ANTIPSYCHOTIC DRUGS , types ,indication ,action, contrainducation and side effect.

Typical antipsychotic:-

-Phenothiazine :- 

-Chlorpromazine:- 40-800 mg

-Perphenazine:- 12-64 mg

-Fluphenazine:- 1-10 mg

Thioridazine:- 100-400mg

-Thioxanthenes:-

-Thiothixene:- 6-30mg

-Butyrophenones:-

-Haloperidol:- 1-20 mg

-Dibenzothiazepine

Atypical antipsychotics:-

-Clozapine:-100-300 mg

-Risperidone:-2-8 mg

-Olanzapine:- 5-20 mg

-Quetiapine:- 50-400 mg

-Aripiprazole:- 15-30 mg/day

INDICATION:-

-Acute and chronic psychosis

- Selected agents used as antiemetics 

- Intractable hiccought 

- Tics and vocal utterances in Toureetts disorder ( haloperidols,pimozide).

ACTION:-

Acts by blocking postsynaptic dopamine receptors in the basal ganglia hypothalamus limbic system brainstem and medulla.

CONTRAINDICATION:-

- Blood dyscrasias

-Parkinson's disease

-Liver renal cardiac insufficiencies.

SIDE EFFECTS:-

Anticholinergic effects:-

Dry mouth 

Blurred vision

Constipation

Urinary retention

Nausea 

Skin rash

Sedation

Orthostatic hypotension

Photosensitivity 

Hormonal effects:-

Decreased libido 

Retrograde ejaculation 

Gynecomastia

Amenorrhoea

Weight gain

ECG CHANGES:-

Prolongation of the QT interval are possible with most of the antipsychotics.

- Reduction of seizures threshold.

Agranulocytosis:-

Clozapine :- weekly biweekly blood investigation hypersalivation .

Extrapyramidal sysmptom(EPS):-

- pseudoparkinsonism

   >Tremor shuffling gait drooling rigidity.

   > 1- 5 days after intiation of.             antipsychotics.

- akinesia

-akathisia( 5-60 days after intiations of therapy).

Dystonia:- Men;<25 years of age

Oculogyric crisis:-

- treated as emergency

- physician should be contacted immediately

-Management:- iv benztropine mesylate

- Tardive dyskinesia.

- Neuroleptic malignant syndrome 

- severe parkinsonian muscle rigidity 

- upto 107°c tachycardia tachypnea

- Fluctuation in blood pressure diaphoresis and rapid deterioration of mental status to stupor and coma.

- This is rare but potentially fatal complication of treatments with neuroleptics drugs .

- It may precipitate within hours- year after drugs initiation.

- Discontinue neuroleptic immediately.

-Management:- Bromcriptine or dantrolene.