* Neuroleptic have as main action to block central dopaminergic receptors
* Atypical antipsychotics have a lower risk of neurological side effects in individuals and can be used as first-line (riserpéridone, olanzapine; sulpiride)
* DEFINITION OF DELAY AND DENIKER:
– Action psycholeptic (=> psychomotor indifference) without hypnotic action
– Reduction of the agitation and aggression
– Reducing action on acute and chronic psychoses
– Are the original production of neurological and autonomic side effects
– Have a dominant subcortical Action
* Act in mesocortical regions and mesolimbic and nigrostriatal (extrapyramidal side effects) and at the tuberoinfundibular system (hyper-prolactin levels, elevated GH).
* They can block other receptors and muscarinic cholinergic; adrenergic (α1); histamine (H1 above).
* Butyrophenones (Haldol) shows the most effective anti-hallucinatory effect and fastest
1- Classification:
A- NL (Neuroleptic) sedative:
* Levomepromazine (Nozinan®)
* Chlorpromazine (Largactil®)
* Sulpiride (Dogmatil®) high dose
B- NL déshinibiteur:
Sulpiride (Dogmatil®) Low dose
C- polyvalent NL:
Haloperidol (Haldol)
2- secondary effects:
Action strong autonomic => Orthostatic hypotension:
Phenothiazines -> Chlorpromazine (Largactil®) / Levomepromazine (Nozinan®)
Hyperkinetic syndrome:
Butyrophenones -> Haloperidol (Haldol)
Akineto-hypertonic syndrome:
Benzamides -> Sulpiride (Dogmatil®)
3- Other side effects:
* Extrapyramidal syndrome (early or late)
* Anticholinergic (atropine): constipation, dry mouth, retrograde ejaculation, confusion, glaucoma, urinary retention …
* Epilepsy (lower the seizure threshold)
* Cardiovascular: orthostatic hypotension (α-adrenergic blocking agent); sinus tachycardia; QT prolongation
* Endocrine effects: generated by hyperprolactinemia (frigidity, impotence, gynecomastia, galactorrhea, dysmenorrhea); obesity
* Skin manifestations: purple color of the face; photosensitivity;
* Blood Accidents
* Blood Accidents: benign leukopenia with relative lymphocytosis; agranulocytosis
* Digestive complications: cholestatic or cytolytic hepatitis; paralytic ileus
Malignant syndrome:
Hyperthermia with profuse sweating, paleness, very important extrapyramidal stiffness, stupor, dehydration with hypotension and tachycardia; elevated muscle enzymes; leukocytosis with polymorphonuclear.
Psychic signs:
Indifference psychomotor (passivity); depressive syndrome (25%); drowsiness; Access anxiety and delusional reactivation (low dose); confusional access (anticholinergic share)
+ Indications: manic (neuroleptic sedatives); acute delirium (neuroleptic sedatives); chronic psychoses; delirious melancholy; intractable insomnia
+ Accessories Indications: psychosomatic disorders (especially gastrointestinal); anomalous movements (Huntington’s disease, Tourette’s syndrome, tics, dystonia); nausea and severe vomiting during treatment with antimitotic. Emesis gravidarum (metoclopramide)
+ Contraindications: Parkinson’s disease; multiple thrust plate; any degenerative disease of CNS; porphyria (chlorpromazine may be used); lobe epilepsy unbalanced; risk of closure glaucoma; history of malignant syndrome;pregnancy (teratogenic risk) Largactil except in case of need
