AKA: First-Generation, Conventional, or Traditional Antipsychotics, Classical Neuroleptics,or Major Tranquilizers.
This class of medications is most often utilized in the treatment of psychotic (positive) symptoms during the course of Schizophrenia.
Here is a list of First-Generation Antipsychotics organized by potency:
Low Potency:
Chlorpromazine (Thorazine)
Chlorprothixene (Taractan)
Levomepromazine (Levoprome)
Mesoridazine (Serentil)
Thioridazine (Mellaril)
Medium Potency:
Loxapine (Loxitane)
Molindone (Moban)
Perphenazine (Trilafon)
Thiothixene (Navane)
High Potency:
Droperidol (Inapsine)
Flupentixol (Fluanxol)
Fluphenazine (Permitil, or Prolixin)
Haloperidol (Haldol)
Pimozide (Orap)
Prochlorperazine (Compro)
Trifluoperazine (Stelazine)
Common Side Effects:
Extrapyramidal Symptoms (EPS) like:
Acute dystonic reactions: muscular spasms of neck (torticollis,) eyes (oculogyric crisis,) tongue, or jaw
Akathisia: A feeling of motor restlessness
Pseudoparkinsonism: drug-induced parkinsonism (cogwheel rigidity, bradykinesia/akinesia, resting tremor, and postural instability.
Tardive dyskinesia
Anticholinergic medications are used to treat EPS:
Anti-Muscarinic agents
Atropine
Benztropine (Cogentin)
Biperiden
Chlorpheniramine (Chlor-Trimeton)
Dicyclomine (Dicycloverine)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl, Sominex, Advil PM, etc.)
Doxylamine (Unisom)
Glycopyrrolate (Robinul)
Ipratropium (Atrovent)
Orphenadrine
Oxitropium (Oxivent)
Oxybutynin (Ditropan, Driptane, Lyrinel XL)
Tolterodine (Detrol, Detrusitol)
Tiotropium (Spiriva)
Trihexyphenidyl
Scopolamine
Solifenacin
Anti-Nicotinic agents
Bupropion (Zyban, Wellbutrin) – Ganglion blocker
Dextromethorphan - Cough suppressant and ganglion blocker
Doxacurium - Nondeplorizing skeletal muscular relaxant
Hexamethonium - Ganglion blocker
Mecamylamine - Ganglion blocker and occassional smoking cessation aid[2]
Tubocurarine - Nondeplorizing skeletal muscular relaxant
Buuuuuuuut, there is such thing as “too much of a good thing” since Anticholinergic medications can cause:
Acute Anticholinergic Syndrome:
Ataxia-loss of coordination
Decreased mucus production in the nose and throat; consequent dry, sore throat
Xerostomia, or dry-mouth with possible acceleration of dental caries
Cessation of perspiration; consequent decreased epidermal thermal dissipation leading to warm, blotchy, or red skin
Increased body temperature
Pupil dilation (mydriasis); consequent sensitivity to bright light (photophobia)
Loss of accommodation (loss of focusing ability, blurred vision – cycloplegia)
Double-vision (diplopia)
Increased heart rate (tachycardia)
Tendency to be easily startled
Urinary retention
Diminished bowel movement, sometimes ileus (decreases motility via the vagus nerve)
Increased intraocular pressure; dangerous for people with narrow-angle glaucoma
Shaking
Possible effects in the central nervous system resemble those associated with delirium, and may include:
Confusion
Disorientation
Agitation
Euphoria or dysphoria
Respiratory depression
Memory problems
Inability to concentrate
Wandering thoughts; inability to sustain a train of thought
Incoherent speech
Irritability
Mental confusion (brain fog)
Wakeful myoclonic jerking
Unusual sensitivity to sudden sounds
Illogical thinking
Photophobia
Visual disturbances
Periodic flashes of light
Periodic changes in visual field
Visual snow
Restricted or “tunnel vision”
Visual, auditory, or other sensory hallucinations
Warping or waving of surfaces and edges
Textured surfaces
“Dancing” lines; “spiders”, insects; form constants
Lifelike objects indistinguishable from reality
Phantom smoking
Hallucinated presence of people not actually there
Rarely: seizures, coma, and death
Orthostatic hypotension (sudden dropping of systolic blood pressure when standing up suddenly) and significantly increased risk of falls in the elderly population.
**!!GOLDEN NUGGET!!**
A mnemonic for Anticholinergic Syndrome:
Hot as a hare (hyperthermia)
Blind as a bat (dilated pupils)
Dry as a bone (dry skin)
Red as a beet (vasodilation)
Mad as a hatter (hallucinations/agitation)
The bowel and bladder lose their tone and the heart goes on alone (ileus, urinary retention, tachycardia)
The good news is that Acute Anticholinergic Syndrome is completely reversible and subsides once all of the causative agent has been excreted.
Physostigmine is a Reversible Cholinergic Agent that can be used in life-threatening cases.
Piracetam (and other racetams), α-GPC and choline are known to activate the cholinergic system and alleviate cognitive symptoms caused by extended use of anticholinergic drugs
Tags: Conventional Antipsychotics, Typical Antipsychotics, Traditional Antipsychotics, Classical Neuroleptics, Major Tranquilizers, schizophrenia, psychosis, atypical, antipsychotic, Low Potency, Chlorpromazine, Thorazine, Chlorprothixene, Taractan, Levomepromazine, Levoprome, Mesoridazine, Serentil, Thioridazine, Mellaril, Medium Potency, Loxapine, Loxitane, Molindone, Moban, Perphenazine, Trilafon, Thiothixene, Navane, High Potency, Droperidol, Inapsine, Flupentixol, Fluanxol, Fluphenazine, Permitil, Prolixin, Haloperidol, Haldol, Pimozide, Orap, Prochlorperazine, Compro, Trifluoperazine, Stelazine
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