1. Rohin Khanna

2.  2 Classes of antipsychotics
 Typical / Conventional
▪ Block Dopamine D2 receptors
▪ Work on +ve symptoms (hallucinations/delusions)
 Atypical / Novel
▪ Block serotonin and dopamine receptors
▪ Also M3 (olanzapine), H1 (quetiapine), α, D4 (clozapine)
▪ Work on +ve and –ve symptoms (blunted affect, poverty
of speech, anhedonia)

3.  Conventional/Typical  Usual Dose, PO/D, mg
 Low Potency
▪ Chlorpromazine (Thorazine) ▪ 100-1000 (IM)
▪ Thioridazine (Mellaril) ▪ 100-800
 Mid Potency
▪ Trifluoperazine (Stelazine) ▪ 2-15
▪ Perphenazine (Trilafon) ▪ 4-32
 High Potency
▪ Haloperidol (Haldol) ▪ 0.5-10 (IM)
▪ Fluphenazine (Prolixin) ▪ 1-10 (IM)
▪ Thiothixene (Navane) ▪ 2-20

4.  High Potency
 Least sedating
 Have no anticholinergic symptoms (dry
mouth, constipation, hot, dry skin, tachycardia, delirium in
elderly)
 High tendency for EPS
 Low Potency
 Most sedating
 Have more anticholinergic symptoms
 Lower tendency for EPS
 Mid Potency
 Well tolerated

5.  Novel /Atypical  Usual Dose, PO/D, mg
 Clozapine (Clozaril)  200-600
 Risperidone (Risperdal)  2-6
 Olanzapine (Zyprexa)  10-20 (IM)
 Quietapine (Seraquel)  300-400
 Aripiprazole (Abilify)  10-30 (IM)
 Ziprasidone (Geodon)  20-80 (IM)

6.  Tend not to induce EPS
 Weight gain, induce onset DM (exp clozapine,
olanzapine)
 Other SE, drooling, sedation, amenorrhea
 Clozapine may cause agranulocytosis
 WBC/ANC baseline
 qWk 6 months, q2wk 6 months, q4wk > 1 year
 Continue for qwk 1 month after d/c

7.  EPS
 Begin several hours to weeks of start treatment
 Include acute dystonia (muscle spasm, stiffness), akinesia
(parkinsonian-like, decreased movements), akathisia
(restlessness, increased movements), tardive dyskinesia
(facial, distal extremities involuntary movements)
 NMS
 Hyperpyrexia, muscle rigidity, agitation, increased
WBC/CK/myoglobinuria
 Tx= supportive, dantrolene (muscle relaxant, binds
ryanodine rec, dec Ca2+), bromocriptine (dopamine
agonist)

8.  Braunwald, E., et al. (2002). Harrison’s manual of medicine.
International Edition: McGraw Hill.
 Bhushan, V., Le, T. (2011). First Aid for the USMLE Step 1
2011: A Student to student guide. McGraw Hill.
 Jann MW, Grimsley SR, Gray EC, Chang WH.
Pharmacokinetics and pharmacodynamics of clozapine. Clin
Pharmacokinet 1993; 24:161.