各論

• Typical Antipsychotics (note EPS)
• Haldol
  • Affects alpha, dopamine-2 receptor.
  • EPS risk: high; Constipation risk: low
• CPZ
  • Sedation:high, EPS: moderate, anticholinergic ( constipation, memory):moderate, CV(orthostatic hypotension) High
• Atypical: (note metabolic syndrome)
• Clozapine
  • Not First line
  • Agranulocytosis 1% risk
  • Monitor CBC (WBC D/C) weekly for first 6 months, every two weeks for next 6 months, then every 4 weeks thereafter
  • Sedation, constipation, tachycardia
• Risperdone
  • Mixed serotonin-dopamine antagonist activity
  • Also antagonizes alpha-2, histamine receptors
  • Lower EPS ( if dose <6mg)
  • Prolactin elevation
    • Galactorrhea, Amenorrhea, decrease in bone density, sexual dysfunction.
  • Orthostasis
  • Tachycardia
• Paliperidone
  • Major metabolite (9-OH) of risperidone
  • “Once-daily” dosing
  • Less prolactin elevation.
• Ziprasidone (GeodonÒ)
  • High affinity for serotonin receptors, moderate dopamine/histamine, no affinity for alpha/beta
  • Minimal effects on metabolic profile
  • EKG changes: QTc prolongation
• Aripiprazole (AbilifyÒ)
  • Dopamine-2 partial agonist, partial serotonin-1A agonist
  • Akathisia
  • Minimal effects on metabolic profile
  • Nausea, Headache
• Olanzapine
  • Potent antagonist of several serotonin receptors, dopaminergic, muscarinic, histaminergic, and alpha
  • Significant potential for metabolic dysregulations
  • Sedation
  • Anticholinergic effects
  • Tachycardia
  • monitor for akathisia at higher doses (>15mg)
• Quetiapine (SeroquelÒ)
  • Antagonist of serotonin, dopamine receptors, some effect on histamine/alpha receptors
  • Side effect similar to Olanzapine