1. Antipsychotics

2. Major tranquilisers

3. Therapeutic effects Emotional quietening Indifference
Psychomotor slowing

4. Indications for use Acute and chronic psychoses
Mania
Schizophrenia
Acute organic confusional states
Alcohol withdrawal
Treatment of vomiting( promethazine)

5. Typical antipsychotics
Phenothiazines
Chlorpromazine
Trifluoperazine
Butyrophenones
Haloperidol
Thioxanthenes
Flupenthixol

6. Atypical antipsychotics
Clozapine
Olanzapine
Risperidone

7. Mechanisms of action
All antipsychotics are Dopamine receptor antagonists
Also blocks 5HT receptors
takes days or weeks to work

8. Atypical antipsychotics
Less incidence of extrapyramidal side effects
Effective against negative symptoms
effective against resistant patients

9. Indications Acute psychotic states schizophrenia
pain in terminal illness
Intractable Hiccup
Sleep disturbances in elderly

10. Phenothiazines -Chlorpromazine
Dopamine receptor antagonist
Also have anticholinergic and anti histamine properties and antiemetic properties

11. Kinetic data
T1/2 35 hours
substantial hepatic first pass metabolism

12. Olanzapine Used as first line treatment of schizophrenia
less side effects
Agranulocytosis reported but less common than clozapine
Metabolic side effects are prominent
Weight gain
Impaired glucose tolerance

13. Adverse effects
Extrapyramidal side effectrs .Tremor Drug induced Parkinsonisim, Tardive dyskinesia
Sedation
Anticholinergic effects
Galactorrhoea and amenorrhoea
Photosensitive rashes
Cholestatic jaundice
Neuroleptic malignant syndrome

14. Injectable preparations
40% of schizophrenics do not take regular medications
depot preparations Flupenthixol and Fluphenazine are available
Can be given at 3-4 week intervals