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AL-Zaytoonah University of Jordan Faculty of Nursing Antipsychotic Drug Prepared by: alaa ali alabbade. Alosh al hmrany.

Ms:-Doaa MS :-Hamza

ANTIPSYCHOTIC DRUG

Outlines
Definition of antipsychotic drugs. the meaning of psychosis and nurosis. Negative and positive symptoms. Classification of antipsychotic comparasion between typical and atypical antipsychotic drug. Typical antipsychotic drug ( the drugs, indication , mechanism of action , side effect ). Atypical antipsychotic drug ( the drugs, indication , mechanism of action , side effect ). Nursing intervention of side effect. Nursing roles. Summary. References .

Definition of Antipsychotic Drug:


Antipsychotic term refers to neouroliptic drugs & tranquilizers , The term antipsychotic is drug used to treat psychosis .

psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality".

Psychotic illness characterized by:


Positive symptoms
Delusions. Hallucination. Disorganized thinking. Agitation. Bizarre behaviors.

Negative symptoms: Social withdrawal Apathy emotional Unresponsiveness' Anhedonia Poverty of speech Lack of drive or initiative

Indication: Schizophrenia. bipolar disease. Organic psychoses (mental disturbances caused by head injury, alcoholism, or other kinds of organic disease). Affective disorders (e.g. depression, mania). agitation associated with Alzheimer's disease.

Definition of schizophrenia: Severe mental disorder that affects about 1% of the population, Schizophrenic patients are typically unable to filter sensory stimuli and may have enhanced perceptions of sounds, colors, and other features of their environment

there is no single cause for this illness. Rather, it is the result of a complex group of genetic, psychological, and environmental factors

Classification of antipsychotic:

Typical antipsychotics

Atypical antipsychotics

Typical Antipsychotic

1- Typical antipsychotics: The older, typical neuroleptics are effective antipsychotic agents with neurologic side effects involving the extrapyramidal motor system such as:(rigidity, unusual body movement, muscle spasm, restlessness) .

They target predominantly the positive symptoms of schizophrenia Typical neuroleptics block the dopamine-2 receptor.

Mechanism of Action of Typical antipsychotic


The typical antipsychotic drug blocked the D2 receptor in normal individuals, acetylcholine and dopamine systems work in opposition in the basal ganglia (a brain area that is very involved in motor control). This permit much of the fine motor control humans can do. Typical antipsychotics block D2 receptors and even though they block ACh receptors to some extent, this causes the balance of DA/ACh to change so that ACh is less opposed. therefor the side effect appear (specially EPS)

The Typical antipsychotic block the D2 receptor

Typical antipsychotics: Generic name trifluoperazine Chlorpromazine fluphenazine mesoridazine perphenazine prochlorperazin
thioridazine

Trade name stelazine Thorazin prolixin serentil trilafon compazin


mellaril

Daily dosage 4-40/mg 40-400/mg 2.5-10/mg 30-400/mg 12-64/mg 15-150/mg


150-800/mg

loxapine

loxitane

20-250/mg

haloperidol
molindone

haldol
moban

1-100/mg
15-225/mg

pimozide
thiothixene

orap
navane

1-10/mg
6-30/mg

1- Extrapyramidal Side Effects (EPS):

Side Effect Of Typical Antipsychotic drug

pseudoParkinson: Resting tremor, muscular rigidity, shuffling gait , bradykinesia (loss and slowing of voluntary motor activity) Akathisia: Person experiences inner restlessness, and an irresistible impulse to move: paces, rocks and moves in a repetitive Manner Acute Dystonias: Involuntary and uncontrolled muscle spasms and body postures, prolonged muscle contractions of head and neck Tardive Dyskinesia (TD): Involuntary movements of tongue and face (e.g., sucking or smacking), and in more severe cases, trunk or limb

2- Anticholinergic effect ( dry mouth, blurred vision , constipation , urinary retention,photosensitivity ) 3- hypersalivation 4- Sedation - initially considerable; tolerance usually develops after a few weeks of therapy; dysphoria 5- Postural hypotension - results primarily from adrenergic blockade; tolerance can develop 6- Neuroleptic malignant syndrome: Catatonia, stupor, fever, unstable blood pressure, muscle rigidity; hyperkalemia , renal failure.

Contraindication: pregnancy. The weeks 4 to 10 are particularly dangerous. poorly controlled seziure. Sever CNS depression. sever cardio vascular disease. bone marrow depression.

Atypical Antipsychotic

Definition: It is a novel antipsychotics that have lesser extra pyramidal side effects and greater efficacy in the treatment of negative symptoms of schizophrenia compared with typical antipsychotics. Action: atypical Antipsychotics blocks both serotonin and dopamine receptors. Advantage: They cause little or no extra pyramidal side effect. Effective in short term. disadvantage: Expenssive

Atypical Antipsychotic:

Mechanism of action:
Newer medication may exert antipsychotric properties by blocking action on postsytsnaptic receptor specific to dopamine D2 , serotonin 5-HT2.

Generic name clozapine risperidone olanzapine quetiapine

Atypical antipsychotic
Trade name clozaril risperidal zyprexa seroquel

Daily dosage 300-900/mg 1-6/mg 5-20/mg 150-750/mg

ziprasidone
aripiprazole

geodon
abilify

40-160/mg
10-30/mg

Side effect for atypical antipsychotic:


1- Weight gain weight gain now attributed to ratio of binding to D2 and 5-HT2 receptors; possibly also histamine (for newer antipsychotics anyway)

2- Sexual dysfunction result from NE blockade erectile dysfunction in 2354% of men retrograde ejaculation in loss of libido and anorgasmia in men and women

3- Neuroleptic malignant syndrome combination of motor rigidity, hyperthermia, and autonomic dysregulation of blood pressure and heart rate (both go up) 4- Risk for developing DM type 2 5- Risk for hyperlipidemia

6- Increase the risk of cardic death

Comparison between Typical and Atypical Antipsychotic Drugs Typical antipsychotics Mechanism of action Generally block D2 Receptors Side Effect -Extrapyramidal Side Effects (EPS)( pseudoparkinsonism , akathisia , dystonia, tardive dyskinesia) Atypical antipsychotics Generally block 5-HT2 Receptors more the D2 receptors blocked Weight gain sexual dysfunction -

Neuroleptic malignant syndrom -Anticholinergic effect ( dry (NMS) mouth, blurred vision , constipation , urinary retention) Risk for developing DM type 2 Risk for hyperlipidemiaNeuroleptic malignant Increase the risk of cardic death syndrom ( NMS) hypersalivation ( atypical were less likely than Sedationtypical antipsychotic to cuse EPS - Postural hypotension effect) ant treat negative symptom more than typical antipsychotic drug .

Nursing intervention for side effect of antipsychotic drug Anticholinergic effect: - Dry mouth

Side effect

- Urinary retention

Frequent sips of water and sugarless candy or gum

Nursing intervention

- constipation
- photo sensitivity: Sever sunburn

Check voiding, try to warm towel on abdomen. Consider catheterization if this does not work. Use stool softener, assess for adequate water intake. Lower dose , use sunscreen and wear clothing on exposed area, use topical to relief sunburn.

Extrapyramidal Side Effects (EPS): - pseudoparkinsonism

Side effect

Nursing intervention Decrease antipsychotic drug doses if possible, and add an anticholinergic drug(dopamine agonist) (Patient must have good renal function to avoid amantadine (dopamine agonist) toxicity). Administer antipsychotic drugs parentally rout work more rapidly than orally, have respiratory support equipment available.

- Acute dystonic reaction

- Akathisia

Side effect

- Tardive dyskinesia (TD)

Health care provider may change antipsychotic agent or give antiparkinsonian agent. Tolerance does not develop to akathesia. Providing soft food, soft shoes for feet movement. There is no treatment for TD (irreversible) especially if not discover early or cannot stop antipsychotic drugs.

Nursing intervention

Cardiovascular side effect: - Hypotension


Behavioral: - Sedation, fatigue:

Side effect

Check blood pressure before giving , advise client to dangle feet before getting out of bed to prevent dizziness and falls.
Change to an antipsychotic drug with a lower sedation profile.

Nursing intervention

Neuroleptic malignant syndrome:

Side effect

- Discontinue all drugs immediately. -Maintain hydration with oral and IV fluid. - Cool body to reduce fever. - Correct electrolyte imbalance. - Renal dialysis for renal failure.

Nursing intervention

Ensure the patient receives his medication. instruct the patient to continue to take medication. Reassure the patient that side effects will be temporary and subside. Assist client in acquiring knowledge about medications. Explain natures of and time span for onset of therapeutic results. Provide written and verbal instructions to reinforce compliance. -Including family members in education process

Nursing Roles

minimize, identify and intervene in side effect experienced by patient as a result of their medication. report occurrence of any of the side effect & complications to physician immediately. Note :- the nurse should tell the pt and family about the medication side effect and complication and to know that the medication will take about month to take a therapeutic effect therefor its important to observe the pt from souside behavior

The antipsychotics drug are a group of medication that use to treat psychosis ( that include schizophrenia , mania .. And reduce the negative and positive symptom It is classifcate to typical antipsychotic drug (that block D2 receptor )and atypical antipsychotic drug( that block 5-HT2 receptor more than D2 receptor) However each medication has many side effect when taken for a lengthy period this effect may produce physical illness like EPS wt gain Nursing intervention may include care for clints treat with antipsychotics .

Summary

References
Psychatric Mental Health Nursing , Mohar , sixth edition Pharmacology For Nursing Care . Fifth edition Clinical Pharmacology For Nurses , John Trounce, 17 edition