Antipsychotic medications

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  • Agran- wbc count below 2000cells/mm3 blood (<5% of normal)
  • Antipsychotic medications

    1. 1. Rohin Khanna
    2. 2.  2 Classes of antipsychotics  Typical / Conventional ▪ Block Dopamine D2 receptors ▪ Work on +ve symptoms (hallucinations/delusions)  Atypical / Novel ▪ Block serotonin and dopamine receptors ▪ Also M3 (olanzapine), H1 (quetiapine), α, D4 (clozapine) ▪ Work on +ve and –ve symptoms (blunted affect, poverty of speech, anhedonia)
    3. 3.  Conventional/Typical  Usual Dose, PO/D, mg  Low Potency ▪ Chlorpromazine (Thorazine) ▪ 100-1000 (IM) ▪ Thioridazine (Mellaril) ▪ 100-800  Mid Potency ▪ Trifluoperazine (Stelazine) ▪ 2-15 ▪ Perphenazine (Trilafon) ▪ 4-32  High Potency ▪ Haloperidol (Haldol) ▪ 0.5-10 (IM) ▪ Fluphenazine (Prolixin) ▪ 1-10 (IM) ▪ Thiothixene (Navane) ▪ 2-20
    4. 4.  High Potency  Least sedating  Have no anticholinergic symptoms (dry mouth, constipation, hot, dry skin, tachycardia, delirium in elderly)  High tendency for EPS Low Potency  Most sedating  Have more anticholinergic symptoms  Lower tendency for EPS Mid Potency  Well tolerated
    5. 5.  Novel /Atypical  Usual Dose, PO/D, mg  Clozapine (Clozaril)  200-600  Risperidone (Risperdal)  2-6  Olanzapine (Zyprexa)  10-20 (IM)  Quietapine (Seraquel)  300-400  Aripiprazole (Abilify)  10-30 (IM)  Ziprasidone (Geodon)  20-80 (IM)
    6. 6.  Tend not to induce EPS Weight gain, induce onset DM (exp clozapine, olanzapine) Other SE, drooling, sedation, amenorrhea Clozapine may cause agranulocytosis  WBC/ANC baseline  qWk 6 months, q2wk 6 months, q4wk > 1 year  Continue for qwk 1 month after d/c
    7. 7.  EPS  Begin several hours to weeks of start treatment  Include acute dystonia (muscle spasm, stiffness), akinesia (parkinsonian-like, decreased movements), akathisia (restlessness, increased movements), tardive dyskinesia (facial, distal extremities involuntary movements) NMS  Hyperpyrexia, muscle rigidity, agitation, increased WBC/CK/myoglobinuria  Tx= supportive, dantrolene (muscle relaxant, binds ryanodine rec, dec Ca2+), bromocriptine (dopamine agonist)
    8. 8.  Braunwald, E., et al. (2002). Harrison’s manual of medicine. International Edition: McGraw Hill. Bhushan, V., Le, T. (2011). First Aid for the USMLE Step 1 2011: A Student to student guide. McGraw Hill. Jann MW, Grimsley SR, Gray EC, Chang WH. Pharmacokinetics and pharmacodynamics of clozapine. Clin Pharmacokinet 1993; 24:161.

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