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Antipsychotics


Definition


  • Antipsychotics are neuroleptic drugs in the following groups: phenothiazines, thioxanthenes, dibenzoxazepines, dihydroindoles, butyrophenones, and diphenylbutylpiperidine and alkali metal. Typical antipsychotics: chlorpromazine (Thorazine), fluphenazine (Permitil), thioridazine (Mellaril), thioxanthene, haloperidol (Haldol), and loxapine (Loxitane). Atypical antipsychotics: clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal).
  • Other agent: lithium (Lithobid).
  • Normal range: see Table 16.10.

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TABLE 16 " “10Normal Levels of AntipsychoticsView LargeTABLE 16 " “10Normal Levels of Antipsychotics Normal Range Toxic Level Lithium 0.4 " “1.0 mEq/L (serum trough " ”12 h postdose) >1.5 mEq/L Haloperidol 2.0 " “15.0 ng/mL Olanzapine 5 " “75 ng/mL Clozapine 100 " “700 ng/mL Fluphenazine 0.2 " “2.0 ng/mL Chlorpromazine Adult therapeutic: 50 " “300 ng/mL Adult: >500 ng/mL Child therapeutic: 30 " “80 ng/mL Child: >200 ng/mL

Use


  • Treatment of psychoses, schizophrenia, mania, Tourette syndrome (haloperidol)

Limitations


  • Immunoassay: RIA " ”nonspecific, semiquantitative due to varying cross-reactivity with parent drug and metabolites.
  • Fluorometry: nonspecific, semiquantitative due to interferences from metabolites.
  • Hemolyzed specimens are unacceptable. Remove serum from clot as soon as possible.
  • Lithium: Lithium heparin and sodium fluoride/potassium oxalate tubes are unacceptable.
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