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They should be vigilant for the occurrence of adverse effects, be willing to adjust or change medications as needed (or work with psychiatric colleagues to do so), and be prepared to treat any resulting medical sequelae.
The first-generation antipsychotics (FGAs) work through dopamine D neuroreceptor blockade, and a subsequent series of new antipsychotics were developed with stronger dopamine blockade.1 To discuss differences in the adverse effect profiles of FGAs, we use the terms “low-potency” and “high-potency,” not to indicate their clinical effectiveness, but rather to indicate their potency in binding to this dopamine DSecond-generation antipsychotics (SGAs) were launched in 1989 when investigators found that clozapine (Clozaril) was more effective than chlorpromazine, with fewer extrapyramidal symptoms.2 These new anti-psychotics were considered atypical because they targeted neuroreceptors other than only dopamine.
Over the past two decades, SGAs have dominated prescribing preferences in the United States under the assumption that they are more effective and safer than FGAs.3 Paliperidone, the active metabolite of risperidone, has been marketed in the United States as Invega since 2007.
With the exception that clozapine is more effective for treatment-resistant patients,6 the choice of antipsychotic should depend on the potential for adverse effects in individual patients.
General comparisons between the FGA and SGA classes are less helpful than comparisons among specific medications because each presents its own challenges in terms of balancing effectiveness with safety and tolerability.
This effect is more common in older adults (with risk of falls), those on blood pressure medications, and those who have other cardiovascular diseases.
With careful dose titration, patients may become tolerant to this effect.All antipsychotic medications are associated with an increased likelihood of sedation, sexual dysfunction, postural hypotension, cardiac arrhythmia, and sudden cardiac death.Primary care physicians should understand the individual adverse effect profiles of these medications.Low-potency FGAs and clozapine are highly likely to cause anticholinergic effects; olanzapine and quetiapine have been shown to do so at high dosages.8 When needed, doses can be lowered or divided to help alleviate this problem.Antipsychotic medications cause four main extrapyramidal symptoms: pseudoparkinsonism, akathisia, acute dystonia, and tardive dyskinesia.JOHN MUENCH, MD, MPH, Oregon Health & Science University, Portland, Oregon ANN M.Tags: Adult Dating, affair dating, sex dating