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Anti-psychotic drugs

 Major tranquilizers – help to people with schizophrenia & psychoses

 mechanism- inhibition of dopamine action in the mesocortical & mesolimbic dopaminergic

pathways of the CNS or block post junctional dopamine D2 receptors

 antipsychotics side effects- Parkinson’s like symptoms, akthisia, tardive dyskinesia

 Parkinson’s symptoms- T- tremor, R-rigidity, A-akithisia, P- postural instability = (TRAP)

Typical (1st generation)-low weight gain Atypical (2nd generation)-high weight gain

1) Phenotiazines: Clozapine

 Chlorpromazine Risperidone

 Fluphenazine Olanzapine

 Trifluoperazine Quetiapine

 Thiordazine

2) Thioxanthenes :

 Cholrprothixene

 Thiothixene

3) Butyrophenones :

 Haloperidol

 Droperidol

4) diphenylbutyrylpiperidine

 pimozide

5) dibenzoxazepine
Loxapine
6) Dihydroidolon
Molindone, Domperidone
Drug Mechanism Thera.use Side-effects Drug –drug Contraindication&
interaction monitoring
First generation Block dopamine antipsychotics EPS-parkinsonism
receptors in Sexual dysfunction
cortical and limbic Anticholinergic side
Advantage; -
areas of brain effects
Low weight gain
Mainly binds at D2 Tardive dyskinesia
Sedation

Inhibit serotonin Antipsychotics Weight gain


Second (5HT) receptors &
Hyperlipidemia
generation dopamine
receptors
Weight gain
Clozapine Inhibit D2,
Advantage- NO 5HT,D,H, alpha 2 Hyperlipidemia
EPS,TD
Proven efficacy
in treatment-
resistant
schizophrenia

Hyperprolactinemia,
Risperidone Blocks D2 & 5HT NO WBC IS
EPS MONITORED

Olanzapine Weight gain


Acute treatment Do not combined
Hyperlipidemia,
Orally of mania With parenteral
disintegrating EPS BDZs- cardiac &
respiratory
Diabetes
problems

Hyperlipidemia
Quetiapine
↑TG
↑ cholesterol
hypothyroidism
akathisia
SYMPTOMS; -

The schizophrenic individual- out of touch with reality, hallucinates, hears voices & exhibit bizarre
behavior. The symptoms are only one aspect of schizophrenia – other symptoms are ;- social
withdrawal, and an inability to communicate or to concentrate

Positive symptoms Negative symptoms

Reality distortions Blunted affect

Delusions persecution Lack of expressed emotion


Grandiosity Poor eye contact & inattentiveness
Thought broadcasting Reduced spontaneity
Thought insertion
Loose associations
Gestures
Mind-reading Alogia
Being controlled
Poor ability to concentrate
Hallucinations

Auditory Avolation/apathy
Olfactory Lack of interest in activities
Somatic No motivation
Visual Social withdrawal
Poor hygiene
Disorganizations

Disorganized speech
Incoherent speech Anhedonia
Tangentially
Loose association Loss of pleasure
Few recreational activities
Disorganized behavior
Attentional impairment
Agitation
Hostility
Assaultiveness Lack of ability to concentrate on tasks or
Uncooperativeness conversations
Inappropriate sexual/social behavior
Inappropriate dress
Catatonia

D.O.C – Ist and 2nd generation


antipsychotics D,O.C= 2Nd generations antipsychotics
Comparison of anti-psychotic drug effects

Typical ist generations Atypical second generations


High sedation Low sedation - respiradone
Low weight gain High weight gain- clozapine
High tardive Dyskinesia Low tardive Dyskinesia - clozapine
High anticholinergic SE Low anticholinergic SE
High sexual dysfunction Low sexual dysfunction
High EPS Low EPS
Neuroleptic malignant syndrome Neuroleptic malignant syndrome