypical antipsychotics. Name a few of these adverse effects.

Answer 4

Metabolic: weight gain, diabetes mellitus (insulin resistance), dyslipidemia, cardiovascular disease predisposition
Risk of EPS, TD, and NMS but less so compared to typical antipsychotics
Increased risk of mortality in patients with dementia-related psychosis
Orthostatic hypotension, syncope, and falls with head injuries
Sedation with some
Hyperprolactinemia
QTc prlongation

Question 5

Adverse effects of atypical antipsychotics are worse with some meds. Which atypical antipsychotic causes more significant weight gain and insulin resistance, and which meds more commonly show QTc prolongation?

Answer 5

weight gain- Olanzapine
QTc prolongation- Ziprasidone and Quetiapine

Question 6

For which population are atypical antipsychotic drugs safe to prescribe?
a. Pregnant clients
b. Lactating clients
c. Young children
d. Middle-aged adults
e. Elderly, including those with dementia

Answer 6

D

Do not use in pregnancy/lactation, young children, or anyone with dementia.

Question 7

In what patients should you exercise caution when prescribing atypical antipsychotics?

Answer 7

Those with hepatic or renal dysfunction

Question 8

Atypical antipsychotics should not be used if there is a history of what? They also should not be used with what types of meds/substances?

Answer 8

History of hypersensitivity reaction

CNS depressant drugs or alcohol

Question 9

What can patients do to prevent excessive weight gain associated with atypical antipsychotics?

Answer 9

Avoid all simple carbohydrates
Exercise regularly (aerobic and strength training)
Maintain a lean and normal body weight