Atypical antipsychotics are drugs used to treat psychosis associated with schizophrenia or other psychotic disorders and are also used as mood stabilizing drugs for the treatment of bipolar disorder. The atypical antipsychotics can be tricky to commit to memory, but this mnemonic will help you master these drugs in no time. Let's get started.
We're in the apartment of our good friend who is an art and drama enthusiast. She's not here yet, but today is her birthday, and we are surprising her with the famous painting of The Scream, since it's her favorite piece of art. Anyway, we're going to use The Scream painting as our symbol for psychosis.
See the way the man in the picture is holding his head while reality swirls around him? This kind of reminds me of psychosis, when people lose their sense of reality. Make sense?
And today, we're talking about the anti-psychotics. which are drugs used to treat psychosis. That part is easy.
It's right in the name, antipsychotics. Moving on, a painting like this belongs locked up in a museum, not in someone's cramped apartment, and especially not in a bright and cheery apartment like this. Yeah, this painting doesn't really belong here, which is our way of symbolizing that we are talking about atypical antipsychotics.
Because the scream painting is in an atypical setting, right? Now. Now, atypical antipsychotics can be intimidating because there is no common ending in their drug names, making it hard to memorize which drugs fall into the atypical antipsychotic category. But don't worry, we've incorporated all that into the mnemonic for you.
Let's take a look. As you might have noticed, this is a surprise party. You know, the kind of party where everyone hides and then surprises the birthday person as they turn on the lights.
My friend here has found the best hiding spot of all, in the closet. This closet is our symbol for the drug clozapine. Closet for clozapine.
They sound pretty similar, don't you think? When you come across clozapine on test day, now you know that it's an atypical antipsychotic. Next, this isn't just any ordinary closet. I mentioned that this friend of mine is super into the performing arts on top of just paintings.
That's why she has a costume closet in her apartment. It's stuffed with all sorts of costumes. and I even see a lance spilling out.
A lance, you know, the spear-looking thing medieval knights would use for jousting. This lance is the symbol for the drug olanzapine. Lance for olanzapine.
Or you can think of it as olanzapine, if that helps. Let's talk about a few more drugs. To pass the time waiting for the birthday girl, my friend in the closet is chilling to some music. He's smart, he brought his AirPods with him. When you think of these AirPods, I want you to remember the drug aripiprazole.
AirPods for aripiprazole. It's the aripiprazole AirPods. Aripiprazole is yet another atypical antipsychotic drug name you should commit to memory.
Some people are whispering over here in the corner. They don't want to be too loud in case the birthday girl shows up, so they're whispering to keep their voices down. By the way, whisper is our symbol for the drug risperidone.
Just think, Whisperadone. Alright. The one on the stepstool there is in charge of planning this whole surprise gig. And she hears someone coming to the door.
Shh, everybody quiet. Especially you two whispering over there. The way the woman is shushing everybody to be quiet is our symbol for quetiapine. Get it? Quiet for quetiapine?
Now you'll have no trouble remembering that quetiapine is an atypical antipsychotic. Last drug name here before we move on. The woman in charge is carrying around her purse, which has a large zipper on it.
This zipper symbolizes ziprazidone. Just think, ziperazidone. Okay, that's it. Those are the typical antipsychotics. Clozapine, olanzapine, aripiprazole, rispiridone, quetiapine, and ziprazidone.
Next, let's move on to the clinical uses of atypical antipsychotics. We've Kinda already covered this previously, so I'll keep this part short. Atypical antipsychotics are used to treat psychosis.
That was what the person with the wild, crazy eyes in the screen painting represented, remember? Now, this is especially useful in people who have schizophrenia. In fact, atypical antipsychotics are first-line treatment for schizophrenia, beating out the typical antipsychotics.
This is because atypical antipsychotics can treat both the positive symptoms of schizophrenia, like hallucinations and delusions, as well as the negative symptoms, like the flat affect and antisocial behaviors. I want to note that psychosis doesn't just show up with schizophrenia. It can appear postpartum and in patients with dementia as well. Therefore, you may see atypical antipsychotics like quetiapine used in a variety of clinical contexts to calm patients down in the hospital.
Just remember this scream painting to remember that antipsychotics treat psychosis, okay? Let's make our way back to that costume closet. True to her character, the woman living here had some Greek drama masks in her closet.
What can I say? She loves the arts. The dual happy and sad faces on these Greek drama masks have historically represented comedy and tragedy. But here, they are also our symbol for bipolar disorder. You know, since people with bipolar disorder are known from swinging between manic and depressive states.
Which is kind of like swinging between the happy and sad drama masks here. Atypical antipsychotics like risperidone have mood-stabilizing effects, which makes them effective in treating bipolar disorder. Alright, with the clinical uses out of the way, now let's move on to some side effects of atypical antidepressants.
False alarm! The person at the door is just the EPS delivery man here with a package to the apartment. We were able to hear him coming even before he knocked on the door because of his large, noisy, rattling EPS truck out front.
The EPS delivery truck is here to remind you that atypical antipsychotics cause extrapyramidal symptoms, abbreviated EPS. So what is EPS anyway? Well, EPS can be simply summarized as a drug-induced disorder that affects the muscles. Specific symptoms include tremors, like this rattling truck, muscle spasms, restlessness, and involuntary actions like lip-smacking or sticking out the tongue. All of these muscle movements have specific names that you should try to get familiar with.
Have you heard of tardive dyskinesia or dystonia or akathisia? While we won't explain these in detail here, it would be a good idea to review the topic on your own. In general, you should remember EPS as a set of movement problems characterized by tremors that can be induced by taking antipsychotic drugs.
The package the EPS delivery man is carrying looks super heavy. he looks like he's barely going to make it to the door. This heavy, overweight package is here to remind you that atypical antipsychotics can cause weight gain.
Get it? An overweight package for weight gain? This weight gain is part of a bigger concept called metabolic syndrome, which also includes high blood sugar.
But it is most important to know that it is expected that patients taking atypical antipsychotics will gain weight. This can often be combated with a healthy diet and consistent exercise. Man, how much longer do we have to wait before this girl shows up?
I mean, my friend in the closet has completely fallen asleep at this point. Between the calming music and the dark closet, it's no wonder he's sleeping. When you think of this guy sleeping, I want you to remember that atypical antipsychotics make people sleepy.
Drowsiness and sedation are other side effects of atypical antipsychotics. And as such, people taking atypical antipsychotics should be advised to avoid other substances that also cause sedation, like benzodiazepines and alcohol. Because we want to avoid over-sedation, right? I mean, at least my friend tried to stay awake. I can tell because he has some empty cola bottles on the floor next to him.
Here at Pixerize, we use cola to represent choline or acetylcholine. So these empty fallen cola bottles should symbolize... anticholinergic effects because choline, or cola signaling, is decreased. Get it? Antipsychotics can cause anticholinergic effects, which include a set of findings like dry mouth, blurry vision, tachycardia, urinary retention, and the like.
Personally, I don't recommend memorizing this laundry list. Instead, I simply remember that acetylcholine causes most of the actions in our rest and digest, or parasympathetic system. Therefore, anticholinergic effects block our rest and digest system, which causes constipation, urinary retention, tachycardia, and blurred vision.
Pretty simple, right? Not only was my friend drinking cola, but he was also snacking on granola while he was waiting. Now that he's fallen asleep, the granola box has spilled granola crumbs onto the floor.
When you think of this empty, spilled granola, I want you to think about agranulocytosis. Spilled granola for agranulocytosis, get it? You can even think of agranolocytosis, if that helps. Notice that the granola box is right next to the closet.
This is important because only the drug clozapine causes agranulocytosis. Got that? Agranulocytosis is a fancy word for falling levels of certain white blood cells, especially neutrophils.
Without these white blood cells, the body is at high risk for infections. As the nurse, you will want to closely monitor the patient's white blood cell count and notify the provider if any signs of infections arise, like a sore throat or a fever. This is high yield on the NCLEX because agranulocytosis can lead to fatal infections and death, thereby proving a danger to patient safety. And the NCLEX is all about patient safety, right?
Let me just make it clear that this is not a luxury apartment. In fact, the lead pipes on the ceiling aren't even covered. You know, that actually has made it easy to decorate with these streamers.
We'll talk about the streamers in a second, but for now, let's focus on these lead pipes. The lead pipes are the symbol for lead pipe muscle rigidity, a characteristic symptom of a side effect called neuroleptic malignant syndrome, or NMS. Basically, taking atypical antipsychotics can precipitate a syndrome called NMS, which is characterized by muscle rigidity often called lead pipe rigidity, because the patient is so rigid and stiff that they resemble a lead pipe. Other signs of NMS include fever, altered mental status, and unstable vital signs.
NMS is a medical emergency. Let me say that again. NMS is a medical emergency. If a patient taking atypical antipsychotics starts to develop muscle rigidity, fever, altered mental status, or unstable vitals, do not give the antipsychotic drug and call the provider immediately. It's actually a good thing our friend is taking so long to come home.
Because we're still hanging up the twisted streamers on the lead pipes. I think things would go faster if that lady noticed that the streamer is stuck in her zipper. Hey, now that I'm thinking about it, these twisted streamers remind me of the abnormal heart rhythm called torsade de pointe. Wouldn't you agree?
You see, the shape of the EKG or rhythm strip in torsade de pointe forms a twisted streamer pattern, which is why the streamers are a recurring symbol for torsade de pointe. I mentioned the zipper earlier, and that's important because Torsade de Pointe is a potential side effect for patients specifically taking Ziprasidone. Ziprasidone prolongs the QT interval, which puts the patient at a higher risk for developing Torsade. Torsade de Pointe is a life-threatening arrhythmia, so patients taking Ziprasidone should have some degree of cardiac monitoring, okay? Alright, that's everything for the atypical antipsychotics.
I know it was a lot, so let's do a quick summary before we go. Atypical antipsychotics are a drug class used to treat psychosis and schizophrenia and other psychotic conditions, and are also used as mood stabilizers for bipolar disorder. Drugs in this category include clozapine, olanzapine, aripiprazole, risperidone, quetiapine, and zeprasidone. Side effects of these drugs include extrapyramidal symptoms, abbreviated EPS, which refers to a constellation of movement problems like tremors, muscle spasms, and restlessness.
Atypical antipsychotics are also well known for causing metabolic syndrome and weight gain. Other side effects include sedation, anticholinergic effects, and neuroleptic malignant syndrome, abbreviated NMS. NMS is a medical emergency characterized by muscle rigidity, fever, confusion, and unstable vitals. Don't forget that clozapine can cause agranulocytosis or a rapid fall in white blood cells, and zepracidone can cause QT prolongation and the abnormal heart rhythm of Torsade de Pointe.
Thanks for tagging along with me at this surprise party! I think the birthday girl is about to show up, so I'll wrap it up here. I'll catch you in the next video!
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