Psychopharmacology Exam 2 (part 2)

Typicals have D2 binding only whereas Atypicals have D2 and 5HT2A binding

Atypicals have less EPS/TD, DIP, Prolactin, and they dont worsen negative symptoms

There is no difference in efficacy between them

Positive symptoms

DIP

Negative/cognitive/affective symptoms

5HT2A antagonism

5HT2A antagonism

5HT2A antagonism

5HT2A antagonist

5HT1A

Mania

Antidepressant actions

5HT2C + H1

None

D2 antagonism

H1 antagonism

M3 antagonism

5HT1A partial agonism

5HT2C antagonism

They are all sedating and cause weight gain as a class, and work on alpha, H1, and M3 receptors

Treatment resistant schizophrenia

600 mg per day

The potential for an illeus

Atropine

Clozapine

Luvox, because it is a CYP1A2 inhibitor and clozapine is metabolized via CYP1A2 which would cause it to reach dangerous levels

Because smoking is an inducer of CYP1A2 which will reduce clozapine levels. When they are admitted to the hospital they will have to quit temporarily and the dose will be decreased, but when they are discharged it is important to increase the dose when they pick up smoking again.

Myocarditis, Agranulocytosis, Seizures, Sedation, Sialorrhea, Weight Gain, Constipation, Orthostatic Hypotension

> 1500

Check ANC weekly for 1st 6 months, then bi-weekly for another 6 months, then every month for the rest of their lives

Benzos r/t excess sedation

H1, alpha 1, M1, M3; anticholinergic actions, orthostatic hypotension, sedation, and weight gain

Sedation = high Weight gain = high EPS = low

5HT2C, H1, and M3; Antidepressant actions, weight gain ++, and sedation

Lower risk overall but still higher than clozapine

5HT2A, 5HT1A, NRI, 5HT2C, H1, M1 and M3, alpha 2; it causes Antidepressant actions, sedation, and weight gain

Quetiapine because it has a low risk for EPS

Sedation: high Weight gain: high EPS: low

50 mg

300 mg

800 mg

Asenapine

It tastes bad and can cause numbness and tingling of the mouth and tongue

Schizophrenics, Bipolar, and Child/Adolescents

5HT2C, 5HT1A, 5HT1B, 5HT1D, 5HT7, alpha 2, and H1; Antidepressant actions, sedation, and weight gain

Sedation: high Weight gain: moderate EPS: moderate

Ziprasidone (Geodon), Lurasidone (Latuda), Lumateperone (Caplyta)

< 6 mg = atypical behavior > 6 mg = typical behavior

5HT2A and alpha 1; causes hyperprolactemia, sedation, and orthostatic hypotension

Sedation = medium Weight gain = high EPS = high

Risk: Hyperprolactemia Benefit: Less sedating

5HT2A and alpha 2; hyperprolactemia, low sedation, mood stabilizer

It is not metabolized by the liver but extreted in the urine

Sedation: moderate Weight gain: moderate EPS: high

Because it must be taken with 500 calories of food for a total of 1000 calories per day

Prolonged QT

5HT2C, 5HT1A, 5HT1B, 5HT1D, 5HT7, alpha 2; Antidepressant effects, low weight gain, low sedation

Sedation: moderate Weight gain: low EPS: high

Potent alpha 1 antagonism

Titrate slowly over several days to avoid orthostatic hypotension

Twice a day

Iloperidone

Lurasidone

Sedation: moderate Weight Gain: low EPS: moderate

CYP3A4. Inducers: Tegretol, St John's Wort; Inhibitors: Grapefruit

Lumateperone

EPS: low Prolactin: low Sedation: high

Lumateperone

Lumateperone

Lumateperone

High risk of akathesia, but not sedating, low weight gain and prolactin level

D2 & 5HT1A partial agonists

5HT7, 5HT1A partial agonist; high akathesia, antidepressant actions, low sedation, low weight gain, and low EPS

Brexpiprazole

5HT7, 5TH1A partial agonist, alpha 1; anxyolitic, antidepressant, low weight gain, low sedation, and moderate EPS

Cariprazine

High D3 partial agonist and 5HT1A partial agonist; antidepressant actions that can treat negative symptoms of schizophrenia, bipolar mixed features, depression, and substance use. Also has low sedation and weight gain, and moderate EPS.

Pimavanserin