Antipsychotic Drugs

- Fluphenazine (Prolixin)

- Haloperidol (Haldol)

- Thiothixene (Navane)

- Trifluoperazine (Stelazine)

- Chlorpromazine (Thorazine)

- Thioridazine

• - constipation
• - decreased sweating
• - dry mouth
• - dilated pupils
• - blurred vision
• - slowed bowel and bladder

*results from blockade of cholinergic receptors

*goes with low potency, typical, first generation antipsychotics

• - hypotension
• - orthostatic hypotension
• - in response reflex tachycardia can occur - antipsychotics prescribed cautiously for individual with severe hypotension, heart failure, or hx or arrhythmias

*goes with low potency, typical, first generation antipsychotics

• - lengthen QT interval
• - leads to "torsades de pontes"
• - ECG monitoring is very important

• *goes with atypical, second generation antipsychotics

• Akathisia: Restlessness
• -restless legs, jittery feelings, nervous energy
• -most common, responds poorly to treatment

• Akinesia: slow motion
• -weakness, fatigue, painful muscles, and anergia
• -this responds to anticholinergics

• Dystonia: Freezing
• -abnormal postures caused by involuntary muscle spasms
• -elicit a sustained, twisted, and contracted positioning or the limbs, trunk, neck, or mouth

Parkinsonism: rigidity, tremor

• Tardive Dyskinesia
• -develops after 6 months of therapy
• -does not respond to anticholinergics (they actually typcially worsen the sx)
• -sx: tongue writhing, tongue protrusion, teethe grinding, and lip smacking
• -sx stop with sleep
• -prevention is key

• Pisa Syndrome
• - leaning to one side
• - older individuals are particularly susceptible
• - increase doses of antiparkinsonian drugs may be helpful

• Neuroleptic Malignant Syndrome
• - potentially lethal
• - not r/t toxic drug levels, can occur after only a few doses
• - onset typically within 1 week
• - *cardinal sign: increased temp (101-103, but can get up to 108)
• - other sx: tremors, impaired ventilation, altered LOC, and autonomic hyperactivity
• - dantrolene (dantrum): skeletal muscle relaxant and bromoctiptine (parlodel): dopamine agonist are drugs of choice for tx
• - antipsychotics should not be reinstituted for atleaste 2 weeks after resolucion of NMS sx

- most common in atypical

• - insulin resistance
• - results in type 2 diabetes with associated problems of hyperglycemia, obesity, increased lipid levels, coagulation abnormalities, and HTN
• - clozapine and olanzapine: most likely to cause

- atypical

• - weight gain
• - crave carbohydrates

- alcohol, antihistamines, antianxiety drugs, antidepressants, barbituates, meperidine, and morphine have s/e that can cause profound CNS depression when mixed with antipsychotics

- antipsychotics are most effective in treating + symptoms

• - first developed
• - anticholinergic and antiadrenergic s/e
• - causes significant weight gain

*low potency traditional antipsychotic

• - cases of sudden death linked to this drug
• - very therapeutic in children with behavioral problems
• - max 800 mg/day because possible pigmental retinopathy

*low potency traditional antipsychotic

• - can be given as long term IM every 2-3 weeks
• - good for noncompliant med pts

*high potency traditional antipsychotic

• - most frequently prescribed
• - used in older adults and pediatric psychiatry
• - can be given IM every 2-4 weeks and beneficial for patients to struggle with med compliance

*high potency traditional antipsychotic

• - increase effectiveness in tx of - sx
• - dopamine increase in frontal lobe

• - gold standard for schizophrenia management
• - serious s/e: agranulocytosis (abs neutrophil count below 500, can be caused by bone marrow suppression)
• - only prescribed if nothing else works
• - causes significant anticholinergic s/e, orthostatic hypotension, sedation and weight gain, sexual dysfunction
• - dose related seizures, excessive salvation
• - *report dyspnea, fever, chest pain, palpitations, tachycardia, and other sx of heart failure

*atypical, second generation antipsychotic

• - treats sx of + and - schizophrenia
• - has very few s/e
• - s/e: orthostatic hypotension, sedation, appetite stimulation, insomnia, agitation, headache, anxiety, rhinitis
• - long acting Im form is available

*atypical, second generation antipsychotic

• - anticholinergic s/e, sedation, weight gain, orthostatic hypotension
• - IM form available
• - effective in tx of acute mania and bipolar

*atypical, second generation antipsychotic

• - s/e: orthostatic hypotension, sedation, appetite stimulation
• - effective for (+) and (-) sx of schizophrenia

*atypical, second generation antipsychotic

• - effective in treating (+) and (-) sx of schizophrenia
• - decreases depression and anxiety
• - s/e: nausea, dyspnea, abdominal pain, constipation, somnolence, insomnia, cryzal symptoms
• - *linked to cardiac problems r/t lengthening the QT interval
• - IM form is available
• - *absorption increases when given with food

*atypical, second generation antipsychotic

• - dopamine system stabilizer
• -3^rd generation
• - decreases (+) symptoms
• - patients begin to feel better with increased energy as (-) sx subside
• - very good s/e profile

• - available only in sublingual tablet
• - tx acute schizophrenia and bipolar disorder
• - more effective in cognitive and (-) sx