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ANTIPSYCHOTIC DRUGS DRUGS

CONVENTIONAL ANTIPSYCHOTICS

ROUTE AND DOSAGE

PHENOTHIAZINES Chlorpromazine ( Thorazine ) Adult: PO, 10-25 mg, bid, tid, or qid to maximum of 2,000 mg/d; IM Child: 5-12 y/o, 23-46 kg, 75 mg/d; 6 mo-5 y/o, 40mg/d; IM,0.55 mg/kg q6-q8h Adult: PO, 4-8 mg tid to qid; IM 5-15 mg//d Adult: IM/SC, 12.5-25mg Child: not recommended Adult: PO, 50-800 mg/d Child: 2-12 y/o, PO, 0.5-3.0 mg/kg/d Adult: PO, 50-400 mg/d (lower dosage for alcohol withdrawal) Adult: 6-50 mg Adult: PO, 2-30 mg/d; IM, 4-30 mg/d Thiothixene ( Navane ) Adult: PO, 0.5-2 mg bid tit id; IM, 5-30 mg/d Child: PO, 0.5-0.15 mg/d 2-80 mg extreme dosage ranges 2.5 mg daily dosage Adult: PO, 10-100 mg/d; IM, 12.5-50 mg/d BUTYROPHENONES Haloperidol ( Haldol ) Droperidol ( Inapsine )

Perphenazine ( Trilafon ) Fluphenazine ( Prolixin ) Thioridazine ( Mellaril ) Mesoridazine (Serentil ) Trifluoperazine ( Stelazine )

THIOXANTHENE

DIBENZAZEPINE Loxapine ( Loxitane )

DIHYDROINDOLONE Molindone ( Moban )

Adult: PO, 50-225 mg/d in divided doses

ATYPICAL ANTIPSYCHOTICS

Adult: PO, 25-450 mg/d Adult: PO, 1 mg bid to 16 mg/d Adult: PO, 5-15 mg/d

Clozapine ( Clozaril) Risperidone ( Risperdal ) Olanzapine ( Zyprexa ) Quetiapine ( Seroquel ) Ziprasidone (Geodon )

Daily dosage 300-600mg Extreme dosage ranges 200-750 Daily dosage 40-160 Extreme dosage ranges 20-200

ANTIPSYCHOTIC DRUGS o Also known as neuroleptics are used to treat the symptoms of psychosis, such as the delusions and hallucinations seen in schizophrenia, schizoaffective disorder , and the manic phase of bipolar disorder. o Off label uses of antipsychotics include treatment of anxiety and insomnia; aggressive behavior and delusions, hallucinations and other disruptive behaviours that sometimes accompany alzheimers disease.

Antipsychotic drugs work on by blocking receptors of the neurotransmitter dopamine. They are the primary medical treatment for schizophrenia and also are used in psychotic episodes of acute mania, psychotic depression and drug-induced psychosis. Mechanism of action The major action of all antipsychotics in the nervous system is to block receptors for the neurotransmitter dopamine.

Side effects o Extrapyramidal side effects: serious neurologic symptoms, are the major side effects of antipsychotic drugs. They include acute dystonia, pseudoparkinsonism and akathisia. o Neuroleptic malignant syndrome is a potentially fatal idiosyncratic reaction to an antipsychotic drug. o Tardive dyskinesia a syndrome of permanent involuntary movements, is most commonly caused by the long term use of conventional antipsychotic drugs. o Anticholinergic side effects often occur with the use of antipsychotics and include orthostatic hypotension, dry mouth, constipation, urinary hesitance or retention, blurred near vision, dry eyes photophobia, nasal congetion, and decreased memory. o Other side effects, antipsychotic drugs increase blood prolactin levels.elevated prolactin may cause breast enlargement and tenderness in men and women,diminished libido, erectile and orgasmic dysfunction and menstrual irregularities and increased risk for breast cancer and may contribute to weight gain. Weight gain accompany most psychotic medications. CLIENT TEACHING o The nurse informs clients taking antipsychotic medication about the types of side effects that may occur and encourages clients to report such problems to the physician instead of discontinuing the medication. o The nurse teaches the client methods of managing or avoiding unpleasant side effects and maintaining the medication regimen. Drinking sugar-free fluids and eating sugar-free hard candy ease dry mouth. o The client should avoid calorie-laden beverages and candy because they promote dental caries, contribute to weight gain, and do little to relieve dry mouth. o Instruct the client methods to prevent or relieve constipation include exercising and increasing water and bulk forming foods in