1st generation antipsychotics

-Mech. of Action

-Adverse Effects

Mech of Action:

 -Block dopamine receptors (mainly D2)

-Effective for positive symptoms

-Not as effective for negative symptoms or cognitive symptoms

Adverse Effects:

-Similar to 2nd gen. but usually w/higher incidence

-More EPSE, anticholinergic SE, hyperprolactinemia

-2nd gen block serotonin & D1 receptors more than D2 receptors, thus lower risk of causing EPSE

-2nd gen relieve positive & negative symptoms

-2nd gen may impove cognitive symptoms

-2nd gen are DOC due to reduced ADRs

FDA approved:

-Schizophrenia, schizoaffective disorder

-Bipolar disorder 

-Treatment-resistant depression

-Agitation, irrability, and aggression in Autism

Off-label:

-Behavior disorders in dementia and delusion disorders

-Mgmt. of personality disorders

-Suppress severe Tourette's symptoms

1) Acute dystonia-

-may develop w/in the 1st days of therapy

-severe spasms of muscles of tongue, face, neck, back, and throat

Medical emergency

-Treat w/ IV anticholoinergic drugs (i.e. diphenhydramine IV)

2) Akathisia-

-Usually occurs w/in the 1st few months of therapy

-Pacing, squirming, need to constantly be in motion

Mistaken for anxiety

-May also respond to anticholinergic drugs

3) Parkinsonism-like movement disorder (Psuedoparkinsonism)-

occurs w/in the first few months of therapy

-Bradykinesia, drooling, tremor, rigidity, shuffling gait, cogwheeling, stooped posture

-Best treated w/ anticholinergic drugs, amantadine or propranolol

4) Tardive Dyskinesia-

-Develops w/ long term therapy

-Involuntary movement of tongue or face, lip smacking, tongue twisting, tongue flicking out of mouth

Can interfere w/chewing, swallowing, or speech

May progress to limbs

-Treat by switching to an antipsychotic w/low EPSE

-Anticholinergic and anti-parkinson drugs are not effective to reverse symptoms

1) Identify and refer ASAP

2) Monitor EPSE using appropriate rating scale:

Abnormal Involutary Movement Scale (AIMS)

Anually- 2nd gen.

Every visit- 1st gen.

(AIMS)

Abnormal Involuntary Movement Scale

2nd generation antipsychotics

-Mech. of Action

-Adverse effects

Mech of Action:

Block serotonin and dopamine receptors (D1, D2, D4)

Adverse Effects:

-Sedation, sexual dysfunction

-Weight gain (monitor BMI)

-Glucose dysregulation (increased risk of developing T2DM)

-Anticholinergic SE (much milder)

-Hpyerprolactinemia (block dopamine, therfore increase milk production, much milder)

-Orthostatic Hypotension (fall risk issue)

-QT prolongation (prolong too much called Torsades de pointes)

-EPSE

-Black box warning (Elderly patients w/dementia-related psychosis have increased risk of death)

1st Generation Antipsychotics

(a.k.a "typical)

2nd generation Antipsychotics

(a.k.a. "atypical)

-Abilify

-olanzepine

-Seroquel

-Risperdal (highest rate of EPSE, still less than 1st gen)