Now second generations were discovered later.
These are examples like clozapine, olanzapine, risperidone -
these guys moderately block the dopamine receptors, they're stronger block of the serotonin receptors
so they have a lower risk of EPS.
Now that should make sense to you because the bigger blockers of the dopamine receptors
are the ones that gave us more of the movement stuff, right?
But these guys have a side note that first generations don’t have.
If you take a second-generation antipsychotic, you have a higher risk of metabolic effects -
I'm talking weight gain, diabetes and dyslipidemia.
So now this medication treatment plan can give you higher cardiovascular risk.
You're increasing your risk for stroke, heart attack, all those things,
so you kinda have to pick your poison and see what the biggest risk factor is for the patient
and it'll help them treat their psychotic symptoms.
Now clozapine has a very unique risk - it’s an effective antipsychotic
but you should only consider it if other antipsychotics where not effective.
Okay, so make yourself a note, I go back and write in the other slide that clozapine is effective,
I want you to have it in two places -
it’s effective but only use it if other antipsychotics were not effective. Here's why:
There's a unique risk to clozapine, it’s agranulocytosis, that means a severe -
I mean very severe and dangerously low white blood cell count caused by the medication, clozapine.
It’s gonna lead to sepsis and can be life threatening.
Without white blood cells you can't fight off infection, puts you at risk for a really significant infection
like sepsis and could threaten the life so it’s really essential if someone is taking clozapine
that they monitor their regular lab work -
they need to have a complete blood count done regularly, that’s a CBC,
a complete blood count done regularly so we can monitor their white blood cell level.