Overview
This lecture covers atypical antipsychotic medications, their uses, key drug names, major side effects, and important safety notes for clinical practice.
Atypical Antipsychotics: Drug Names & Mnemonics
- Atypical antipsychotics treat psychosis in schizophrenia and other disorders, and act as mood stabilizers in bipolar disorder.
- Main drugs: clozapine, olanzapine, aripiprazole, risperidone, quetiapine, and ziprasidone.
- Mnemonics: closet for clozapine, lance for olanzapine, airpods for aripiprazole, whisper for risperidone, quiet for quetiapine, zipper for ziprasidone.
Clinical Uses
- First-line treatment for schizophrenia due to effectiveness on both positive (hallucinations, delusions) and negative (flat affect, antisocial) symptoms.
- Used to treat psychosis in other contexts (e.g., postpartum, dementia patients).
- Have mood stabilizing effects and are effective for bipolar disorder.
Side Effects & Safety
- Extrapyramidal symptoms (EPS): movement disorders including tremors, muscle spasms, restlessness, and involuntary movements.
- Metabolic syndrome: weight gain and high blood sugar, particularly notable in this drug class.
- Sedation and drowsiness; caution combining with other sedating substances (e.g., alcohol, benzodiazepines).
- Anticholinergic effects: dry mouth, blurry vision, tachycardia, urinary retention, constipation.
- Agranulocytosis (dangerous drop in white blood cells) is linked specifically to clozapine—requires monitoring for infection.
- Neuroleptic Malignant Syndrome (NMS): medical emergency with muscle rigidity, fever, confusion, unstable vitals—stop drug and call provider immediately.
- Ziprasidone can prolong the QT interval on EKG and cause life-threatening torsades de pointes arrhythmia—monitor cardiac status.
Key Terms & Definitions
- Atypical antipsychotics — newer class of antipsychotic drugs with fewer movement side effects.
- Extrapyramidal symptoms (EPS) — drug-induced movement disorders like tremors and spasms.
- Metabolic syndrome — group of risk factors (weight gain, high blood sugar) often caused by these drugs.
- Anticholinergic effects — symptoms from blocking the parasympathetic nervous system (e.g., dry mouth, constipation).
- Agranulocytosis — dangerous decrease in white blood cells; risk with clozapine.
- Neuroleptic Malignant Syndrome (NMS) — life-threatening side effect with rigidity, fever, and mental status changes.
- QT prolongation/Torsades de pointes — dangerous heart rhythm, especially with ziprasidone.
Action Items / Next Steps
- Review detailed symptoms of EPS (tardive dyskinesia, dystonia, akathisia).
- Remember to monitor white blood cell counts for patients on clozapine.
- Ensure cardiac monitoring for patients taking ziprasidone.
- Study side effect management and emergency protocols for NMS.