Huppert’s Notes: Pathophysiology and Clinical Pearls for Internal Medicine >Key Medications

&Interventions in Psychiatry
Laura A. Huppert, Timothy G. Dyster, (Lead Contributing Editor)+
TABLE 13.4Antipsychotic Medications

Class Drug : Generic (Trade Name) Mechanism of Action Use Side Effects

•Sedation, orthostatic hypotension,

anticholinergic side effects
•Metabolic side effects (weight gain,
hyperlipidemia, ↑HgA1c)
•QTc prolongation, heart block
•Hyperprolactinemia
Extrapyramidal symptoms (EPS):
Abnormal movements and/or tone

•- Acute dystonia (min–hrs: spasm,

twist). Tx: Benztropine
(anticholinergic), diphenhydramine
(antihistamine)
•- Akathisia (days–wks). Tx:
Lorazapam, propranolol.
•- Parkinsonism (wks–months). Tx:
Benztropine, amantadine.
•- Tardive dyskinesia (months–years).
chlorpromazine (Thorazine) Tx: Stop medication, can be
Schizophrenia (+ symptoms), delirium,
Typical/1st Generation fluphenazine (Prolixin) haloperidol Block D2 dopamine receptor irreversible.
Tourette’s
(Haldol) perphenazine (Trilafon) Neuroleptic malignant syndrome
(NMS):

•Definition: Rare reaction to

antipsychotic drug that causes
autonomic instability and rigidity
•Onset: Subacute, typically within one
week of drug initiation
•Symptoms: Severe “lead pipe”
rigidity, autonomic dysfunction
(elevated HR, BP, RR, temp),
nausea/vomiting, altered mental
status. Make have leukocytosis,
elevated CK
•Treatment: Stop the offending
medication. Provide supportive
treatment. Can consider the use of
benzodiazepines and dantrolene if
severe
 1st and 2nd generation are equally
effective at reducing psychotic
symptoms. EPS is less common with
2nd generation drugs and thus
preferred.

Drug-specific side effects by

medication:
clozapine (Clozaril) olanzapine
(Zyprexa) quetiapine (Seroquel) Block D2 dopamine + 5HT2A Schizophrenia (+/– symptoms), bipolar •Clonazapine: Agranulocytosis,
Atypical/2nd Generation
risperidone (Risperdal) aripiprazole serotonin receptor disorder, OCD, depression seizure, weight gain, myocarditis
(Abilify) ziprasidone (Geodon) •Olanzapine: Weight gain (monitor
lipids, glucose at 3 months)
•Quetiapine: Weight gain, sedative
•Risperidone: Hyperprolactinemia
•Aripiprazole: Weight neutral, less risk
of metabolic SEs, partial dopamine
agonist
•Ziprasidone: QT prolongation
(monitor EKG)

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