Antipsychotics — Atypical (2nd Gen)

Psychiatric

Mark this drug class

Examples

risperidoneolanzapinequetiapinearipiprazoleclozapine

Prefix / Suffix: Often end in -pine, -done, -piprazole

Physiology

Atypicals affect both dopamine and serotonin pathways, addressing both positive and negative symptoms with less EPS risk.

Mechanism of Action

Block both dopamine D2 and serotonin 5-HT2A receptors, providing broader symptom control with lower EPS risk than typicals.

Indications

Schizophrenia (positive and negative symptoms)
Bipolar disorder
Major depression (adjunct)
Treatment-resistant schizophrenia (clozapine)

Side Effects / Adverse Effects

Metabolic syndrome: weight gain, hyperglycemia, dyslipidemia (especially olanzapine, clozapine)
Sedation
Lower but still possible EPS
Agranulocytosis (clozapine — requires WBC monitoring)
QT prolongation
Hyperprolactinemia (risperidone)

Contraindications

Dementia-related psychosis (increased mortality — black box)
Severe bone marrow suppression (clozapine)

Nursing Considerations

Monitor weight, blood glucose, lipids at baseline and periodically (metabolic syndrome)
Clozapine: weekly CBC for 6 months, then biweekly (agranulocytosis risk)
Monitor for EPS even though less common
Encourage healthy diet and exercise to offset weight gain
Assess for sedation — take at bedtime if applicable
Effects on negative symptoms may take weeks

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Disclaimer: PharmPal Nurse is for education only and is not medical advice. Do not use it to diagnose, treat, prescribe, or make patient-care decisions; always verify with current drug references, your instructor, facility policy, and a licensed provider. In emergencies, call local emergency services.