a.       High Potency – haloperidol, trifluoperazine, fluphenazine – more extrapyramidal symptoms less Anticholernergic

 a.       Low  Potency - thioridazine, chlorpromazine – more anticholinergic, antihistamine, and alpha blockade effects less extrapyramidal symptoms

 a.       Toxicity – highly lipid soluble so takes a long time to be cleared, dopamine receptor antagonism = hyperprolactinemia and galactorrhea, anti muscarinic – dry mouth and constipation, alpha block – hypotension, histamine – sedation, weight gain

Neuroleptic Malignant Syndrome,  Tardive dyskinesia

Atypical for old closets to quietly risper from A to Z

a.       Olanzapine (Zyprexa or in combination with fluoxetine Symbyax), clozapine, quetiapine (Seroquel), risperidone (Risperdal), aripiprazole (Abilify), ziprasidone (Geodon) 

a.       Blocks 5-HT2, dopamine, alpha (hypotension) and H1 (sedation and weight gain) receptors 

a.       SE – less extrapyramidal and anticholinergic then traditional

                                                   i.      Quetipaine, olanzapine, and clozapine – weight gain and risk for DM

                                                 ii.      Clozapine – cause agranulocytosis which causes weekly WBC monitoring 

LMNOP: movement - tremor, nephrogenic DI, hypOthyroidism, Pregnancy Problems 

tremor, sedation, edema, heart block, polyuria, Fetal Cradiac defects - Ebsteins anomaly and malformation of the great vessels

4 hours - acute dystonia (muscle spasm, stiffness, oculogyric crisis) 

4 Days - akinesia (parkinsonian symptoms)

4 wk akathisia (restlessness)

4 month tardive dyskinesia 

Seroquel) atypical 

alpha blocking, atropine like (anticholenergic) - tachycarida, urinary retention

amitriptyline have more anticholinergic SE than nortriptyline

Despramine is less sedating and has loer seizure threshold

Convulsions, Coma, Cardiac Tox (arrhythmias), resp depression, hyperpyrexia, confusion, hallucinations in elderly (b/c of anticholinergics) ((use nortriptyline in elderly))

Treatment is NaHCO3 for CV tox

hyperthermia, muscle rigidty, cardiovascular collapse, flushing, diarrhea, seizures

Treatment: benzos and then cyproheptadine (5-HT2 receptor antagonist)

A2 antagonist (increases release of NE and serotonin) potent 5-HT2 and 5-HT3 receptor antogonist

SE - antihistamine (sedation), increase appetitie weight gain and dry mouth 

use in old ladies who don't want to eat and sleep 

mesocortical-mesolimbic - regulate mentation and mood - antipsychotic effects

nigrostriatal tract - extrapyramidal function 

tuberoinfundibular pathways - prolactin release 

chemoreceptor trigger zone - emesis

Extrapyramidal effects - Parkinson like syndrome - bradykinesia, rigidity and tremor 

respond to a lower dose and muscarinic blocking agents 

from muscarinic receptors and alpha adrenoceptors 

atropine like - dry mouth, constipation, urinary retention, and visual problems

central M block - confusional state 

alpha - postural hypotension

hyperprolactinemia - gynecomastia, amenorrhea galactorrhea syndrome and infertility

due to dopamine block in the pituitary - normally inhibits prolactine secretion

Atypicals - diabetogenic esp clozapine and olanzapine 

Aripiprazole and ziprasidone - cery little hyperglycemia or prolactinemia or weight gain 

.8 to 1.2 for actue symptoms and .4 to .7 for maintenance 

dehydration or treatment with NSAIDs, ACEIs or loops can increase the level to toxic, Caffeine and theophylline - increase the clearance

1.5 - 2 - diarrhea, nausea, vomiting , dizziness, muscle weakness >2 - blurred vision confusion, incontinence, muscle twitches >2.5 - seizures arrythmias, hypotension, ARF, death 

Treatment - hemodialysis 

At start - GI, sedation, tremor, ataxia 

Chronic - hair loss, Hepatic - hyperammonemia, Neuro - sedation tremor Heme - thrombocytopenia and agranulocytosis 

Weight gain 

Pancreatitis 

no sedation, not addictive, well tolerated

Dizziness, headache, gi symptoms, drowsiness

2 or more weeks for effectivness 

Sertraline, venlafaxine, paroxetine, high potency benzo - alprazolam, clonazepam - use scheduled

beta blocker for specific situation 30 min before 

SSRIs-fluvoxamine, paroxetine, sertraline, fluoxetine - all in higher doses 

TCA - clomipramine 

SSRIs - sertraline, paroxetine 

Beta blockers if used right away - can prevent 

Clonidine - alpha 2 agonsit 

Prazoin - for nightmares 

Antipsychotics as last resort 

Jitteriness - restlessness or anxiety - time limited can use half dose to start, add BZD or BB

Sleep - insomina or hypersomnia - Change the dose timing

GI - N/diarrhea - time limited - take with food

neutral - short term, long term 5 to 20%

highest risk is mirtzapine and paroxetine 

lowest risk is bupropion