Mental Health Nursing: Pharmacology: Antipsychotic

Medications

C. Calzolari2016

Antipsychotic MedicationsAntipsychotic medications treat the s/s of psychotic illnesses

such as schizophrenia, manic and delusional disorders.

These drugs do not cure psychotic illnesses: they are effective in managing symptoms as long as the patient takes them consistently.

There are many adverse side effects with this class of medication.

2 categories: Typical (First Generation) Antipsychotics (Neuroleptics) Atypical (Second Generation) Antipsychotics (Neuroleptics)

Typical Antipsychotic Medications

Phenothiazines

Phenothiazine –Type Drugs

Non phenothiazine Drugs

What is Phenothiazine?Phenothiazine is an organic compound.

Its derivatives are used as antipsychotics.

They also have antiemetic properties.

They control the symptoms by blocking the transmission of dopamine.

They have strong sedative properties.

Side Effects of Phenothiazine DerivativesAnticholinergic effects

Sedation

Hypotension

Sexual Dysfunction

Agranulocytosis

Neuroleptic Malignant Syndrome (rare)

Photosensitivity

Extrapyramidal symptoms (EPS)

EXTRA… WHAT?!?!

Extrapyramidal symptoms (EPS) include:

DystoniaAkathisiaParkinsonismTardive Dyskinesia

Anticholinergic Effects

Typical symptoms include dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate, and decreased sweating.

Other symptoms that affect the CNS are: impaired concentration, confusion, attention deficit, and memory impairment.

Neuroleptic Malignant Syndrome

FDA WARNING

In April 2005, FDA has alerted healthcare professionals that both typical and atypical antipsychotics are associated with an increased risk of mortality in elderly patients treated for dementia –related psychosis.

Antipsychotics are not indicated for the treatment of dementia-related psychosis.

Black Box Warnings

Patients with dementia-related psychosis who are treated with antipsychotic drugs are at increased risk for death, as shown in short-term controlled trials; deaths in these trials appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature

This drug is not approved for treatment of patients with dementia-related psychosis

PhenothiazinesPhenothiazine –Type Drugs

Thorazine (chlorpromazine)- introduced in 1954.

Permitil, Prolixin (fluphenazine)Serentil (mesoridazine besylate)Phenazine, Trilafon (perphenazine)Prozine, Sparine (promazine)Mellaril (thioridazine)Stelazine (triflouperazine)

PhenothiazinesPhenothiazine –Type Drugs

Thorazine is the oldest antipsychotic drug approved by the FDA in 1954.

Prolixin can cause photosensitivity.Mellaril is not to be taken if a person has irregular EKGs

and is on CVS drugs. This drug is not used as a first line medicine.

All drugs in the phenothiazine family should be used with caution for patients with cardiovascular, liver or renal disease.

These drugs are not to be used along with CNS depressants (this includes ETOH).

Non-phenothiazine Drugs

Taractan (chloroprothixene)Haldol (haloperidol)Loxitane (loxapine succinate)Moban (molindone HCL)Orap (pimozide)Navane (thiothixene)

Non-phenothiazine Drugs3rd category of TYPICAL antipsychotics

This class of drugs was introduced with the hope that there would be less side effects.

Unfortunately, the side effects of nonphenothiazines are identical to those of phenothiazines.

They may have less sedative effects and less anti-cholinergic effects, BUT there is a higher incidence of EPS symptoms.

Orap is used for Tourette’s disorder.

Atypical Antipsychotic Medications2nd generation of antipsychotics

Clozaril (clozapine) –1st introduced in 1990.Abilify (aripiprazole)Zyprexa (olanzapine)Seroquel (quetiapine fumarate)Risperdal (risperidone)Geodon (ziprasidone)

Atypical Antipsychotic Medications

Although the claims are that this class of antipsychotics cause less side effects, there are still significant ones to be aware of:Neuroleptic Malignant SyndromeTardive Dyskinesia – can be irreversibleSignificant weight gainAltered temperature regulationOrthostatic hypotension Increased glucose levelsCVA in the elderlyHigh cholesterol and triglyceride levelsMyocarditis and agranulocytosis with Clorazil Irregular heart rhythms with Geodon

Increased Prolactin Levels

Seen with Typical and some atypical (esp. Risperdal) antipsychotics.

Clinical manifestations of prolactin levels:Menstrual irregularitiesSexual dysfunctionTender breastsOPWeight Gain

Other Side Effects:

SedationOrthostatic HypotensionWeight Gain

Patient Education

These drugs have many interactions with other drugs.

Instruct the patient to keep a list of all prescription and non-prescription drugs, including herbs, supplements, teas, etc.

Many of these drugs require frequent blood tests and MD visits.

These drugs do not cure the disease. The patient must continue taking them even if they feel better.

Teach patient how to recognize symptoms of EPS and NMS.

Patient Education

The patient must inform the physician before undergoing any procedure or surgery that involves CNS depressants.

The patient should not consume ETOH or street drugs while taking these medications.

Monitor caffeine use.Teach patient to avoid extreme temperatures.Teach the patient how to avoid orthostatic

hypotension.