In Class Activity: Antipsychotic Table

Atypical Antipsychotic
Action Block postsynaptic dopamine receptors in the basal ganglia, hypothalamus, limbic system, brainstem and medulla. These medications also affect serotonin levels. Treatment of hallucinations and delusions (psychotic symptoms). They may also be seen in bipolar disorder, major depression, and delusional disorder. Treatment of the negative symptoms of schizophrenia, e.g. flat affect, apathy, lack of motivation, social withdrawal. Reduction in aggressive behavior. Augmentation of antidepressant and antimanic medications. Side or Adverse Effects
Extrapyramidal side effects (EPS) see

Typical Antipsychotic
Blocks post-synaptic Dopamine-2 (D2) receptors in the basal ganglia, hypothalamus, limbic system, brainstem, and medulla.

Intended Effects

Treatment of hallucinations and delusions (psychotic symptoms). They may also be seen in bipolar disorder, major depression, and delusional disorder. Treatment of tics, vomiting, and intractable hiccups. Reduction in aggressive behavior ** These drugs are not very helpful with negative symptoms.

Common Side Effects to both the typical and Atypical

Side or Adverse Effects

Extrapyramidal side effects (EPS) see description below

description below ** much less than the Typical Sedation Anticholinergic effects see description below ** much less than the Typical

Sedation Anticholinergic effects see description below Weight gain Photosensitivity Decreased Seizure threshold Orthostatic hypotension Galactorrhea/amenorrhea

Contraindications

Weight gain Photosensitivity Decreased Seizure threshold Orthostatic hypotension Galactorrhea/amenorrhea Sexual dysfunction CNS depressants like alcohol have additive depressant effects when given with these drugs. Cigarette smoking causes reduced plasma concentrations of some antipsychotics Beta-blockers given with antipsychotics can cause severe hypotension Anti-depressants in conjunction with antipsychotics may cause increased blood concentration of the antidepressant SSRIs in conjunction with antipsychotics may cause sudden onset of extrapyramidal symptoms (EPS).

Sexual dysfunction

CNS depressants like alcohol have additive depressant effects when given with these drugs. Cigarette smoking causes reduced plasma concentrations of some antipsychotics Beta-blockers given with antipsychotics can cause severe hypotension Anti-depressants in conjunction with antipsychotics may cause increased blood concentration of the antidepressant SSRIs in conjunction with antipsychotics may cause sudden onset of extrapyramidal symptoms (EPS).

Toxic effect Teaching

Neuroleptic Malignant Syndrome (NMS) see description below Regular administration of antipsychotic medications can prevent exacerbations of psychosis. Those taking clozapine must have their blood counts monitored frequently because the drug may cause bone marrow toxicity Risperdal is available in a depot preparation, and may be more effective in this form, especially in those having problems adhering to their oral regimens.

Neuroleptic Malignant Syndrome (NMS) see description below Taking these drugs regularly will prevent recurrence of psychotic and other symptoms. Failure to take antipsychotics as prescribed can lead to relapses and repeated hospitalizations. Doses should be lowered for the elderly Haldol and Prolixin are available in depot preparations, and may be more effective in this form, especially in those having problems adhering to their oral regimens.

Drugs

Clozaril (clozapine) Risperdal (risperidone) Zyprexa (olanzepine) Seroquel (quetiapine) Geodon (ziprasidone) Abilify (aripiprazole) Invega (paliperidone)

Haldol (haloperidol) Prolixin (fluphenazine) Trilafon (perphenazine) Stelazine (trifluoperazine) Navane (thiothixene) Thorazine (Chlorpromazine)