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Typical Antipsychotics

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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