Snapshot A 23-year-old male is brought into the inpatient psychiatric hospital after a suicide attempt. When talking with the patient he seemed to be responding to internal stimuli at times. He states that he heard voices telling him to kill himself. He said he has heard these voices for over a year now but within the past month they have become louder, more persistent and convincing. Overview 2 classes login to view 7 more bullets Targets login to view 5 more bullets Typical Antipsychotics Overview Typical AntipsychoticsHigh Potency Antipsychotics (in Descending Order)AdvantagesDisadvantagesUnique FeaturesHaloperidol •Fewer side effects of sedation and hypotension •High association with extrapyramidal symptoms •Able to use as long-acting depot injections •Can be given IM in acute situationsFluphenazinePerphenazineChlorpromazine •Lower frequency of extrapyramidal side effects •Greater incidence of anticholinergic side-effects, hypotension, sedation •Corneal depositsThioridazine •Retinal depositsQT prolongation Introduction Overview login to view 2 more bullets Drugs ("haloperidol + -azines") login to view 6 more bullets Clinical uses login to view 9 more bullets Toxicity login to view 44 more bullets Side Effects of High Potency Antipsychotics Extrapyramidal Side Effects of High Potency D2 Blockers (Haloperidol, Fluphenazine, Perphenazine)3 Hours: Acute Dystonia3 Days - Weeks: Bradykinesia (Pseudo-Parkinsonism)3 Months: Akathisia3 Years: Tardive DyskinesiaEmergency: Neuroleptic Malignant Syndrome •Muscle spams (neck, eye, diffuse) •Trouble swallowing •Symptoms of Parkinson's disease: tremors, bradykinesia, rigidity •Sustained feeling of motion/restlessness •Uncontrollable repetitive, stereotypical writhing movements, usually of the tongue •High fever •Muscle rigidity •Unstable vitals •Increased CK, K+, and WBC'sTreatment of Side Effects •Anticholinergic medications:(benztropine, diphenhydramine, trihexyphenidyl) •β-blockers •Benzodiazepines •Stop high potency D2 blockers and switch to atypicals (clozapine preferred) •Can be treated with valbenazine •Stop antipsychotic •IV fluids •Cooling •DantroleneNOTE: You can always decrease the dose or switch to a different antipsychotic – choose the drug with the side-effect profile that the patient can tolerate. Atypical Antipsychotics Overview Atypical AntipsychoticsMedicationUnique features and side effectsRisperidone •High potency •Usually first line •Hyperprolactinemia •Weight gainOlanzapine •Severe weight gain •Very sedatingZiprasidone •Minimal to no weight gain •Increased QTcQuetiapine •Low potency •Sedating •Weight gain •Useful in bipolar depression and augmentation of major depression therapyLurasidone •Minimal weight gain •Useful in biploar depressionClozapine •Weight gain •Most effective anti-psychotic •Decreased suicide risk •Agranulocytosis •Myocarditis •Sialorrhea •Orthostatic hypotension •Increased seizuresAripiprazole •D2 partial agonist •Augmentation of major depression therapy Introduction Drugs login to view 6 more bullets Mechanism login to view 1 more bullet Clinical use login to view 8 more bullets Toxicity login to view 14 more bullets