Trade Name Thorazine

Generic Name Chlorpromazine

Frequency / Route

Classification Antiemetic, Antipsychotic, Tranquilizer

Action Depresses brain areas that control activity and aggression, including the cerebral cortex, Hypothalamus, and limbic system, by an unknown mechanism.

Indication - To manage symptoms of psychotic disorders or control manic manifestations of manic-depression in outpatients - To control acutely disturbed or manic hospitalized patients - To treat nausea and vomiting

Contraindication Comatose states; hypersensitivity to chlorpromazine, phenothiazines, or their components; use of large amounts of CNS depressants

Nursing Responsibility Dont open or crush E.R. capsules. Chlorpromazine shouldnt be used to treat dementia-related psychosis in the elderly because of an increased risk of death. Protect concentrate from light. Use cautiously in patients with cardiovascular, hepatic, or renal disease because of increased risk of developing hypotension, heart failure, and arrhythmias.

Trilafon

Perphenazine

Antiemetic, Antipyschotic

Depresses areas of the brain that control activity and aggression, including cerebral cortex, hypothalamus, and limbic system, by an unknown mechanism. Also prevents nausea and vomiting by inhibiting or blocking dopamine receptors in medullary chemoreceptor trigger zone and peripherally by blocking vagus nerve in the GI tract.

- To treat psychotic disorders - To treat severe nausea and vomiting

Blood dyscrasias; bone marrow depression; cerebral arteriosclerosis; coma; concurrent use of CNS depressants (large doses); coronary artery disease; hepatic impairment; hypersensitivity to perphenazine, other phenothiazines, or their components; myeloproliferative disorders; severe CNS depression; severe hypertension or hypotension; subcortical brain damage

Shouldnt be used to treat

dementia-related psychosis in the elderly. Use cautiously in patients with depression or hepatic, pulmonary, or renal dysfunction and in elderly patients Monitor temperature frequently, and notify prescriber if it rises Monitor blood pressure of patient who takes large doses especially if surgery is indicated, because of the increased risk of hypotension.

Prolixin

Fluphenazine

Antipsychotic

May block postsynaptic dopamine receptor sites in the CNS. This action may depress areas of the brain that control activity and aggression, including the cerebral cortex, hypothalamus, and limbic system.

To control psychotic disorders

Blood dyscrasias, bone marrow depression, cerebral arteriosclerosis, coma, concomitant use of large amounts of another CNS depressant, coronary artery disease, hepatic dysfunction, hypersensitivity to phenothiazines, myeloproliferative disorders, severe CNS depression, severe hypertension or hypotension, subcortical brain damage

Use cautiously in patients with a history of glaucoma or renal impairment. Monitor temperature; a significant, unexplained rise can indicate intolerance and a need to discontinue drug. Notify prescriber immediately if this occurs. Watch for signs of hepatic failure, such as jaundice. Notify prescriber about worsening psychotic Symptoms Advise patient not to mix oral solution with beverages that contain caffeine (coffee, cola), tannins (tea), or pectins (apple juice). Caution patient about possible dizziness or lightheadedness. Be aware that high doses and large dosage changes in patient with a seizure disorder may lower seizure threshold. Frequently monitor blood pressure and assess for chest pain in patients with heart disease. Administer drug with food, milk, or a full glass of water to minimize GI distress. Instruct patient to notify prescriber immediately if she develops unusual symptoms.

Mellaril

Thioridazine

Antipsychotic

Depresses areas of the brain that control activity and aggression, including the cerebral cortex, hypothalamus, and limbic system by blocking postsynaptic dopamine2 (D2) receptors. Drug may relieve anxiety by indirectly reducing arousal and increasing filtration of internal stimuli to the brain stem reticular activating system.

To treat schizophrenia in patients unresponsive to other antipsychotic drugs

Coma; concurrent use of drugs that inhibit the metabolism of thioridazine ,concurrent use of drugs that prolong the QT interval; concurrent use of high doses of a CNS depressant; history of arrhythmias; hypersensitivity to the drug. Severe CNS depression; severe hypertensive.

Serentil

Mesoridazine

Antipsychotic

It has a piperidine side-chain and is a metabolite of thioridazine. It acts by blocking postsynaptic CNS dopamine receptors.

To treat schizophrenia in patients who failed to respond to other antipsychotic drugs, either because they were ineffective or because intolerable adverse effects prevented attainment of effective dose

Severe CNS depression and coma; prolonged QT interval (>450 msec), including congenital prolongation; history of arrhythmias. Lactation.

Monitor serum potassium level before and during therapy, and administer potassium supplements as prescribed. Monitor patient for neuroleptic malignant syndrome Assess patient for signs of blood dyscrasias, including cellulitis, fever, and pharyngitis. Advise patient to change position slowly to minimize orthostatic hypotension.

Navane

Thiothixene

Antipsychotic

Increases dopamine turnover by blocking postsynaptic dopamine receptors in the mesolimbic system. Eventually, dopamine neurotransmission decreases, resulting in antipsychotic effects.

To treat psychotic disorders, such as acute psychosis, psychotic depression, and schizophrenia

Blood dyscrasias, coma, hypersensitivity to thiothixene or its components, Parkinsons disease, severe CNS depression, shock, use of quinidine

Administer thiothixene capsules with food or milk if needed to minimize GI distress. Dont give drug within 1 hr of an antacid. Urge patient to avoid smoking or to begin a smoking cessation program while taking thiothixene. Encourage patient to avoid extreme temperature changes during drug therapy Use haloperidol cautiously in patients with a history of prolonged QT interval, patients with uncorrected electrolyte disturbances, Avoid stopping haloperidol abruptly unless severe adverse reactions occur. Monitor for signs of

Haldol

Haloperidol

Antidyskinetic , Antipsychotic

May block postsynaptic dopamine receptors in the limbic system and increase brain turnover of dopamine, producing an antipsychotic effect.

- To treat psychotic disorders - To treat nonpsychotic behavior disorders and Tourettes syndrome - To treat acute psychotic episodes

Comatose conditions, severe CNS depression, Parkinson's disease, lesion of the basal ganglia.

- To provide longterm antipsychotic therapy for patients who require parenteral therapy Loxitane Loxapine Antipsychotic May treat psychotic disorders - To treat psychotic by blocking dopamine at disorders and postsynaptic receptors in the schizophrenia brain.With prolonged use, - To treat acute loxapine enhances exacerbations of antipsychotic effects by causing psychotic depolarization blockade of disorders dopamine tracts, resulting in decreased dopamine neurotransmission. Blood dyscrasias, bone marrow depression, cerebrovascular disease, coma, coronary artery disease, hypersensitivity to loxapine or its components, impaired hepatic function, myeloproliferative disorders, severe druginduced CNS depression, severe hypertension or hypotension. Hypersensitivity to molindone, its components, or other antipsychotic drugs, including haloperidol, loxapine, phenothiazines, and thioxanthenes

neuroleptic malignant syndrome. Advise patient to take tablets with food or a full glass of milk or water to reduce GI distress.

Tell patient not to take antacids and antidiarrheals within 2 hours of loxapine. Caution patient to avoid alcohol while taking loxapine. Assess for signs of tardive dyskinesia, including involuntary protrusion of tongue and chewing movements.

Moban

Molindone

Antipsychotic

Stelazine

Trifluoperazine

Antianxiety, Antipsychotic

Occupies dopamine receptor sites in the reticular activating and limbic systems in the CNS. By blocking dopamine activity in these areas, molindone reduces the symptoms of psychosis, helping the patient to think and behave more coherently. Inhibits dopamine D2 receptors in the brain. It has weak anticholinergic and sedative effects but strong extrapyramidal and antiemetic effects. It controls severely disturbed, agitated or violent behaviour but may also be used for nonpsychotic anxiety.

To manage symptoms of psychotic disorders

-To treat psychotic disorders -To relieve anxiety

Preexisting CNS depression and coma; bone marrow depression, blood dyscrasias, liver disease, hypersensitivity to phenothiazines, prolactin dependent tumours. Pregnancy (1st trimester), lactation.

Assess patient for signs and symptoms of neuroleptic malignant syndrome Instruct patient to follow treatment regimen and to notify prescriber before discontinuing drug because gradual dosage reduction may be needed. Use trifluoperazine cautiously in patients with glaucoma because of drugs anticholinergic effect. Advise patient to take drug with food Instruct patient to notify prescriber immediately if she experiences difficulty swallowing or speaking

Clozaril

Clozapine

Antipsychotic

May produce antipsychotic effects by interfering with dopamine binding to dopamineespecially D4 receptors in the limbic region of the brain and by antagonizing adrenergic, cholinergic, histaminic, and serotoninergic receptors.

To treat severe schizophrenia unresponsive to standard drugs; to reduce risk of recurrent suicidal behavior in schizophrenia or schizoaffective disorders

Angle-closure glaucoma, coma, history of clozapineinduced agranulocytosis or severe granulocytopenia, hypersensitivity to clozapine or its components, myeloproliferative disorders, severe CNS depression, uncontrolled epilepsy, WBC count below 3,500/mm3

Use cautiously in patients with hepatic, renal, or cardiovascular disease and in elderly patients with dementia related psychosis Monitor temperature. Inform patient that hell need weekly blood tests. Instruct patient to avoid hazardous activitiesuntil drugs CNS effects are known. Monitor for orthostatic hypotension Monitor patients blood glucose and lipid levels as ordered Urge patient to avoid alcohol because of its additive CNS effects. Caution diabetic patient to monitor blood glucose level closely Monitor patients blood pressure routinely during therapy Notify prescriber if patient develops tardive dyskinesia or urinary incontinence. Advise patient to avoid alcohol and smoking during olanzapine therapy. Monitor patients blood glucose level routinely because olanzapine may increase risk of hyperglycemia.

Risperdal

Risperidone

Antipsychotic

Selectively blocks serotonin and dopamine receptors in the mesocortical tract of the CNS to suppress psychotic symptoms.

To manage psychotic disorders

Hypersensitivity to risperidone or its components

Zyprexa

Olanzapine

Antipsychotic

May achieve antipsychotic effects by antagonizing dopamine and serotonin receptors. Anticholinergic effects may result from competitive binding to and antago-nism of the muscarinic receptors M1 through M5.

-To treat psychosis -To treat manic phase of acute bipolar disorder -As adjunct to treat acute bipolar disorder -To treat agitation associated with schizophrenia and bipolar I mania

Angle-closure glaucoma; lactation. IM: History of CVS disease, heart surgery.

Seroquel

Quetiapine

Antipsychotic

May produce antipsychotic effects by interfering with dopamine binding to dopamine type 2 (D2)-receptor sites in the brain and by antagonizing serotonin 5-HT2, dopamine type 1 (D1), histamine H1, and adrenergic alpha1 and alpha2 receptors.

-To treat schizophrenia -To manage psychotic disorders other than schizophrenia -To treat depressive episodes in bipolar disorder -To treat acute manic episodes in bipolar I disorder

Hypersensitivity to quetiapine or its components

Geodon

Ziprasidone

Antipsychotic

Selectively blocks serotonin and dopamine receptors in the mesocortical tract of the CNS, thereby suppressing psychotic symptoms.

-To treat schizophrenia -To treat acute manic or mixed episodes of bipolar disorder -As adjunct to lithium or valproate for maintenance treatment of bipolar I disorder

Concurrent use of other drugs that prolong QT interval, history of arrhythmia, hypersensitivity to ziprasidone or its components, history of prolonged QT interval, recent acute MI, uncompensated heart failure AV block, cardiac arrhythmias, congenital heart disease, history of congenital long-QT syndrome; hypersensitivity to paliperidone, risperidone, or its components

Invega

Paliperidone

Antipsychotic (Atypical)

The main active metabolite of risperidone, paliperidone selectively blocks serotonin and dopamine receptors in mesocortical tract of CNS to suppress psychotic symptoms.

To treat schizophrenia

Monitor patients (particularly young adults) closely for suicidal tendencies Monitor patient for orthostatic hypotension Instruct patient to take quetiapine with food to reduce stomach upset. Instruct patient to rise slowly from a seated or lying position to reduce the risk of dizziness or fainting. Monitor patient, especially elderly woman, for involuntary movements Monitor patients blood glucose and lipid levels routinely, as ordered Instruct patient to take ziprasidone with food to increase absorption. Advise patient to avoid hazardous activities until CNS effects are known. Drug shouldnt be given if patient has a condition that severely narrows GI tract Instruct patient to take tablet whole with liquid. Urge patient to rise slowly from sitting or lying to minimize orthostatic hypotension.

Abilify

Aripiprazole

Atypical antipsychotic

May produce antipsychotic effects through partial agonist and antagonist actions. Aripiprazole acts as a partial agonist at dopamine (especially D2) receptors and serotonin (especially 5-HT1A) receptors.

-To treat acute schizophrenia; to maintain stability in patients with schizophrenia -To treat acute manic and mixed episodes in bipolar I disorder -To treat agitation in schizophrenia or bipolar mania - To treat irritability associated with autistic disorder

Breast-feeding, hypersensitivity to aripiprazole or its components

Use cautiously in patients with CV disease, cerebrovascular disease, or conditions that would predispose them to hypotension. Also use cautiously in elderly patients because of increased risk of serious adverse cerebrovascular effects, such as stroke and transient ischemic attack. Monitor patient for difficulty swallowing or excessive somnolence Advise patient to get up slowly from a lying or sitting position during aripiprazole therapy to minimize orthostatic hypotension. Urge patient to avoid alcohol during aripiprazole therapy.