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Antipsychotics



- 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