Antipsychotic Medications Cheat Sheet
Categories of Antipsychotic Medications
Antipsychotic medications are categorised into two main groups:
1. Atypical (2nd generation): Generally preferred, with lower risk of extrapyramidal
side effects (EPSE).
2. Typical (1st generation): Higher risk of EPSE and more severe side effects.
- To remember: 2nd children are weirder and more atypical but are not restless (less
extrapyramidal side effects), while 1st children are less weird and typical but are restless
(more extrapyramidal side effects).
Common Side Effects of Antipsychotic Medications
Glasgow Antipsychotic Side-Effect Scale (GASS): 22-question self-reporting tool for
identifying antipsychotic side effects
- Neuroleptic Malignant Syndrome (NMS): High fever, muscle rigidity, autonomic
instability, altered mental status (emergency).
- Metabolic effects: Weight gain, hyperglycemia, increased cholesterol levels.
- Extrapyramidal side effects (EPSE): Tremors, muscle rigidity, restlessness, bradykinesia
(more common with typical antipsychotics).
- Anticholinergic effects: Dry mouth, constipation, blurred vision, urinary retention.
- QT prolongation: Can increase the risk of arrhythmias (more common with
haloperidol).
- Lowered seizure threshold: Increased risk of seizures at high doses.
- Sedation: Common in drugs with histamine receptor antagonism.
- “No meals”: NMS, metabolic effects, extrapyramidal side effects, anticholinergic side
effects, lowered seizure threshold, sedation.
1. No – NMS.
2. M – Metabolic effects.
3. E – Extrapyramidal side effects.
4. A – Anticholinergic side effects.
5. L – Lowered seizure threshold.
6. S – Sedation.
- NMS (Neuroleptic Malignant Syndrome) symptoms:
- “FRASH”: fever, rigidity, autonomic instability, stupor, hyperreflexia.
1. F – Fever.
2. R – Rigidity.
3. A – Autonomic instability (BP fluctuations).
4. S – Stupor (altered mental status).
5. H – Hyperreflexia: muscles have an increased, overactive reflex.
, Clozapine
- Clozapine is used for schizophrenia unresponsive to other antipsychotics. Regular
monitoring is critical with clozapine due to serious side effects.
1. Cardiac issues: ECG monitoring may be required due to the risk of QT prolongation.
2. Seizure risk: Clozapine lowers the seizure threshold, so be cautious.
3. Blood levels: Monitor blood levels to ensure therapeutic range and avoid toxicity.
4. Agranulocytosis: Monitor white blood cell count to detect low levels, which increase
infection risk.
5. Metabolic effects: Monitor weight, blood sugar, and cholesterol levels.
- “C SBAM”: cardiac issues, seizures, blood levels, agranulocytosis, metabolic side effects.
1. C – Cardiac issues.
2. S – Seizures.
3. B – Blood levels.
4. A – Agranulocytosis.
5. M – Metabolic side effects.
SSRIs/ SNRIs
- SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine
reuptake inhibitors) are both types of antidepressants, but SNRIs affect both serotonin
and norepinephrine levels in the brain, while SSRIs primarily focus on serotonin.
- They are both used to treat conditions like depression, anxiety disorders and sometimes
chronic pain: nerve pain.
- SSRIs: fluoxetine, sertraline, paroxetine, citalopram and escitalopram.
- SNRIs: duloxetine and fluoxetine.
- Side effects:
1. Increased GI bleeding risk, especially in the elderly or when used with NSAIDs.
2. Serotonin syndrome: a potentially life-threatening condition caused by excess
serotonergic activity, with symptoms like agitation, tremors, hyperreflexia and
autonomic instability.
MAOIs
- MAOIs (monoamine oxidase inhibitors) are a class of older antidepressants that inhibit
the enzyme monoamine oxidase, which breaks down neurotransmitters like serotonin,
norepinephrine and dopamine, therefore increasing their levels in the brain and
alleviating depression.
- They are used in depression when other antidepressants haven’t worked (refractory
depression) and can also be used for panic disorders, social anxiety disorders and
atypical depression (reversed biological symptoms such as increased appetite and
weight gain and hypersomnia- excessive sleep and lethargy, preserved mood reactivity
and interpersonal rejection sensitivity).
- Examples:
Categories of Antipsychotic Medications
Antipsychotic medications are categorised into two main groups:
1. Atypical (2nd generation): Generally preferred, with lower risk of extrapyramidal
side effects (EPSE).
2. Typical (1st generation): Higher risk of EPSE and more severe side effects.
- To remember: 2nd children are weirder and more atypical but are not restless (less
extrapyramidal side effects), while 1st children are less weird and typical but are restless
(more extrapyramidal side effects).
Common Side Effects of Antipsychotic Medications
Glasgow Antipsychotic Side-Effect Scale (GASS): 22-question self-reporting tool for
identifying antipsychotic side effects
- Neuroleptic Malignant Syndrome (NMS): High fever, muscle rigidity, autonomic
instability, altered mental status (emergency).
- Metabolic effects: Weight gain, hyperglycemia, increased cholesterol levels.
- Extrapyramidal side effects (EPSE): Tremors, muscle rigidity, restlessness, bradykinesia
(more common with typical antipsychotics).
- Anticholinergic effects: Dry mouth, constipation, blurred vision, urinary retention.
- QT prolongation: Can increase the risk of arrhythmias (more common with
haloperidol).
- Lowered seizure threshold: Increased risk of seizures at high doses.
- Sedation: Common in drugs with histamine receptor antagonism.
- “No meals”: NMS, metabolic effects, extrapyramidal side effects, anticholinergic side
effects, lowered seizure threshold, sedation.
1. No – NMS.
2. M – Metabolic effects.
3. E – Extrapyramidal side effects.
4. A – Anticholinergic side effects.
5. L – Lowered seizure threshold.
6. S – Sedation.
- NMS (Neuroleptic Malignant Syndrome) symptoms:
- “FRASH”: fever, rigidity, autonomic instability, stupor, hyperreflexia.
1. F – Fever.
2. R – Rigidity.
3. A – Autonomic instability (BP fluctuations).
4. S – Stupor (altered mental status).
5. H – Hyperreflexia: muscles have an increased, overactive reflex.
, Clozapine
- Clozapine is used for schizophrenia unresponsive to other antipsychotics. Regular
monitoring is critical with clozapine due to serious side effects.
1. Cardiac issues: ECG monitoring may be required due to the risk of QT prolongation.
2. Seizure risk: Clozapine lowers the seizure threshold, so be cautious.
3. Blood levels: Monitor blood levels to ensure therapeutic range and avoid toxicity.
4. Agranulocytosis: Monitor white blood cell count to detect low levels, which increase
infection risk.
5. Metabolic effects: Monitor weight, blood sugar, and cholesterol levels.
- “C SBAM”: cardiac issues, seizures, blood levels, agranulocytosis, metabolic side effects.
1. C – Cardiac issues.
2. S – Seizures.
3. B – Blood levels.
4. A – Agranulocytosis.
5. M – Metabolic side effects.
SSRIs/ SNRIs
- SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine
reuptake inhibitors) are both types of antidepressants, but SNRIs affect both serotonin
and norepinephrine levels in the brain, while SSRIs primarily focus on serotonin.
- They are both used to treat conditions like depression, anxiety disorders and sometimes
chronic pain: nerve pain.
- SSRIs: fluoxetine, sertraline, paroxetine, citalopram and escitalopram.
- SNRIs: duloxetine and fluoxetine.
- Side effects:
1. Increased GI bleeding risk, especially in the elderly or when used with NSAIDs.
2. Serotonin syndrome: a potentially life-threatening condition caused by excess
serotonergic activity, with symptoms like agitation, tremors, hyperreflexia and
autonomic instability.
MAOIs
- MAOIs (monoamine oxidase inhibitors) are a class of older antidepressants that inhibit
the enzyme monoamine oxidase, which breaks down neurotransmitters like serotonin,
norepinephrine and dopamine, therefore increasing their levels in the brain and
alleviating depression.
- They are used in depression when other antidepressants haven’t worked (refractory
depression) and can also be used for panic disorders, social anxiety disorders and
atypical depression (reversed biological symptoms such as increased appetite and
weight gain and hypersomnia- excessive sleep and lethargy, preserved mood reactivity
and interpersonal rejection sensitivity).
- Examples:
