Pediatric Psych Drugs


Enuresis (>7 yr):

Nausea + Migraine:

Headache

Over-reactive child:

Aggressive Child:

PTSD/Nightmares:

Nightmares Alone:

Performance Anxiety:

Hallucinations:

Psychosis w/Depression:

 

Anti-Psychotic Meds

Agitated Patient
Drug Dose
Haloperidol 0.5 - 5 mg IV/IM
Ativan (Lorazepam) 1-2 mg IV/IM
Versed (Midazolam) 1-2 mg IV/IM
Benadryl (Diphenhydramine) 25 - 50 mg IV/IM
Geodon (Ziprasidone) 10 mg IM q2h prn
Zyprexa (Olanzapine) 5 - 10 mg IM
  • All antipsychotics can prolong ventricular repolarization, leading to a prolonged QT interval, which can in turn lead to torsades de pointes and sudden cardiac death.
  • The greatest propensity to prolong QTc are Thioridazine, Pimozide, Droperidol, and Ziprasidone.
  • The incidence of sudden cardiac death among patients taking antipsychotics is about twice that of the general population


Anti-psych and weight gain
↑↑ Weight Weight   Weight Neutral
- Olanzapine (ZYPREXA)
- Clozapine (CLOZARIL)
- Risperidone

- Quetiapine (SEROQUEL)
- Abilify (Aripiprazole)

- Geodon (ZIPRASIDONE)
Metabolic Syndrome:
     Fasting Glucose
      TGL, HDL
     Hypertension

Relative receptor-binding affinities of atypical antipsychotics
Receptor Ziprasidone
(Geadon)
Risperidone
(Risperdal)
Olanzapine
(Zyprexa)
Quetiapine
(Seroquel)
Clozapine
(Clozaril)
Aripiprazole
(Abilify)
D1 ++ + ++ + ++ +
D2 +++ +++ +++ ++ + ++++
D3 ++ ? + + ? ?
D4 ? + + - + ?
5-HT2A +++++ +++++ ++++ + ++++ ++++
5-HT2C +++++ ++++ ++++ - ++ ++
5-HT2A ++++ + - + + ++++
5-HT1D ++++ + + - - -
a 1 ++ +++ ++ +++ +++ -
a 2 - +++ + + +++ -
ACh - - + - ++ -
M1-muscarinic - - ++++ ++ ++++ -
H1-histaminergic ++ + ++++ ++++ ++++ ++
5-HT/NE reuptake ++ - - -5HT
+NE
-5HT
+NE
++5HT


Side effect profile:
NAME EPS effect SEDAT. ACH ORTHO-
STASIS
COMMENTS/
POTENTIAL SE
Abilify VL VL VL VL Headace, N/V, Akathesia & anxiety (activating agent)
Chlorpromazine M H M MH Photosensitivity, rare cytopenias, seizures
Clozapine N H H H Agranulocytosis, seizures, wt. gain, hypersalivation, diabetes, hyperlipidemia
Fluphenazine H L L L GI upset, headache, edema, leulopenia & akathesia
Haloperidol H L L L Akathesia, anxiety, lethargy & hyperprolactinemia
Olanzapine VL M LM LM Akathisia, headache, rhinitis, wt. gain, hyperglycemia, constipation, & dry mouth.
Perphenazine M L L L Anorexia, rare cytopenia, hepatotoxicity
Quetiapine VL MH M M Agitation, headache, dry mouth, wt. gain, diabetes, & hyperlipidemia
Risperidone LM LM VL LM Nausea, anxiety, tremor, wt. gain & hyperglycemia, akathesia & hyperprolactinemia
Thioridazine L H H MH Dec. libido, retrograde ejaculation, wt. gain & rarely retinitis pigmentosa
Thiothixene H L L LM Agitation, photosensitivity, & hepatotoxicity
Ziprasidone VL LM VL L Nausea, headache, & weakness.
* N = None, H = High, L = Low, VL = Very Low, M = Moderate, LM = Low-Moderate, MH = Moderate-High.