Antipsychotics

Antipsychotics are drugs used to treat schizophrenia and other psychotic disorders by balancing dopamine and serotonin in the brain.

Definition of Antipsychotics:

• Antipsychotics are drugs used primarily to manage psychotic disorders, such as schizophrenia, bipolar disorder, and delusional disorders.
• They are also known as neuroleptics or major tranquilizers.

Classification of Antipsychotics:

1. Typical (First-generation

   • Examples: Chlorpromazine, Haloperidol, Fluphenazine
   • Mechanism of Action:
     • Primarily dopamine D2 receptor antagonists in the mesolimbic pathway.
     • Reduce positive symptoms (hallucinations, delusions).

2. Atypical (Second-generation)

   • Examples: Risperidone, Clozapine, Olanzapine, Quetiapine, Aripiprazole
   • Mechanism of Action:
     • D2 receptor antagonism (weaker than typicals)
     • Also 5-HT2A receptor antagonism (helps with negative symptoms and fewer EPS)

Therapeutic Uses:

• Schizophrenia
• Bipolar disorder (acute mania)
• Severe agitation
• Delusional disorder
• Tourette syndrome (Haloperidol)

Side Effects:

1. Typical:

   • Extrapyramidal Symptoms (EPS): dystonia, akathisia, parkinsonism, tardive dyskinesia
   • Neuroleptic Malignant Syndrome (NMS)
   • Hyperprolactinemia

2. Atypical:

   • Weight gain (Olanzapine)
   • Agranulocytosis (Clozapine)
   • Metabolic syndrome (diabetes, dyslipidemia)

Pharmacokinetics:

• Lipophilic; stored in fat; long half-lives
• Hepatic metabolism via CYP450

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