-
clozapine and EPS (why)
- very little amt
- bc of low potency at D2
-
Which antipsychotics may improve TD sx's
-
receptors blocked by clozapine and the clinical effect
- alpha-1
- alpha-2
- H1
- M1
- hypotention, sedation, metabolic effects, bowel obstruction, enuresis, sialorrhea
-
clozapine black box warnings
- agranulocytosis
- seizures
- myocarditis
- CV/resp rxns
- death (in elderly pts with dementia)
-
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
-
missed clozapine doses
if > 2 days missed, have to restart titration
-
clozapine and smoking
smoking decreases levels
-
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
-
Risperidone doses > 6 mg
- D2 binding similar to FGAs
- most EPS among the atypicals
-
receptors blocked by risperidone and clinical effect
- alpha-1
- H1
- orthostatic hypotension
-
olanzapine side effects
most metabolic side effects
-
receptors blocked by olanzapine and clinical effect
- alpha-1
- H1
- M1
- metabolic effects
- anticholinergic effects (bc of this very little EPS)
-
olanzapine and smoking
smoking decreases levels (CYP 1A2 induction)
-
Atypicals that have very little EPS effects
- clozapine
- olanzapine
- quetiapine
-
receptors blocked by quetiapine and the clinical effect
- high alpha-1
- low M1
- H1
- orthostasis, sedation, metabolic effects
-
receptors blocked by ziprasidone and the clinical effect
- weak effecs to M1, alpha-1, H1
- little to now weight gain, minimal metabolic effects
-
ziprasidone inhibits the reuptake of ___
- NE and 5HT
- activating at low doses (start at medium dose and quickly titrate up)
-
how to take ziprasidone
take with 500 calories of food
-
aripiprazole receptors
- partial agonist activity at D2 and 5HT1a
- antagonist acticty at 5HT2a
-
aripiprazole side effect and why
- akathisisa
- high degree of serotonergic properties
- highly activating at low dose/AM dosing
-
paliperidone clinical teaching
- 9-OH risperidone (active metabolite of risperidone)
- ER tablet shell found in stool
-
Asenapine dosage form
only sublingual
-
Asenapine side effects
- well tolerated
- metabolic effects, sedation, orthostasis
-
iloperidone receptor blocking and clinical effect
-
lurasidone receptor affinity and clinical effect
- minmal or no alpha-1, H1, or M receptor affinity
- favorable metabolic profile
- not sedating
-
when to dose lurasidone and why
- with evening meal
- minimize akathisia/sedation
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