PSYCHOSIS + SCHIZOPHRENIA: 1ST GEN Flashcards
MoA
Blocks post-synaptic dopamine D2 receptors in the brain
What are the 1st gen antipsychotics?
Phenothiazines and butyrophenone
Others: thioxanthenes
pimozide, sulpride
Why are typical antipsychotics not preferred?
- More extrapyramidal symptoms (EPS)
- More hyperprolactinaemia
Phenothiazines
Hepatotoxic & acute dystonic reactions
Split into groups (1, 2 & 3)
Group 1 phenothiazines
chlorpromazine, levomepromazine
promazine
Group 1 phenothiazines properties
- Most sedation
- Moderate antimuscarinic and EPSEs
Group 2 phenothiazines
periciazine
Group 2 phenothiazines properties
- Moderate sedation
- Least EPSEs
Group 3 phenothiazines
- fluphenazine
- prochloperazine
- trifluoperazine
Group 3 phenothiazines properties
- Moderate sedation
- High EPSEs (e.g. someone with parkinson’s, we must avoid these)
Butyrophenones
benperidol, haloperidol
Thioxanthenes
flupentixol
zuclopentixol
Butyrophenones properties
Moderate sedation
High EPSEs (similar to group 3 phenothiazines)
Thioxanthenes properties
Moderate sedation
Antimuscarinic effects
EPSEs
Pimozide and sulpride
- Reduced sedation
- Antimuscarinic effects
- EPSEs
Which phenothiazine has the most sedative but moderate antimuscarinic and
EPSE side-effect?
Group 1
- Chlorpromazine
- Levomepromazine
- Promazine
CLPY (SLEEPY)!
Which phenothiazine has fewer sedative effects but the MOST WORSE antimuscarinic and EPSE side-effect?
Group 3
- Fluphenazine
- Perphenazine
- Prochlorperazine
- Trifluoperazine
Which phenothiazine has moderate sedative effects but the LEAST worse antimuscarinic and EPSE side-effect?
Group 2 Phenothiazines
- Pericyazine
What are the other indications for
Phenothiazines other than schizophrenia?
- Prochlorperazine e.g.
Buccastem M
- Nausea and vomiting
- Vertigo
- N&V associated with migraines - Chlorpromazine
- For relief of persistent hiccups - Levomepromazine
- Antiemetic in palliative care
- Restlessness and confusion
