Atypical Antipsychotics

Summary

Atypical antipsychotics are a class of psychiatric medications that includes drug names like aripiprazole. Some drug names of this class end in -pine, like clozapine, olanzapine, and quetiapine. Other drug names end in -done, like risperidone, ziprasidone, and paliperidone.

These drugs work by blocking dopamine and serotonin receptors in the brain.

Clinically, atypical antipsychotics are used to treat schizophrenia, where they are effective at treating both positive and negative symptoms. They are also used to treat bipolar disorder.

Side effects include drowsiness and sedation, QT prolongation, hyperglycemia, extrapyramidal symptoms, neuroleptic malignant syndrome, hypercholesterolemia, orthostatic hypotension, and anticholinergic effects. Atypical antipsychotics should be used with caution in patients with dementia. In addition, they may cause seizures and weight gain.

Some side effects are specific to individual drugs. Clozapine can cause agranulocytosis, a severe drop in white blood cells. Risperidone can cause gynecomastia, or enlargement of male breast tissue.

Key Points

• Atypical Antipsychotics
  • Drug Names
    • Risperidone (Risperdal)
    • Clozapine (Clozaril)
    • Aripiprazole (Abilify)
    • Olanzapine (Zyprexa)
    • Quetiapine (Seroquel)
    • Ziprasidone (Geodon)
    • Paliperidone (Invega)
  • Mechanism
    • Block dopamine and serotonin receptors
  • Clinical Use
    • Schizophrenia
      • Treats both positive and negative symptoms
        • Positive symptoms include hallucinations, delusions, disorganized thinking
        • Negative symptoms include flat affect, anhedonia (inability to feel pleasure), anergia (lack of energy)
    • Bipolar Disorder
      • Can be used to stabilize mood and prevent recurrence of manic and depressive episodes
  • Side Effects
    • Metabolic Changes
      • Mainly seen with olanzapine, clozapine, paliperidone, and quetiapine
      • Hyperglycemia
        • Atypical antipsychotics have an impact on glucose metabolism and can lead to hyperglycemia
        • Monitor blood glucose regularly
      • Weight Gain
        • Can contribute to metabolic issues and cardiac risks
        • Encourage regular physical activity and healthy diet
      • Hypercholesterolemia
        • Monitor lipid levels
    • Agranulocytosis (Clozapine)
      • A severe decrease in white blood cells, posing a risk of infection
      • Report any signs of infection (fever, sore throat, etc.)
      • Monitor CBC regularly
    • Orthostatic Hypotension
      • A sudden drop in blood pressure upon standing, causing dizziness or fainting
      • Educate patient on changing positions slowly to prevent falls
    • QT Prolongation
      • Can lead to torsades de pointes, a life-threatening arrhythmia
      • Monitor ECG regularly
      • Avoid concurrent use with other medications that prolong the QT interval
      • Most common with ziprasidone, although may be seen with most atypical antipsychotics
    • Anticholinergic Effects
      • Includes urinary retention, constipation, dry mouth, tachycardia, and blurred vision
      • Atypical antipsychotics generally have less anticholinergic effects than typical antipsychotics
    • Sedation
      • Often recommended to take at night
    • Neuroleptic Malignant Syndrome (NMS)
      • Life threatening condition
      • Characterized by hyperthermia, autonomic dysregulation, altered mental status, and generalized muscle rigidity
      • Notify provider immediately if NMS is suspected
    • Seizures
      • Some atypical antipsychotics may lower the seizure threshold
    • Extrapyramidal Symptoms (EPS)
      • Includes akathisia, tardive dyskinesia, parkinsonism, dystonia
      • Atypical antipsychotics generally have less EPS than typical antipsychotics
    • Gynecomastia (Risperidone)
      • Enlargement of male breast tissue
  • Precautions
    • Use with caution in dementia