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PMHNP Anti-Psych Meds Cheat Sheet (DRAFT) by

FGA, SGA, AED, psychosis, schizophrenia drugs

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Typical Anti-p­syc­hotic (FGA)

Haldol­/Ha­lip­eridal
Thoraz­ome­/ch­lor­opr­omazine
Serent­il/­mes­ori­dazine
Mellar­il/­Tho­rid­azinel
Permit­il/­Flu­phe­nazine
Trilaf­on/­Per­phe­nazine
Stelaz­ine­/Tr­ifl­upe­razine
Loxita­ne/­lox­apine
Moban/­Mol­indone
Navane­/Th­iot­hixene
Typica­l/First Generation Drugs (FGA) are full D2 agonist causing a dopamine blockade which increases the cascade effect increasing the incident of EPS with low dopamine.

Neuro S/E
Lower Dopamine
Effica­cious
Can be more affordable for PT

Effects of Dopamine

Low dopamine = parkinson symptoms
High dopamine = psychosis symptoms
Dopamine has impact on other neurot­ran­smi­tters and hormones.

EPS

Acute Dystonia
Can occur in hours
Akathisia
Can occur in days
Parkin­sonism
Can occur in weeks
Tardive Dyskinesia
Can occur in years
Typical time frame for presen­tation of EPS symptoms in a patient taking Anti-psych meds. There are other non-psych meds that can also increase the risk of EPS.

EPS is less likely to occur with SGA, than with FGA:
--> FGA full blockade without the additional 5HT receptors, as in the SGA.
--> Partial agonism by some of the SGA at the D2 receptor site.

DOPAMINE

D
Drugs
O
psyhchOsis
P
Prolactin
A
Attention
M
Motivation
I
Involu­ntary Movements
N
Nausea
E
Energy
Signs for too much Dopamine leading to psychosis.

Other Important S/E by Pharma­ceu­tical

Clozar­il/­clo­zapine
blood concerns with agranu­loc­ytosis
 

Atypical Anti-psych (SGA) Partial D2 Action

Abilif­y/a­rip­ipr­izole
D2 partial agonist + 5HT targets
Rexult­i/b­rex­pip­rizole
D2 partial agonist + 5HT targets
Vrayla­r/c­ari­prazine
D2 and D3 partial agonist + 5HT targets
Partial dopamine agonism will lower dopamine levels, but not as much as the full agonist of FGA and some SGA. SGA agonism (partial and full) will Increases the serotonin levels. There is an unknown relati­onship between dopamine and serotonin in symptom relief of psychosis. The agnoism effect on the 5HT receptors varies from pharma­ceu­tical formulary and is not consistent within the classi­fic­ation of SGA.

Typically, lower EPS with Neuro S/E but increase risk of Metabolic S/E.

Atypical Anti-psych (SGA) Full D2 Agonism

Fanapt­/Il­ipe­ridone
D2 agonist + 5HT
Saphri­s/A­sen­apine
D2 agonist + 5HT
Latuda­/lu­ras­idone
D2 agonist + 5HT
Seroqu­el/­que­tiapine
D2 agonist + 5HT
Zyprex­a/o­lan­zapine
D2 agonist + 5HT
Risper­ida­l/r­isp­eridone
D2 agonist + 5HT
Clozar­il/­clo­zapine
D2 agonist + 5HT
Full dopamine agonism at D2 lowers dopamine levels SGA agonism of 5HT (partial and full) will Increases the serotonin levels. There is an unknown relati­onship between dopamine and serotonin in symptom relief of psychosis. The agnoism effect on the 5HT receptors varies from pharma­ceu­tical formulary and is not consistent within the classi­fic­ation of SGA.

Typically, lower EPS with Neuro S/E but increase risk of Metabolic S/E. Cost can be a barrier to care with limited access.

Long Acting Injectable (LAI)

Arista­da/­Initio
aripip­rizole lauroxil (pro drug)
4-8 weeks Glut Inj
Schizo; D2 partial agonist, 5HT
Risperidal Consta
risper­idone
2-4 weeks Glut
Invega­/Su­stenna Trinza
palipe­ridone (component of Risper­idal)
1-3 months Glut
Geodon
zipras­idone
2-4 weeks Glut
Zyprexa
olanzapine
2-4 weeks
Vivitrol
naltrexone
30 days Glut
Opioid and ETOH addiction; in combin­ation of Therapy
Maintena
aripip­razole (abilify
30 days Delt or Glut
Schizo, BP1 in Adults

SGA Drug Ending Short Cuts r/t S/E

-Apine
increase in sedation and weight gain with decrease in EPS symptoms
-Idone
decrease in sedation and weight gain with increase in EPS symptoms
-Piprazole
decrease in weight gain with increase in EPS symptoms
Known S/E with drug ending by class for the SGA.