Kingdom of Saudi Arabia

King Saud University

Collage of Nursing

Antipsychotic drugs

Prepared by : Heba Makki AlNimer

425204634

Supervised by : Dr.Elham

Antipsychotic drugs

Outlines:

*Definition*Clinical Indications

*Classifications*Action

*Side effect and complications*Contraindications

*Nursing management of patient receiving *antipsychotic drugs

Definition:

Antipsychotic drugs are drugs used to treat symptoms of psychotic disorders, such as delusion and hallucinations.

Clinical Indications for Antipsychotic Drugs*Primary Indication: Schizophrenia

*Schizoaffective disorder

*Manic*Other Indications :

^Tourette's syndrome

^disturbed behavior: senile dementia associated with Alzheimer's disease

*Inappropriate Use :

^Management of drug withdrawal syndromes (e.g. opioids)

^Anxiety relief -- not appropriate given availability of specific anxiolytic agents

*Nonpsychiatric Indications :

^antiemesis

^relief of puritis

^neuroleptanesthesia

Classifications: Standard (traditional) Antipsychotics.Atypical Antipsychotics.

•Standard (traditional) Antipsychotics

•Action:•Standard Antipsychotic drugs act by

blocking dopamine type2 (D2) receptor in the nigrostriatal area of basal ganglia. Thus. These drugs referred to as dopamine receptor antagonists.

Type of Standard Antipsychotic

route Dosage(adult) Trade name Generic name

O , IM

IM

O,IM,IV

O,IM

O,IM25mg IM

O

300-800

40-800

8-40

6-20

1-20

200-700

ThorazinePromacidNeurazineLargactil

Sparine

Trilafon

Stelazine

ProlixinProlixin,medicateDecanoate(long acting)

mellaril

PhenothiazinesChlorpromazine

 Promazine

 Perphenazine

 Trifluoperazine

 Fluphenazine

Thioridazine

Continue>>>

route Dosage (adult)

Trade name Generic name

O,IM50-100mg

 IM

O100mg IM

6-20

105-5

1-10

HaldolHaldol decanoate (long acting)safinace

OrapClopixolDecanoate(long acting)

ButyrophenonesHaloperidol

Other drugsPimozideclopenthizol

Side effects:

:CNS*Extrapyramidal side effect(EPS)

acute onset of EPS: it occurs within few days,weeks or months.

Acute dystonic reaction:• Eye : oculogyric crisis in which the eyes are pulled up or to the

side.• Neck: pulling the head to one side(torticollis) or pulling the head

back (retrocollis).• Tongue: involuntary protrusions of tongue.• Body: torsion spasm.

• Pseudo-parkinsonism(parkinsonian like syndrome):

It is characterized by:

• Hypokinesia: it is loss of movement, and may present asslowing or difficulty initiating movement, as well as decreased or absent arm swing when walking.

• Rigidity all over the body.• Masked like face.• Short shuffling gait.• Drippling of saliva.• Monotonous and slurred speech.• Loss of postural reflexes which leads to fall.

• Akathisia:It is characterized by:

• Subjective feeling of restlessness and irritability.

• Inability to sit still.• Crossing and uncrossing legs frequently.• Inability to relax.

late onset of EPS: it occurs at least 6-24 months.

• Tardive dyskinesia: is a jerky irregular movements affecting

primarily the lower face, extremities and trunk.

»Sedation »Epileptogenic effect.

 

Autonomic side effect(anti-cholinergic side effect):• Dry mouth, blurring of vision, urinary retention,

constipation. Cardiovascular system:• Orthostatic hypotension, light headedness,dizziness

accompanied by tachycardia,palpitation and arrhythmia.

Respiratory system:• Nasal congestion especially with Mellaril which may

lead to ulceration. Dermatological effect:• Allergic reaction with rashes.

• dermatitis.

Complications:Agranulocytosis:

•White cell count drop to very low levels,the symptoms include: high fever, sore throat, mouth sores and malaise.

Neuroleptic malignant syndrome: (lead to death)It is rare and It is characterized by:

Hyperthermia: up to 107F, autonomic dysfunction ,hypertension, tachycardia.

Allergic obstructive jaundice:

Abdominal pain, anorexia, nausea, fever, bilirubin in urine and increase in serum bilirubin.

Contraindication:

Cardiovascular diseases (myocardial infraction)Hypotension or hypertension, bone marrow disease, epilepsy, liver disease, pulmonary disease, pregnant women 1st trimester.

Atypical AntipsychoticsDefinition:

It is a novel antipsychotics that have lesser extra pyramidal side effects and greater efficacy in the treatment of negative symptoms of schizophrenia compared with typical antipsychotics.

Action:atypical Antipsychotics blocks both serotonin and dopamine receptors.

Advantage:They cause little or no extra pyramidal side effect.

Effective in short term.

disadvantage:

Very expensive

Types of atypical Antipsychotics:

Dosage Trade name Generic name

Tablets 25-100mg\day

Ampoule 2ml\day

 1mg to 3-6mg\day

Leponex, Clozaril,Clozapex

Risperdal,Apexidone

Clozapine

Risperidone

Side effect of Clozapine:*Agranulocytosis

*Seizure*It can be sedating, cause hypotension and

tachycardia.

Contraindication:*Hypersensitivity to drugs

*History of drug induced agranulocytosis*Alcoholic patient

*Severe cardiac disease

*Impaired bone marrow function

Side effect of Risperidone:

Common: insomnia anxiety and headache

Less: fatigue, dizziness, constipation, abdominal pain, weight gain.

Contraindication:Patient with known hypersensitivity to the product.

Role of nurse:

general rules r\t psychotropic medication:

ensure the patient receives his medication, instruct the patient to continue to take medication, reassure the patient that side effects will be temporary and subside.

nurses' role toward compliance to medication:

assist client in acquiring knowledge about medications, explain natures of and time span for onset of therapeutic results, provid written and verbal instructions to reinforce compliance, including family members in education process

nurses' role toward side effect:important part of psychiatric nurse's role is to minimize, identify and intervene in side effect experienced by patient as a result of their medication.

nurses' role toward complications:report occurrence of any of the side effect & complications to physician immediately.

THANK YOUREFERNCE:• www.WHO.org• www.mentalhealthdrugs.com• http://www.pharmacology2000.com/

Central/psychotics/Antipsy_obj1.htm