Antipsychotics

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- Phenothiazines
    - Chlorpromazine
    - Thioridazine
    - Mesoridazine
    - Fluphenazine
- Thiothixenes
    - Thiothixene
- Butyrophenones
    - Haloperidol
- Discussion:
    - in low doses they are useful for the management of the agitation and
          confusion of delirium and dementia;
    - elderly may be more susceptible to effects of given dose of
          Chlorpromazine, since oral therapy w/ that drug
          results in higher plasma levels in elderly;
    - relatively more potent agents, esp Haloperidol & Fluphenazine,
          cause highest incidence of side effects in extrapyramidal system,
          including pseudo-Parkinsonism, akathisias, and dystonias;
    - because of age-related changes in the central nervous system, elderly
          are more prone to have extrapyramidal symptoms of pseudo-
          Parkinsonian type, but they are less likely to have dystonias than
          younger patients;
    - immediate management of such effects should involve tapering dosage or
          discontinuing drug if possible & using anticholinergic medication;
          - long-term use of anticholinergic medications in this manner is not
              recommended, since it may increase risk for tardive dyskinesia
              & cause other anticholinergic side effects, including delirium;
    - pts w/ early development of other types of extrapyramidal symptoms,
          such as akathisias or pseudo-Parkinsonism, may also be more likely
          to acquire tardive dyskinesia;
          - it may be wise to use a neuroleptic w/ lower potency, such as
              Chlorpromazine or Thioridazine, in pts w/
              extrapyramidal side effects;
          - Thioridazine has lowest incidence of extrapyramidal symptoms &
              may cause least dopaminergic blockade in the striatum;
    - least potent antipsychotics (Chlorpromazine & Thioridazine
          tend to be most sedating and to have most anticholinergic effects;
    - least potent antipsychotics (Chlorpromazine & Thioridazine) tend to be
          most sedating and to have most anticholinergic effects;
          - use of such drugs in combination w/ antidepressant that also has
              high anticholinergic activity may cause toxic anticholinergic
              reactions, including delirium;
          - autonomic side effects are also relatively frequent w/ less
              potent neuroleptics, & resultant hypotensive episodes may
              predispose to falls, myocardial infarction, or CVA;