Atypical Antipsychotics

Psychopharmacology
Dr .Ayaanle MBBS
ATYPICAL ANTIPSYCHOTICS
o Atypical antipsychotics block both dopamine and
serotonin receptors and are associated with fewer side
effects than traditional antipsychotics; in particular,
they rarely cause EPSEs, tardive dyskinesia, or
neuroleptic malignant syndrome.
o They are more effective in treating negative symptoms
of schizophrenia than traditional antipsychotics.
o Because they have fewer side effects and increased
effectiveness in treating negative symptoms, these
drugs are now first line in the treatment of schizophrenia.
EXAMPLES
Atypical antipsychotics include:
o Clozapine (Clozaril)
o Risperidone (Risperdal)
o Quetiapine (Seroquel)
o Olanzapine (Zyprexa)
o Ziprasidone (Geodon)
SIDE EFFECTS
Some anti-HAM effects (antihistaminic, antiadrenergic,
and antimuscarinic)
o 1% incidence of agranulocytosis and 2 to 5% incidence of
seizures with clozapine
o Olanzapine can cause hyperlipidemia, glucose
intolerance, weight gain,and liver toxicity; monitor liver
function tests (LFTs).
o Quetiapine has less propensity for weight gain but has
been shown to cause cataracts in beagle dogs, so
periodic (every 6 months) slit lamp examination is
recommended.
MOOD STABILIZERS
o Mood stabilizers are also known as antimanics and are
used to treat acute mania and to help prevent relapses of
manic episodes. Less commonly, they may be used for:
Potentiation of antidepressants in patients with major
depression refractory to monotherapy
Potentiation of antipsychotics in patients with
schizophrenia
o Mood stabilizers include lithium and two anticonvulsants,
carbamazepine and valproic acid.
Lithium
oLithium is the drug of choice in the treatment of

acute mania and as prophylaxis for both manic
and depressive episodes in bipolar disorder.
oIts exact mechanism of action is unknown, but it
has been shown to alter neuronal sodium
transport.
SIDE EFFECTS
Side effects of lithium include:
o fine tremor
o Sedation
o Ataxia
o Thirst
o Metallic taste
o Polyuria
o Edema
o weight gain
o GI problems
o benign leukocytosis
o Thyroid Enlargement
o hypothyroidism
o nephrogenic diabetes insipidus.
Carbamazepine (Tegretol)
o Carbamazepine is an anticonvulsant that is especially

useful in treating mixed episodes and rapid-cycling bipolar
disorder.
o It is also used in the management of trigeminal
neuralgia.
o It acts by blocking sodium channels and inhibiting
action potentials.
o Its onset of action is 5 to 7 days.
SIDE EFFECTS
o Side effects include skin rash, drowsiness, ataxia, slurred
speech, leukopenia,hyponatremia, aplastic anemia, and
agranulocytosis
o It elevates liver enzymes and has teratogenic effects
when used during pregnancy (neural tube defects).
o Pretreatment complete blood count (CBC) and LFTs
must be obtained and monitored regularly.
Valproic Acid (Depakene) Anti dote carnitine
o Valproic acid is an anticonvulsant that is especially useful in

treating mixed manic episodes and rapid-cycling bipolar
disorder.
o SIDE EFFECTS
o Side effects include sedation, weight gain, alopecia,
hemorrhagic pancreatitis,hepatotoxicity, and thrombocytopenia.
o It has teratogenic effects during pregnancy (neural tube
defects).
o Monitoring of LFTs and CBCs is necessary
ANXIOLYTICS/HYPNOTICS
o Anxiolytics, including benzodiazepines, barbiturates,
and buspirone, are the most widely prescribed
psychotropic medications.
o In general, they all work by diffusely depressing the CNS,
causing a sedative effect.
Common indications for anxiolytics/hypnotics include:
Anxiety disorders
Muscle spasm
Seizures
Sleep disorders
Alcohol withdrawal
Anesthesia induction
Benzodiazepines (BDZs)
Benzodiazepines are first-line anxiolytics
o Advantages include safety at high doses (as opposed to
Barbiturates).Naloxone
o A significant limitation is imposed on the duration of BDZ
use due to their potential for tolerance and dependence
after prolonged use
Long Acting (1 to 3 Days)
o Chlordiazepoxide (Librium)—used in alcohol
detoxification, presurgery anxiety
o Diazepam (Valium)—rapid onset, used in treatment of
anxiety and seizure control
o Flurazepam (Dalmane)—rapid onset, treatment of
insomnia
Intermediate Acting (10 to 20 Hours)
o Alprazolam (Xanax)—treatment of panic attacks
o Clonazepam (Klonopin)—treatment of panic attacks,
anxiety
o Lorazepam (Ativan)—treatment of panic attacks, alcohol
withdrawal
o Temazepam (Restoril)—treatment of insomnia
Short Acting (3 to 8 Hours)
o Oxazepam (Serax)
o Triazolam (Halcion)—rapid onset, treatment of insomnia

Atypical Antipsychotics

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Psychopharmacology

oLithium is the drug of choice in the treatment of

o Carbamazepine is an anticonvulsant that is especially

o Valproic acid is an anticonvulsant that is especially useful in

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