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Psychiatry ` Psychiatry—PharMacology Psychiatry ` Psychiatry—PharMacology sEctiON iii 573
Typical antipsychotics Haloperidol, pimozide, trifluoperazine, fluphenazine, thioridazine, chlorpromazine.
MEchaNisM Block dopamine D receptor ( cAMP).
2
cliNical UsE Schizophrenia (1° positive symptoms), psychosis, bipolar disorder, delirium, Tourette syndrome,
Huntington disease, OCD. Use with caution in dementia.
PotENcy High potency: Haloperidol, Trifluoperazine, Fluphenazine (Hal Tries to Fly High)—more
neurologic side effects (eg, extrapyramidal symptoms [EPS]).
Low potency: Chlorpromazine, Thioridazine (Cheating Thieves are low)—more anticholinergic,
antihistamine, α -blockade effects.
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aDVErsE EFFEcts Lipid soluble stored in body fat slow to be removed from body.
Endocrine: dopamine receptor antagonism hyperprolactinemia galactorrhea,
oligomenorrhea, gynecomastia.
Metabolic: dyslipidemia, weight gain, hyperglycemia.
Antimuscarinic: dry mouth, constipation.
Antihistamine: sedation.
α -blockade: orthostatic hypotension.
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Cardiac: QT prolongation.
Ophthalmologic: Chlorpromazine—Corneal deposits; Thioridazine—reTinal deposits.
Neuroleptic malignant syndrome.
Extrapyramidal symptoms— ADAPT:
Hours to days: Acute Dystonia (muscle spasm, stiffness, oculogyric crisis). Treatment:
benztropine, diphenhydramine.
Days to months:
Akathisia (restlessness). Treatment: β-blockers, benztropine, benzodiazepines.
Parkinsonism (bradykinesia). Treatment: benztropine, amantadine.
Months to years: Tardive dyskinesia (chorea, especially orofacial). Treatment: atypical
antipsychotics (eg, clozapine), valbenazine, deutetrabenazine.
Atypical Aripiprazole, asenapine, clozapine, olanzapine, quetiapine, iloperidone, paliperidone,
antipsychotics risperidone, lurasidone, ziprasidone.
MEchaNisM Not completely understood. Most are 5-HT
2
and D antagonists; aripiprazole is a D partial
2
2
agonist. Varied effects on α and H receptors.
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cliNical UsE Schizophrenia—both positive and negative Use clozapine for treatment-resistant
symptoms. Also used for bipolar disorder, schizophrenia or schizoaffective disorder and
OCD, anxiety disorders, depression, mania, for suicidality in schizophrenia.
Tourette syndrome.
aDVErsE EFFEcts All—prolonged QT, fewer EPS and
anticholinergic side effects than typical
antipsychotics.
“-apines”—metabolic syndrome (weight gain, Olanzapine, clOzapine Obesity
diabetes, dyslipidemia).
Clozapine—agranulocytosis (monitor WBCs Must watch bone marrow clozely with clozapine.
frequently) and seizures (dose related).
Risperidone—hyperprolactinemia (amenorrhea,
galactorrhea, gynecomastia).
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