CNPT2 Exam 1 Drugs

brand/generic names, drug class, approved drug uses, MOA, normal adult dosing, contraindications and black box warnings

Quetiapine brand

Quetiapine brand

Seroquel

Quetiapine class

Atypical dibenzothiazepine antipsychotic

Quetiapine use

Schizophrenia, bipolar disorder

Quetiapine MOA

Antagonizes multiple neurotransmitter receptors in the brain (serotonin 5-HT2, dopamine D 1 and 2, H1, alpha 1 and 2)

Quetiapine dose

IR: 150-750 mg PO divided BID or TID, ER: 400-800 mg PO qPM

Quetiapine contraindications

Electrolyte abnormality, hypokalemia, long QT syndrome, arrhythmias

Quetiapine BBW

May cause suicidal thoughts in children and young adults, not for dementia related psychosis

Aripiprazole brand

Abilify

Aripiprazole class

2nd generation antipsychotic

Aripiprazole use

Schizophrenia, bipolar I, major depressive disorder

Aripiprazole MOA

Partially agonizes dopamine D2 and serotonin 5-HT1A receptors, antagonizes serotonin 5-HT2A receptors

Aripiprazole dose

10-15 mg PO qD

Aripiprazole contraindications

None

Aripiprazole bbw

Not for dementia related psychosis

Risperidone brand

Risperdal

Risperidone class

2nd generation antipsychotic

Risperidone use

Schizophrenia, bipolar I

Risperidone MOA

Antagonize dopamine D2, serotonin 5-HT2, and other receptors

Risperidone dose

Oral: 1-4 mg PO divided qD or BID, injection: 25 mg IM q2weeks

Risperidone contraindications

Hypersensitivity to paliperidone

Risperidone BBW

Not approved for dementia related psychosis

Olanzapine brand

Zyprexa

Olanzapine class

2nd generation antipsychotic, thienobenzodiazepine

Olanzapine use

Schizophrenia, bipolar I, agitation

Olanzapine MOA

Antagonizes dopamine, serotonin 5-HT2, and other receptors

Olanzapine dose

10-20 mg PO qD

Olanzapine contraindications

Alcohol use, CNS depressant use

Olanzapine bbw

Not approved for dementia related psychosis

Lithium brand

Lithobid

Lithium class

Bipolar disorder agents

Lithium use

Bipolar disorder, mania and maintenance

Lithium MOA

Alters neuronal sodium transport

Lithium dose

IR: 600-1800 mg divided BID or TID, ER: 900-1200 mg divided BID or TID

Lithium contraindications

Brugada syndrome, cardiovascular arrhythmias

Lithium bbw

NTI drug, start treatment only if facility is available for prompt and accurate lithium levels

Lamotrigine brand

Lamictal

Lamotrigine class

Anti mania anticonvulsant

Lamotrigine use

Bipolar disorder, partial seizures

Lamotrigine MOA

Inhibits voltage dependent sodium channels, decreasing presynaptic glutamate and aspartate release

Lamotrigine dose

Varies significantly by disease state

Lamotrigine contraindications

Avoid abrupt withdrawal

Lamotrigine BBW

Serious rashes requiring hospitalization may occur

Varenicline brand

Chantix

Varenicline class

Smoking cessation aid

Varenicline use

Smoking cessation

Varenicline MOA

Partial a4B2 nicotinic receptor agonist, also binds 5-HT3 receptors, small stimulation of dopamine activity

Varenicline dose

Days 1-3: 0.5 mg PO qD, Days 4-7: 0.5 mg PO BID, weeks 2-12: 1 mg PO BID

Varenicline contraindications

Caution with history of seizures, caution with alcohol use

Varenicline BBW

None

Clozapine brand

Clozaril, FazaClo, Versacloz

Clozapine class

Atypical second generation antipsychotic

Clozapine use

Schizophrenia, bipolar I

Clozapine MOA

Dibenzodiazepine, primarily through antagonism of D2 receptor and serotonin type 2A (5-HT2A) receptors

Clozapine dose

12.5 mg PO qD or BID, increased to 300-450 mg per day

Clozapine contraindications

None

Clozapine BBW

Orthostatic hypotension, bradycardia, syncope, and cardiac arrest have been reported; fatalities due to myocarditis and cardiomyopathy; hepatotoxicity; severe neutropenia (absolute neutrophil count <500); seizures have been associated in a dose-dependent manner; elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death

Haloperidol brand

Haldol

Haloperidol class

First generation antipsychotic

Haloperidol use

Schizophrenia, bipolar disorder, agitation

Haloperidol MOA

Butyrophenone antipsychotic that non selectively blocks post synaptic dopamine D2 receptors in the brain

Haloperidol dose

Psychosis: 0.5-5 mg PO in divided doses, schizophrenia: 2-5 mg IM in divided doses (20 mg/day)

Haloperidol contraindications

None

Haloperidol BBW

Increased mortality in elderly patients with dementia-related psychosis