Psychopharmacology Full Study Guide MIDTERM and FINAL
WITH ALL THE MEDICATION GUIDES AND PRESCRIPTIONS
, Antipsychotics
Generic/Brand FDA Approved Indications
Drug Class Common Dosing Clinical Pearls Common Theme
Name (O昀昀-Label Uses)
• Schizophrenia • Generally use
• Short-term & 2nd line
• Severe behavioral problems as 2nd line
d/t risk of TD
(1-12) when patients
• Often prescribed for
• Hyperactivity (children, do not respon
sedation (↓ doses
short-term) to other
chlorpromazine more sedative than
• D2 antagonist • Severe, acute • 200-800 mg/day antipsychotics
(Thorazine) antipsychotic)
agitation/aggression OR when
• Avoid in patients
associated with psychiatric injection are
taking other drugs
d/o, substance intoxication, required
with anticholinergic
other organic causes • T cholinergic
properties
• Bipolar disorder s/e, weight
• PO: 1-20 mg/day gain, sedation
(max 40 mg/day) orthostasis
• Psychotic disorders • T prolactin
昀氀uphenazine • IM: 1/3 to 1/2 PO
• D2 antagonist • Tics daily dose • LAI: 2 weeks
• T risk tardive
(Prolixin) • Bipolar disorder
1st Generation
• LAI: 12.5-100 mg/2 dyskinesia,
weeks tardive
haloperidol • D2 antagonist • Behavioral disorders, • PO: 1-40 mg/day • LAI: 4 weeks dystonia, DIP,
(Haldol) nonpsychotic (children) • IM: 2-5 mg • ↓ sedation akathisia
• Hyperactivity (children, short- • LAI: 10-20x previous • Monitor BMI
term) daily PO dose • Consider
• Tourette syndrome monitoring
• Schizophrenia fasting
• Agitation/aggression triglycerides &
(severe/acute, associated with fasting glucos
psych d/o, substance
in patients wit
intoxication, other organic
high risk of
causes), Bipolar disorder
metabolic
(acute mania/hypomania,
mixed features), Delirium
complications
(hyperactive) • Patients
, generally hav
• T sedation (dose similar
dependent, transient) antipsychotic
• Schizophrenia
• weight gain (may responses to
• Acute agitation associated cause weight loss)
loxapine • 60-100 mg/day (2-4 generation
• D2 antagonist with schizophrenia or • T e昀케cacy of clozapine
(Loxitane) doses daily) antipsychotics
bipolar I disorder (acute)
• Capsule loxapine (this is not tru
• Bipolar disorder
succinate dose of atypical
loxapine dose antipsychotics
• 12-24 mg/day (TID)
perphenazine • Schizophrenia • Hospitalized pts: 16- • Oral is less potent
• D2 antagonist
(Trilafon) • Bipolar disorder 64 mg/day (2-4 doses than IM
daily)
• Bene昀椀ts usually do not
outweigh risks
1st Generation cont.
• QTC prolongation (dose
dependent, start low/go
• 200-800 mg/day slow)
• Schizophrenia (patients who • Baseline and monitor
thioridazine (TID) ECG and potassium
• D2 antagonist fail tx with other
(Mellaril) • Starting: 50-100 • Consider monitoring Mg
antipsychotics)
mg/day • CYP2D6 inhibitors,
昀氀uvoxamine, pindolol,
propranolol T levels
• Contraindicated in poor
CYP2D6 metabolizers
• 15-30 mg/day
• Max dose: 60
thiothixene • Schizophrenia
• D2 antagonist mg/day, higher doses • weight gain
(Navane) • Bipolar disorder
may be given in
divided doses
• Schizophrenia
• Psychosis: 15-20
tri昀氀uoperazine • Nonpsychotic anxiety (short-
• D2 antagonist mg/day • weight gain
(Stelazine) term, 2nd line)
• Anxiety: 1-6 mg/day
• Bipolar disorder
, • “Gold standard” when • Bind more
• Tx-resistant schizophrenia other drugs for potently to
• Recurrent suicidal behavior psychosis fail 5HT2A than D2
• Depends on plasma
in patients with • Monitor for life- • Strong a昀케nity
• D2 & 5HT2A level (response
antagonist schizophrenia/ threatening for
threshold 350 ng/mL;
schizoa昀昀ective disorder neutropenia (REMS antihistamine
clozapine • Atypical >700 ng/mL not well
antipsychotic • Agitation/aggression and program) anticholinergi
(Clozaril) tolerated)
psychosis associated with • Cigarette smoking can binding (exce
• 2nd generation • Starting: 25 mg
dementia (severe/refractory), levels asenapine)
antipsychotic • Increase 25-50
Bipolar disorder (tx • T risk seizures, • Monitor BMI,
mg/day q72h
resistant), psychosis in myocarditis, weight waist
Parkinson disease gain, cardiometabolic circumference
s/e, sedation BP, fasting
-pines
olanzapine • D2 & 5HT2A • Schizophrenia (13+) • 10-20 mg/day • LAI: 2 or 4 weeks glucose, fastin
(Zyprexa) antagonist • Bipolar disorder (acute/mixed • Starting: 5-10 • Cigarette smoking can lipids
• Atypical mania, depression, mg/day PO levels
antipsychotic maintenance) • Increase 5 mg/day • T risk of metabolic s/e
• 2nd generation • Acute agitation associated once/week
antipsychotic with bipolar I disorder or
schizophrenia (IM)
• Tx resistant MDD
• Agitation/aggression and
psychosis associated with
dementia, anorexia nervosa,
Bipolar disorder (hypomania),
Delirium (hyperactive),
Delusional infestation, MDD
with psychotic features
WITH ALL THE MEDICATION GUIDES AND PRESCRIPTIONS
, Antipsychotics
Generic/Brand FDA Approved Indications
Drug Class Common Dosing Clinical Pearls Common Theme
Name (O昀昀-Label Uses)
• Schizophrenia • Generally use
• Short-term & 2nd line
• Severe behavioral problems as 2nd line
d/t risk of TD
(1-12) when patients
• Often prescribed for
• Hyperactivity (children, do not respon
sedation (↓ doses
short-term) to other
chlorpromazine more sedative than
• D2 antagonist • Severe, acute • 200-800 mg/day antipsychotics
(Thorazine) antipsychotic)
agitation/aggression OR when
• Avoid in patients
associated with psychiatric injection are
taking other drugs
d/o, substance intoxication, required
with anticholinergic
other organic causes • T cholinergic
properties
• Bipolar disorder s/e, weight
• PO: 1-20 mg/day gain, sedation
(max 40 mg/day) orthostasis
• Psychotic disorders • T prolactin
昀氀uphenazine • IM: 1/3 to 1/2 PO
• D2 antagonist • Tics daily dose • LAI: 2 weeks
• T risk tardive
(Prolixin) • Bipolar disorder
1st Generation
• LAI: 12.5-100 mg/2 dyskinesia,
weeks tardive
haloperidol • D2 antagonist • Behavioral disorders, • PO: 1-40 mg/day • LAI: 4 weeks dystonia, DIP,
(Haldol) nonpsychotic (children) • IM: 2-5 mg • ↓ sedation akathisia
• Hyperactivity (children, short- • LAI: 10-20x previous • Monitor BMI
term) daily PO dose • Consider
• Tourette syndrome monitoring
• Schizophrenia fasting
• Agitation/aggression triglycerides &
(severe/acute, associated with fasting glucos
psych d/o, substance
in patients wit
intoxication, other organic
high risk of
causes), Bipolar disorder
metabolic
(acute mania/hypomania,
mixed features), Delirium
complications
(hyperactive) • Patients
, generally hav
• T sedation (dose similar
dependent, transient) antipsychotic
• Schizophrenia
• weight gain (may responses to
• Acute agitation associated cause weight loss)
loxapine • 60-100 mg/day (2-4 generation
• D2 antagonist with schizophrenia or • T e昀케cacy of clozapine
(Loxitane) doses daily) antipsychotics
bipolar I disorder (acute)
• Capsule loxapine (this is not tru
• Bipolar disorder
succinate dose of atypical
loxapine dose antipsychotics
• 12-24 mg/day (TID)
perphenazine • Schizophrenia • Hospitalized pts: 16- • Oral is less potent
• D2 antagonist
(Trilafon) • Bipolar disorder 64 mg/day (2-4 doses than IM
daily)
• Bene昀椀ts usually do not
outweigh risks
1st Generation cont.
• QTC prolongation (dose
dependent, start low/go
• 200-800 mg/day slow)
• Schizophrenia (patients who • Baseline and monitor
thioridazine (TID) ECG and potassium
• D2 antagonist fail tx with other
(Mellaril) • Starting: 50-100 • Consider monitoring Mg
antipsychotics)
mg/day • CYP2D6 inhibitors,
昀氀uvoxamine, pindolol,
propranolol T levels
• Contraindicated in poor
CYP2D6 metabolizers
• 15-30 mg/day
• Max dose: 60
thiothixene • Schizophrenia
• D2 antagonist mg/day, higher doses • weight gain
(Navane) • Bipolar disorder
may be given in
divided doses
• Schizophrenia
• Psychosis: 15-20
tri昀氀uoperazine • Nonpsychotic anxiety (short-
• D2 antagonist mg/day • weight gain
(Stelazine) term, 2nd line)
• Anxiety: 1-6 mg/day
• Bipolar disorder
, • “Gold standard” when • Bind more
• Tx-resistant schizophrenia other drugs for potently to
• Recurrent suicidal behavior psychosis fail 5HT2A than D2
• Depends on plasma
in patients with • Monitor for life- • Strong a昀케nity
• D2 & 5HT2A level (response
antagonist schizophrenia/ threatening for
threshold 350 ng/mL;
schizoa昀昀ective disorder neutropenia (REMS antihistamine
clozapine • Atypical >700 ng/mL not well
antipsychotic • Agitation/aggression and program) anticholinergi
(Clozaril) tolerated)
psychosis associated with • Cigarette smoking can binding (exce
• 2nd generation • Starting: 25 mg
dementia (severe/refractory), levels asenapine)
antipsychotic • Increase 25-50
Bipolar disorder (tx • T risk seizures, • Monitor BMI,
mg/day q72h
resistant), psychosis in myocarditis, weight waist
Parkinson disease gain, cardiometabolic circumference
s/e, sedation BP, fasting
-pines
olanzapine • D2 & 5HT2A • Schizophrenia (13+) • 10-20 mg/day • LAI: 2 or 4 weeks glucose, fastin
(Zyprexa) antagonist • Bipolar disorder (acute/mixed • Starting: 5-10 • Cigarette smoking can lipids
• Atypical mania, depression, mg/day PO levels
antipsychotic maintenance) • Increase 5 mg/day • T risk of metabolic s/e
• 2nd generation • Acute agitation associated once/week
antipsychotic with bipolar I disorder or
schizophrenia (IM)
• Tx resistant MDD
• Agitation/aggression and
psychosis associated with
dementia, anorexia nervosa,
Bipolar disorder (hypomania),
Delirium (hyperactive),
Delusional infestation, MDD
with psychotic features
