1. chlorpromazine
    • class: phenothiazines
    • first anti-psych on market. not very potent.
    • most effective against + sx
    • non-selective as DA antag, also blocks HA, NE, ACh, 5-HT receptors.
    • SE: sedation (alpha-adren, HA), antichol, EPSE ([parkinson's like, dystonia, akathisia due to ACh and decreased DA in nigrostriatal pathway], tardive dyskinesia due to dopamine hypersensitivity in nigrostriatal pathway)
  2. haloperidol
    • class: butyrophenones
    • more potent than chlorpromazine
    • more selective as DA antag
    • SE: similar to chlorpromazine, but less sedation and greater parkinson's like effects
    • enhances CNS depressant action, decreases amphetamine response
    • severe hypotension w/ alcohol
    • decreased Sz threshold
  3. clozapine
    • class: atypical antipsychotics
    • effective for 30% of tx-resistant pts;
    • more effective against - sx
    • blocks all DA, all 5-HT-R...more selective for 5-HT2A and DA2
    • SE: low incidence of EPSE, but potent antichol & anti-serotonin (inhibits nigrostriatal pathway?)
    • SE: ** AGRANULOCYTOSIS...1-2% patients die!
    • SE: weight gain, blood lipids, T2DM
  4. risperidone
    • class: atypical antipsychotics
    • more effective than haloperidol for - sx
    • developed to have D2 and 5HT2A antag activity as clozapine, but without SE.
    • SE: insomnia, agitation, EPSE with increased dose (but low risk), prolactinemia (tuberoinfundibular), lower weight gain and sedation, lowest metabolic SEs.
    • SE: NO agranulocytosis or anticholinergic.
  5. olanzapine
    • class: atypical antipsychotics
    • higher efficacy...long t1/2 (give qd)
    • 5-HT2A, D1-4 antagonist activity; also blocks ACh, adren, HA receptors
    • SE: low EPSE at usual doses, highest weight gain, higher metab SEs
    • SE: no agranulocytosis
    • SE: increased weight gain, blood lipids, T2DM, similar to clozapine.
  6. quetiapine
    • class: atypical antipsychotics
    • 5HT2A, D1, D2 antagonist
    • SE: no EPSE across entire dose range, intermeiate weight gain, lower metabolic SE.
    • SE: no antichol, but possible cataracts.
  7. ziprasadone
    • class: atypical antipsychotics
    • as effective as haloperidol; highly effective for + sx, improve - sx
    • blocks 5-HT2, D2 receptors, but is 5-HT1A agonist.
    • poor bioavailaility, metab'd to inactive products.
    • SE: little/no prolactinemia or weight gain
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