[Thorazine]

Typical Anti-Psychotic - low potency;

Inhbits D2 receptor - effective for positive symptoms; Aliphatic side chain - low potency (↓ risk of EPS, ↑ risk of anti-muscarinic effects);

Tx: Huntington's chorea (DA antag);

SE: Corneal deposits, ↑ PRL (severe), ↓ INSULIN (impairs glc tolorance), Jaundice, ANTI-DIURETIC, ORTHOSTATIC hypoT, skin rxns (urticaria and dermatitis), EPS;

CI: In dementia-related psychosis (↑ mortality in the elderly)

Typical Anti-Psychotic - high potency;

Inhibits D2 receptor - effective for positive symptoms; Piperazine group - ↑ potency (↑ risk of EPS, ↓ anti-muscarinic effects);

SE: EPS, ↑ PRL, skin rxns (urticaria and dermatitis)

Typical Anti-Psychotic;

Inhibits D2 receptor - effective for positive symptoms; Piperdine ring - ↓ incidence of EPS;

SE - ↑ PRL, highly anti-muscarinic

[Haldol]

Typical Anti-Psychotic - very high potency;

Inhibits D2 receptor - effective for positive symptoms;

Tx: Huntington's chorea (DA antagonism);

SE - EPS, ↑ PRL, less orthostatic hypoT than with other typical antipsychotics.

Atypical Anti-Psychotic;

D2 (low affinity) and 5-HT2A (high affinity) antagonism;

↑ efficacy for Negative Sx (in addition to tx + sx);

5HT2A antg limits EPS SE;

SE - BLOOD DYSCRASIAS (w/ leukopenia prodrome), ↑ risk of DM typeII, weight gain/Metabolic Syndrome (esp in kids and adolescents);

Atypical Anti-Psychotic;

D2 (low affinity) and 5-HT2A (high affinity) antagonism;

↑ efficacy for Negative Sx (in addition to tx + sx);

5HT2A antg limits EPS SE;

Tx: only approved agent for CHILDREN and TEENS;

SE - ↑ risk of DM typeII, moderate risk metabolic syndrome, ↑ PRL secretion and less/minor orthostatic hypoT;

Atypical Anti-Psychotic;

D2 (low affinity) and 5-HT2A (high affinity) antagonism;

↑ efficacy for Negative Sx (in addition to tx + sx);

5HT2A antg limits EPS SE;

SE - WEIGHT GAIN, ↑ risk of DM typeII, high risk of Metabolic Syndrome*

Atypical Anti-Psychotic;

D2 (low affinity) and 5-HT2A (high affinity) antagonism;

↑ efficacy for Negative Sx (in addition to tx + sx);

5HT2A antg limits EPS SE;

SE - ↑ risk of DM typeII, moderate incidence of metabolic syndrome.

No ↑ PRL*

Atypical Anti-Psychotic;

D2 (low affinity), 5-HT2A, 5-H1A, 5HT2C (high affinity) antagonism* (note different than many atypicals);

↑ efficacy for Negative Sx (in addition to tx + sx);

5HT2A antg limits EPS SE;

SE - ↑ risk of DM typeII, low incidence of metabolic syndrome

[Abilify];

Atypical Anti-Psychotic;

3MoA: D2 partial agonist, 5-HT2 antagonist, and 5-HT1A partial agonist;

↑ efficacy for Negative symptoms (as well as positives);

No effect/possible↓ of PRL levels;

SE - ↑ risk of DM typeII, low incidence of metabolic syndrome;

Cortex - ↓ seizure threshold;

Basal ganglia - ↑ DA metabolism + DA blockade (EPS - dystonia, akinesia, parkinsonian syndrome, perioral tremor, neuroleptic malig syndrome,tardive dyskinesia), ↑ Ach turnover;

Limbic - main site of anti-psychotic efx;

Hypothalamus - ↑ PRL;

Brainstem - dec reflexes;

CTZ - protect AGAINST N/V

Atypicals ↑ risk of Type II DM;

↑ PRL secretion (due to inhibition of D2) - Avoid in patients with breast carcinomas. Sustained hyperPRL can cause sexual dysfxn, amenorrhea, gynecomastia, galactorrhea, hypoestrogenism (poss osteopenia);

Direct and indirect effects;

Orthostatic hypotension - esp with chlorpromazine

Acute dystonia;

Akathesia;

Parkinsonian syndrome;

Neuroleptic Malignant Syndrome;

Perioral tremor;

Tardive dyskinesia

Prolixin Decanoate, Haldol Decanoate, Risperidal Consta;

These formulations are the antipsychotic with a fatty acid complexed to them making them more lipophilic.

Are injected IM where tissue esterases hydrolyze the drug and allow slow release of the active compound;

Consider for patients who are non-compliant, have had several relapses, default on oral meds or have poor oral absorption/ideosyncratic pharm rxns.

Weight Gain/Metabolic syndrome (esp with clozapine and olanzapine), 

Urticaria/dermatitis (esp with phenothiazines),

Blood dyscrasias (esp with clozpine)

To treat N/V (act on CTZ to ↑ DA and reduce Nausea);

To treat alcoholic hallucinations during detox;

Neuropsychiatric dz marked by movement disorders (Tourette's, HD, intractable hiccups).

Hemodialysis: ultrafiltration of the blood. Rquires that the toxin is water-soluble, relatively small, and mostly unbound in plasma.

Used in cases of severe Asprin or severe Theophylline OD.

Hemoperfusion involves passing blood through a charcoal cartridge filter to remove drugs bound to plasma proteins.

Used in cases of Carbamazepine, Phenobarbital, Phenytoin, and Theophylline OD*