Atypical Antipsychotics

CROQA are your atypical antipsychotics. Clozapine (agranulocytosis, does not cause EPRs), Risperidone (can cause extra-pyramidal reactions and hyperprolactinemia), Olanzapine (can cause weight gain), Quetiapine (like clozapine, is least likely to induce EPRs), Aripiprazole (doesn’t really cause sedation or hypotension and is the most widely prescribed antipsychotic)

Risperidone -> definitely causes EPR and hyperprolactinemia -> hyperprolactinemia presents as nipple discharge and gynecomastia and elevated prolactin levels

Recall that dopamine is an inhibitor of the prolactin release pathway (bromocriptine is the treatment of prolactinoma)

In general antipsychotics affect dopamine receptors:

• D1 receptors: D1 and D5 activate adenylyl cyclase
• D2 receptors: D2 D3 and D4 inactivate adenylyl cyclase (atypical antipsychotics BLOCK these)

Aripiprazole is uniquely a D2 partial agonist.