Class: butyrophenone

increase D2 blocking, decrease 5HT antagonist

Class: phenothiazines

d2 blockade

chemical straightjackets

MOA: 5ht2 and d2 antagonist, decreased ADRs and decreased severity

high first pass metabolism, highly plasma protein bound

nigrostriatal symptoms due to D2 block: dystonia, pseudoparkinsonism, treat with anticholinergic like benztropine

Late onset/permanent: tardive dyskinesia, tardive dystonia, tardive akithisia

severe/dangerous: hyperthermia(due to myoclonus) treat with bromocriptine

muscle rigidity treat w/ dantrolene

CV effects: hypotension via alpha 1 block 

QT prolongation tarsades de pointe

hypotension, failure to ejaculate, alpha 1 effects, sedation, endocrine effects, body weight gain, hyperlipidemia,, hyperglycemia

1st gen

phenothiazine

d2 receptor blockade

agitated pts, increased adverse rxns

1st gen

butyropherone

increased d2 blocking 

decreased 5ht2 antagonist

increased nigrostriatal symptoms

2nd gen

5ht2 block >>> d2 block

almost no extrapyramidal symptoms

adrs: myocarditis, agranulocytosis, worst metabolic syndrome

2nd gen

lower risk of hyperprolactinemia

lower extrapyramidal symptoms

worst metabolic syndrome

2nd gen 

sedation

2nd gen

low sedation

stimulatory: insomnia, anxiety, agitation

2nd gen

active metabolite of risperidone- no advantage

2nd gen

least metabolic effects

good for diabetics

ADRs: qt prolong (torsades)

2nd gen

least metabolic effects

good for diabetics

d2 agonist

little no d2 antagonism

very low ADR

related to 5ht and NE

treat w/ SSRIs and SNRIs

NE and GABA

treat w/ SNRIs and benzo

NE and GABA

SNRIs and benzo

5ht and NE

SNRIs and SSRIs

5ht 

SSRIs and SNRIs