ANTIPSYCHOTIC DRUG:

second generation
ATYPICAL

Prepared by: Mary Grace V. Fuentes

 More efficacy

The Third Rule of Neurotransmission:

With great power comes great

responsibility
More Severe Side Effects
 ATYPICAL
• second-generation antipsychotics
• developed in the late '80s and the '90s
• Block both dopamine and serotonin receptors.
• This dual blocking action help relieve neurological adverse effects
associated to typical antipsychotics.
• These drugs had been proven to be much more effective at controlling the
signs and symptoms of these serious psychiatric illnesses than the
medications that were commonly used at the time, e.g., barbiturates (Briles,
Rosenberg, Brooks, et al, 2012).
 MODE OF ACTION
• Antagonists
• Atypical antipsychotic drugs have a similar blocking effect on D2 receptors
but appear to be more selective in targeting the intended pathway to a
larger degree than typical antipsychotics.
• They also interact with other neurotransmission systems, particularly with the
serotonergic and noradrenergic pathways.
WHAT ARE ATYPICAL ANTIPSYCHOTICS USED FOR?

Atypical antipsychotics are used for:

• Treatment of acute and chronic psychoses (e.g. schizophrenia)
• Acute mania (olanzapine, quetiapine, risperidone)
• Organic psychoses (e.g. dementia-associated agitation)
• Severe behavioural disorders in children (risperidone)
 ATYPICAL DRUGS
• Asenapine (Abilify)
• Clozapine (Clozaril)
• Olanzapine (Zyprexa)
• Quatiapine (Seroquel)
• Respiridone (Risperdal)
 ASENAPINE (ABILIFY)
• Used to treat the
symptoms of psychotic
condition such as
schizophrenia and Bipolar
disorder

• Newest antipsychotic
drug
 PATIENT TEACHING
• Tell patient to remove tablet from package only when ready to take it and to use
dry hands. Tell him to firmly press and hold thumb button, and then pull out tablet
pack from case. Then, he should peel back the colored tab, being careful not to
push tablet through the tab because doing so could damage tablet. Instruct
patient to place tablet under his tongue and let it dissolve completely. Tell him to
then slide tablet pack back into case until it clicks.
• Caution patient not to crush, chew or swallow tablets.
• Advise him not to eat or drink for at least 10 minutes after taking asenapine.
• Urge patient to avoid alcohol while taking asenapine.
• Caution patient to avoid hazardous activi ties until drug’s effects are known.
• Urge patient to avoid activities that raise body temperature suddenly, such as stren-
uous exercise and exposure to extreme heat, and to compensate for situations that
cause dehydration, such as vomiting or diarrhea.
 CLOZAPINE (CLOZARIL)
• Watch CLOZely for
agranulocytosis
 PATIENT TEACHING
• Tell patient that he’ll receive only a 1-week supply at a time. �* Instruct
patient taking orally disintegrat- ing tablets (Fazaclo) to leave tablet in blis-
ter pack until ready to take it. Tell him to peel foil back to remove tablet
(rather than pushing tablet through foil) and then to immediately place
tablet in mouth and let it dissolve before swallowing. Explain that no water is
needed.
• Inform patient that he’ll need weekly blood tests.
• Instruct patient to avoid hazardous activi- ties until drug’s CNS effects are
known.
• If patient stops drug for more than 2 days, stress need to contact prescriber
for instructions; dosage will need to be changed.
• Tell patient to consult prescriber before using alcohol or taking OTC drugs.
• Advise female patients to notify prescriber if pregnancy occurs or is
suspected.
 OLANZAPINE (ZYPREXA)
• used to treat certain
mental/mood conditions
(such as schizophrenia, First line of
bipolar disorder). It may
also be used in treatment of
combination with other schizophrenia
medication to treat
depression. This
medication can help to
decrease hallucinations
and help you to think
more clearly and
positively about yourself,
feel less agitated, and
take a more active part
in everyday life.
 PATIENT TEACHING
• Advise patient to avoid alcohol and smoking
• Teach patient to open orally disintegrating tablet sachet by peeling back
foil on the blister and not by pushing tablet through the foil. Immediately
after opening blister, tell him to use dry hands to remove tablet and place it
in his mouth. Explain that tablet will disintegrate rapidly in saliva so he can
easily swallow it without liquid.
• Urge patient to avoid hazardous activities until drug’s CNS effects are
known.
• Instruct patient to change position slowly to minimize effects of orthostatic
hypotension.
• Urge family or caregiver to watch patient closely for suicidal tendencies,
especially when therapy starts or dosage changes and particularly if patient
is a child, teenager, or young adult.
 QUETIAPINE (SEROQUEL)
used to treat certain mental/mood
conditions (such as schizophrenia, bipolar
disorder, sudden episodes
of mania or depression associated
with bipolar disorder).

QUETIapine = Quiet time

( Sedation)
 PATIENT TEACHING
• Instruct patient to take quetiapine with food to reduce stomach upset.
• Advise patient not to stop taking quetia- pine suddenly because doing so
may exac- erbate his symptoms.
• Inform patient that quetiapine therapy may cause dizziness or drowsiness.
Advise him not to drive or perform other activities that require alertness until
drug’s full CNS effects are known.
• Instruct patient to rise slowly from a seated or lying position to reduce the risk
of dizziness or fainting.
• Caution patient to avoid consuming alco- holic beverages because they
can increase dizziness and drowsiness.
• Urge family or caregiver to watch patient closely for suicidal tendencies,
especially when therapy starts or dosage changes and particularly if patient
is a young adult.
• Encourage patient on long-term therapy to have regular eye examinations
so that cataracts can be detected.
RESPIRIDONE (RISPERDAL)
Low risk of EPS with a high
risk of metabolic side
effects
Less sedating side great
for elderly patients

RISE-PAIR-idone
gives RISE to a
PAIR

HYPERPROLACTINEMIA
PATIENT TEACHING
• Instruct patient to dilute risperidone oral solution with water, coffee, orange
juice, or low-fat milk but not with cola or tea.
• Tell patient prescribed orally disintegrat- ing tablets to break open the blister
unit with dry hands by peeling the foil back to expose the tablet. Stress the
importance of not pushing tablet through the foil because this could
damage the tablet. Once patient has removed tablet, she should place
immediately on her tongue, where it will dissolve within seconds. Tell patient
not to chew orally disintegrating tablet or attempt to spit it out of her mouth.
• Urge patient to avoid alcohol because of its additive CNS effects.
• Caution diabetic patient to monitor blood glucose level closely because
risperidone may increase it.
 NURSING
SIDE EFFECTS RESPONSIBILITY
• Drowsiness and orthostic • Patient Safety(routine
hypotension assessment of ambulatory
status/ability, neurological
status, and orthostatic vital
signs.)
• Advise patient to rise slowly
from lying or sitting position
to minimize orthostatic
hypotension.
 NURSING
SIDE EFFECTS RESPONSIBILITY
• Weight, serum glucose,
• Metabolic Disorders serum cholesterol, and
serum lipids should be
periodically checked.
 NURSING
SIDE EFFECTS RESPONSIBILITY
• should be monitored for other risk
• QTc prolongation factors for torsades de pointes, like
congenital prolonged QT syndrome,
bradycardia, hypokalemia,
hypomagnesemia, heart failure,
and medical conditions or drug
interactions which may increase the
serum level of the QTc prolonging
medication
 NURSING
SIDE EFFECTS RESPONSIBILITY
• DIABETES MELLITUS • random glucose, glycated
haemoglobin (HbA1C), fasting
plasma glucose, homeostasis model
assessment insulin resistance
(HOMA-IR), post-prandial glucose,
the oral glucose tolerance test
(OGTT) and the intravenous glucose
tolerance test (IVGTT), and the
hyperinsulinaemic-euglycaemic
clamp.
 NURSING
SIDE EFFECTS RESPONSIBILITY
• Myocarditis Monitor present with unexplained
fatigue, dyspnea, tachypnea,
fever, chest pain, palpitations,
other signs or symptoms of heart
failure
 NURSING
SIDE EFFECTS RESPONSIBILITY
• CATARACT • clinicians should inquire about visual
changes and ensure that guidelines
for visual monitoring are followed
 NURSING
SIDE EFFECTS RESPONSIBILITY
• Confusion
• Agitation • Treatment includes discontinuing
• Hypethermia the antipsychotic, supportive
• Muscular rigidity treatment to maintain hydration,
and management of fever and
• seizures other renal or cardiovascular signs
and symptoms

Recent antipsychotic use

Neuroleptic Malignant Syndrome

 NURSING
SIDE EFFECTS RESPONSIBILITY
Anticholinergic and • Lowering or dividing the dose of
anticholinergics may help alleviate
Antiadrenergic Effects some of the adverse events as they
• dry mouth, constipation, are often dose related
urinary retention, and
blurred vision
 NURSING
SIDE EFFECTS RESPONSIBILITY
• Tardive Dyskinesia
• vitamin E supplementation
• A late appearing side effect of
antipsychotic medications, is with either vitamin E-rich
characterized by abnormal,
involuntary movements such as foods or the use of a daily
lip smacking, tongue
protrusion, chewing, blinking, multivitamin up to the daily
grimacing and choreiform
movements of the limbs and requirement
feet. These movements are
embarrassing for the clients
and may cause them to
become more socially isolated,
decreasing or discontinuing the
medication can arrest the
progression.
 NURSING
SIDE EFFECTS RESPONSIBILITY
• AKATHASIA Charac • Treatment: Betablockers
terized by restless such as propanolol have
movement,
pacing, inability to been the most effective in
remain still, and the treating akathisia, whereas
client’s report of Benzodiazepines have
inner restlessness.
Clients are very provided some success as
uncomfortable with well.
these sensations
and may stop • Reduce dose, change drug,
taking the propranolol,
antipsychotic
medication to
avoid these side
effects.
 NURSING
SIDE EFFECTS RESPONSIBILITY
• SEIZURES • Patients with clozapine-induced
seizures may be managed by dose
reduction or addition of an
antiepileptic, usually allowing
continuation of therapy
THANK YOU!!!
• https://www.scribd.com/document/350250118/Review-of-Antipsychotic-
Drugs
• http://primarypsychiatry.com/management-of-antipsychotic-side-effects/
• Videbeck S. (2011) Psychiatric Mental health Nursing 5th Ed.,Wolter Kluwer
Health, Lippinctt Williams & Wilkins