fbpx
Lesson 6 of 9
In Progress

Second Generation Antipsychotics

Jimmy October 25, 2021

  • Mechanism
    • Dopamine receptor inhibition
    • Serotonin, histamine, a2, norepinephrine receptor inhibition
DrugOnset (IM)Onset (IV)
Olanzapine 5-10 mg15-30 min?? (1-2 min)
Ziprasidone 10-20 mg15-45 min
  • Effects
    • Reduces psychotic symptoms
    • Minimal EPS due to multi-receptor binding and intrinsic anticholinergic effect
  • Adverse Effects
    • Less akathisia, QTc prolongation
    • Few short-term adverse effects

  • Controversies
    • Better than first-generation antipsychotics?¬†
      • Similar onset of action, less need for benzodiazepine/anticholinergic¬†

Kishi 2015

  • IM olanzapine
    • Noninferior/superior to haloperidol
    • Less anticholinergic use and less AEs

Miner 2018

  • IM olanzapine
    • No additional medications needed at 1 hour in > 80% of cases

Klein 2019

  • IM olanzapine and IM droperidol
    • Less need for rescue sedation compared with haloperidol 
    • Increased cases of intubation in the olanzapine group

  • Controversies
    • Intravenous administration of medication labeled for intramuscular use?

Chan 2013

  • IV olanzapine + midazolam
    • Compared with droperidol + midazolam or midazolam alone
    • Olanzapine and droperidol groups comparable for sedation, QTc, AEs
    • Less airway AEs than midazolam alone

Martel 2015

  • IV olanzapine
    • Review of 713 patients who received IV olanzapine
    • 0.6% akathisia, 0% dystonia
    • 3 patients intubated‚Ķbut what would have happened with standard of care?