This is a brief video on antipsychotics, also called neuroleptics, including their mechanisms, their indications, and side effects
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ADDITIONAL TAGS:
Anti-
psychotics
(neuroleptics)
First-generation antipsychotics
First-gen side effects
Extrapyramidal side effects
Neuroleptic malignant syndrome
Atypical antipsychotics
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First generation (typical) antipsychotics
Haloperidol and -azines
High potency: haloperidol, trifluoperazine, fluphenazine
Medium potency: perphenazine
Low potency: chlorpromazine, thioridazine
MoA: high affinity antagonist for dopamine (D2) receptor, thus increasing concentration of cAMP
Indications: schizophrenia positive symptoms (and brief psychotic disorder, schizophreniform), schizoaffective, other psychoses, bipolar, delirium, Tourette, Huntington’s
First-generation antipsychotics
First-gen side effects
Extrapyramidal side effects
Neuroleptic malignant syndrome
Atypical antipsychotics
First generation (typical) antipsychotics:
Side effects
Delay cardiac conduction (prolong QTc interval), risk of torsades de pointes
Anticholinergic effects →
Blurred vision, constipation, dry mouth, urinary retention
Worse with lower potency antipsychotics
Antihistamine effect → sedation
Anti alpha1 effect → orthostatic hypotension
Endocrine: hyperprolactinemia → osteoporosis, amenorrhea, galactorrhea, gynecomastia, and sexual side effects
Caused by D2 blockage on tuberoinfundibular pathway
Extrapyramidal symptoms
Neuroleptic malignant syndrome
First-generation antipsychotics
First-gen side effects
Extrapyramidal side effects
Neuroleptic malignant syndrome
Atypical antipsychotics
First generation (typical) antipsychotics:
SEs: extrapyramidal side effects
Caused by D2 blockage on nigrostriatal pathway
Hours to days: acute dystonic rxn (sustained muscle contraction); tx with IM diphenhydramine or benztropine
Days to weeks: akathisia (restlessness)
Weeks to months: parkinsonism (tremor, cogwheel rigid, hypokinesia); tx with lower dose antipsychotic or diphenhydramine or benztropine
Months to years: tardive dyskinesia (hyperkinetic movement of head, limbs, trunk → perioral movements (tongue, facial grimacing, and lip puckering) are common)
Tx by switching 1st-gen→2nd-gen or 2nd-gen→clozapine
First-generation antipsychotics
First-gen side effects
Extrapyramidal side effects
Neuroleptic malignant syndrome
Atypical antipsychotics
First generation (typical) antipsychotics:
SEs: neuroleptic malignant syndrome
Idiosyncratic reaction presenting with confusion, vital sign (autonomic) instability, hyperpyrexia (high fever), rhabdomyolysis (myoglobinuria), renal failure, cardiovascular collapse
Fever
Encephalopathy
Vitals unstable
Enzyme increase
Rigidity of muscles
Treat with dantrolene
Don’t confused with malignant hyperthermia!
First-generation antipsychotics
First-gen side effects
Extrapyramidal side effects
Neuroleptic malignant syndrome
Atypical antipsychotics
Atypical (2nd generation) antipsychotics
Aripiprazole, -apines, -idones
aripiprazole, asenapine, clozapine, olanzapine, quetiapine, iloperidone, lurasidone, paliperidone, risperidone, ziprasidone
MoA: weaker D2 antagonist and serotonin (5-HT2a) agonist
Indications: schizophrenia (positive and negative symptoms)
Side effects:
Delay cardiac conduction (prolong QTc interval), risk of torsades de pointes
Less anticholinergic and EPS effects
Metabolic (weight gain, diabetes, high lipid) → -apines
Agranulocytosis → clozapine (very potent)
Hyperprolactinemia → risperidone
First-generation antipsychotics
First-gen side effects
Extrapyramidal side effects
Neuroleptic malignant syndrome
Atypical antipsychotics