SOUMYA MARY

1ST YEAR MSc (N)

 DEFINITION

Antipsychotics are defined as drugs used for the
treatment of psychotic symptoms.

These are also known as neuroleptics, major

tranquilizers, D2 receptor blockers and anti-
schizophrenic drugs.
 INDICATIONS

Organic Psychiatric Disorders
Delirium
Dementia
Drug-induced psychosis and other organic mental
disorders
Functional Disorders
Schizophrenia
Schizoaffective disorders
Paranoid disorders
Mood Disorders

Mania
Major depression with psychotic symptoms
Childhood disorders
Attention-deficit hyperactivity disorder
Autism
Enuresis
Conduct disorder

Neurotic and other Psychiatric disorders
Anorexia nervosa
Intractable obsessive compulsive disorder
Medical disorders
Huntingtons chorea
Intractable hiccough
Nausea and vomiting
Tic disorder
Tetanus
 CLASSIFICATION

Typical /Classical antipsychotics

Phenothiazines
Chlorpromazine, triflupromazine, thioridazine,
mesoridazine, triofluoperazine, fluphenazine.

Butyrophenones
Haloperidol, droperidol, trifluperidol, penfluridol.

Thioxanthenes
Thiothixene, chloroprothixene, flupenthixol

Atypical neuroleptics
Clozapine, olanzapine, risperidone, quetiapine,
ziprasidone,amisulpride, remoxipride.

Miscellaneous
Reserpine, loxapine, pimozide
MECHANISM OF ACTION

PHARMACOLOGICAL ACTIONS

CNS
Behavioural effect
Reduces aggression and motor activity, relieves
anxiety, emotional quietening and drowsiness. It
normalises the sleep disturbances seen in psychoses

Other CNS Actions
Lowers seizure threshold and can precipitate
convulsions in untreated epileptics.
Decreases gonadotrophin secretion and may result in
amenorrhea in women. It increases the secretion of
prolactin resulting in galactorrhea and
gynecomastia.
Because CPZ is dopamine antagonist, it can cause
extrapyramidal motor symptoms
Antiemetic action

Autonomic nervous system

CPZ blocks the adrenergic receptors. CPZ also has

anticholinergic properties which leads to side effects
like dryness of mouth, blurred vision, reduced
sweating, decreased gastric motility, constipation and
urinary retention

CVS
orthostatic hypotension and reflex tachycardia due to
blockade of alpha adrenergic receptors.

Kidney
CPZ depresses ADH secretion and has weak diuretic
effects.
 PHARMACOKINETICS

CPZ is incompletely absorbed following oral
administration and also undergoes significant first
pass metabolism. It is highly protein bound; has a
t1/2of 20 to 24hr and is therefore given once a day.
 ADVERSE REACTIONS

Cardiovascular and autonomic effects
Postural hypotension
palpitation
blurred vision
dry mouth
constipation
nasal stuffiness
urinary retention.
CNS effects

They are extrapyramidal symptoms like
Acute distonias : Facial grimacing, tics, muscle
spasms, protruding tongue
Parkinsonism Bradykinesia, tremors and rigidity
Perioral tremors rabbit syndrome
Akathesia
Tardive dyskinesia : involuntary movements of face,
tongue,eyelids, trunk and limbs
Malignant neuroleptic syndrome

Endocrine disturbances
Gynecosmatia, amenorrhea, and galactorrhea due to
dopamine receptor blockade

Hypersensitivity reactions
Jaundice, agranulocytosis, and skin rashes
 HALOPERIDOL

Potent antipsychotic with actions similar to
chlorpromazine
Lesser incidence of autonomic side effects and is
therefore preferred in older patients
Useful in acute schizophrenia, and is the drug of
choice in Gilles de la Tourettes syndrome and
Huntingtons disease
ATYPICAL ANTIPSYCHOTICS

Causing fewer side effects Like less sedation and
less anticholinergic side effects.
Being effective in suppressing both positive and
negative symptoms of schizophrenia.
Being effective in resistant cases of psychoses
No endocrine side effects, no galactorrhea and
gynecomastia.
It is effective in patients not responding to
conventional antipsychotics
 ADVERSE EFFECTS

Important disadvantage with clozapine is that it may
cause Agranulocytosis
Clozapine can also cause sedation, weight gain and
hypotension
Riserpine causes serious side effects including
depression because of which it is now not used as an
antipsychotic

Advantages of Risperidone
At low doses no involuntary movements.
Low sedation
Advantages of Olanzapine
Does not cause agranulocytosis
 NURSING IMPLICATIONS

Level of sedation should be watched
Patients and the attendants should be warned not to
abruptly discontinue the drug
Most antipsychotics cause anticholinergic side effects
like dryness of mouth and constipation
Patient should be reassured particularly if there are
obsessions and anxiety.
Nurse should ensure that the patient
has actually taken the drug

Two nurses should always be concerned with drug
administration
Monitor laboratory values regularly
Prevent falls and other complications associated with
orthostatic hypotension
Teach the relatives about the importance of drug
compliance and side effects of the drug
All medications given must be charted on the
patients case record
 ASSIGNMENT

Write a brief note on the common antipsychotic drugs
used in your clinical setting and specify the nursing
interventions followed during drug administration.

Submit the assignment on 1/05/2015 before 4 pm.