Neuroleptic Antipsychotics

Acetazolamide is a carbonic anhydrase inhibitor that reduces aqueous humour production and is therefore indicated in glaucoma to reduce the intraocular pressure. Salbutamol is a selective, short-acting beta2-agonist used as a bronchodilator in asthma. Tolbutamide is a short-acting sulphonylurea used in type 2 (non-insulin dependent) diabetes mellitus. Chlorpromazine is an aliphatic neuroleptic antipsychotic drug used in schizophrenia. Zafirlukast is a leukotriene-receptor antagonist that is indicated in the prophylaxis of asthma but should not be used to relieve acute severe asthma. 

A. Neuroleptics Antipsychotic potency, sedative, and extrapyramidal motor effects... 

The Rauwolfla alkaloid reserpine was originally used as a neuroleptic/antipsychotic agent. It was then discovered to be an effective antihypertensive agent. Reserpine causes depletion of the noradrenaline stores in peripheral postganglionic sympathetic neurons. In addition it causes depletion of noradrenalin in central nervous structures involved in the regulation of blood pressure. 

The first psychotropics of the modern era (e.g., lithium, neuroleptic antipsychotics, tricyclic and monoamine oxidase inhibitor antidepressants) were discovered serendipitously. These agents were not engineered to have selective actions, but instead produce a wide range of central biochemical effects and generally affect more than one neurotransmitter system simultaneously, resulting in multiple repercussions ... 

Therapeutic Efficacy. Early evidence supporting clozapine s efficacy came from one double-blind, placebo-controlled study and six other neuroleptic-controlled, random-assignment studies (43, 57, 58, 59 and 60 Novartis, unpublished data). When compared with neuroleptics such as CPZ and haloperidol, clozapine was found to be more effective (i.e., three studies found clozapine significantly superior and two others found a trend favoring clozapine ( p = 0.10)). When the results of these studies were combined, the probability that clozapine is superior to neuroleptic antipsychotics was highly statistically significant ( p = 1 x 1CT °) (Table 5-11 and Table 5-12). 

If lithium, valproic acid, or atypical antipsychotic monotherapies are not effective in the acute situation, they can be used together (atypical combo in Fig. 7—35). If this is not effective, a benzodiazepine or a conventional antipsychotic (i.e., a neuroleptic) can be added to first- or second-line monotherapies, especially for the most disturbed patients (Fig. 7—35). That is, sedating benzodiazepines can be used for lesser degrees of agitation (benzo assault weapon in Fig. 7—35), but neuroleptic antipsychotics may be necessary for the most disturbed and out-of-control patients (nuclear weapon in Fig. 7—35). Neuroleptic antipsychotics should be restricted to the acute phase, and administered sparingly. 

OFFICIAL NAMES Major tranquilizers (neuroleptics/antipsychotics) Chlorpromazine (Thorazine) chlorprothixene (Taractan) clozaril (Clozapine) fluphenazine (Permitil, Prolixin) haloperidol (Haldol) loxapine (Daxolin, Loxitane) mesoridazine (Serentil) molindone (Lidone,... 

CNS Sedative-hypnotic Anticonvulsant Muscle relaxant Anesthetic Analgesic (narcotic and non-narcotic) Anxiolytic Dementia/cognition Antidepressant Neuroleptic/antipsychotic... 

Chemicae/Pharmaceuticae/Other Ceass Neuroleptics Antipsychotics Major tranquilizers Chemical Formuea C10FI12O Chemical Structures ... 

Other side effects characteristic of most neuroleptic-antipsychotic drugs include autonomic effects such as postural hypotension and impaired sexual function. Increased plasma prolactin represents an endocrine effect. 

A variety of neurologic syndromes, involving particularly the extrapyramidal system, occur following short- or long-term use of neuroleptic (antipsychotic) drugs. These include akathisia, dystonia, neuroleptic malignant syndrome, parkinsonism, and tardive dyskinesia. 

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