Psychotropic drugs

Question 1

Class: First-generation (typical) antipsychotic, phenothiazine class.
Indications:

Primarily used to treat schizophrenia and other psychotic disorders.
Effective for controlling positive symptoms like delusions, hallucinations, and disorganized thinking.

Mechanism of Action:

Blocks dopamine D2 receptors in the brain, particularly in the mesolimbic pathway, reducing psychotic symptoms.

Side Effects:

Extrapyramidal symptoms (EPS): Dystonia (muscle stiffness), akathisia (restlessness), parkinsonism, and tardive dyskinesia.
Neuroleptic malignant syndrome (NMS): A rare but life-threatening reaction with symptoms like fever, muscle rigidity, and altered mental status.
Sedation, weight gain, and anticholinergic effects (dry mouth, constipation).
Orthostatic hypotension and prolonged QT interval (cardiac effects).

Answer 1

Fluphenazine (Prolixin)

Question 2

Class: First-generation (typical) antipsychotic, butyrophenone class.
Indications:

Used for schizophrenia, acute psychosis, and control of severe agitation.
Also used to manage Tourette’s syndrome and severe behavioral problems in children.

Mechanism of Action:

Strongly blocks dopamine D2 receptors in the brain, especially in the mesolimbic and nigrostriatal pathways.

Side Effects:

Extrapyramidal symptoms (EPS): High risk compared to other antipsychotics.
Tardive dyskinesia with long-term use.
Neuroleptic malignant syndrome (NMS).
Sedation, dizziness, and orthostatic hypotension.
Prolonged QT interval, which can lead to arrhythmias.
Anticholinergic effects are generally less prominent compared to other first-generation antipsychotics.

Answer 2

Haloperidol (Haldol)

Question 3

Class: Anticholinergic, antiparkinsonian agent.
Indications:

Used primarily to treat or prevent extrapyramidal symptoms (EPS) caused by antipsychotic medications, including dystonia and parkinsonism.
Also used in the management of drug-induced parkinsonism and for tremors.

Mechanism of Action:

Blocks central muscarinic acetylcholine receptors, balancing dopamine and acetylcholine levels in the brain, which reduces the motor side effects associated with antipsychotics.

Side Effects:

Dry mouth, blurred vision, constipation, and urinary retention.
Cognitive impairment and memory issues (especially in elderly patients).
Tachycardia, confusion, and hallucinations at higher doses.
Risk of worsening existing psychiatric symptoms in psychotic disorders.

Answer 3

Benztropine (Cogentin)

Question 4

Class: First-generation (typical) antipsychotic, phenothiazine derivative.

Indications:

Sedative used to treat symptoms

Schizophrenia and other psychotic disorders.
Bipolar disorder (particularly for acute manic episodes).
Severe behavioral problems in children.
Nausea and vomiting.
Intractable hiccups.
Acute intermittent porphyria.
Adjunct treatment in tetanus.

Mechanism of Action:

Blocks dopamine D2 receptors in the brain, particularly in the mesolimbic pathway, which helps reduce positive symptoms of psychosis (e.g., hallucinations, delusions). It also has anticholinergic, antihistaminic, and alpha-adrenergic blocking properties.

Side Effects:

Extrapyramidal Symptoms (EPS): Including dystonia (muscle stiffness), akathisia (restlessness), parkinsonism (tremors, rigidity), and tardive dyskinesia (involuntary movements, often irreversible).
Sedation: Due to histamine H1 receptor antagonism.
Anticholinergic Effects: Dry mouth, constipation, urinary retention, blurred vision.
Orthostatic Hypotension: Due to alpha-adrenergic blockade.
Weight Gain: Common with many first-generation antipsychotics.
Metabolic Changes: Although less pronounced than with second-generation antipsychotics, some changes in blood glucose and lipid levels can occur.
Neuroleptic Malignant Syndrome (NMS): A rare but life-threatening condition characterized by muscle rigidity, fever, altered mental status, and autonomic dysfunction.
QT Prolongation: Increased risk of arrhythmias.
Photosensitivity and Skin Reactions: Increased sensitivity to sunlight and possible skin pigmentation changes with long-term use.
Hyperprolactinemia: Resulting in galactorrhea, gynecomastia, menstrual irregularities, and sexual dysfunction.

Answer 4

Chlorpromazine (Thorazine®)