Antipsychotics: Typical

Key points

• Typical antipsychotics (haloperidol, chlorpromazine): block dopamine D2 receptors.
• Side effects relate to D2 blockade: raised prolactin (galactorrhoea, gynaecomastia), extrapyramidal effects.
• Extrapyramidal side effects: acute dystonia → procyclidine; akathisia (restlessness); parkinsonism; tardive dyskinesia (late, orofacial movements).
• Chlorpromazine: more sedating and anticholinergic; haloperidol: more extrapyramidal effects.
• Other: neuroleptic malignant syndrome, QT prolongation, lowered seizure threshold, photosensitivity (chlorpromazine).

Decision points in this pathway

• Extrapyramidal side effect type?

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