Antipsychotic drugs Kingdom of Saudi Arabia King Saud University Collage of Nursing Antipsychotic drugs Prepared by : Heba Makki AlNimer 425204634 Supervised by : Dr.Elham

Antipsychotic drugs

Outlines: *Definition *Clinical Indications *Classifications *Action *Side effect and complications *Contraindications *Nursing management of patient receiving *antipsychotic drugs

Definition: Antipsychotic drugs are drugs used to treat symptoms of psychotic disorders, such as delusion and hallucinations.

Clinical Indications for Antipsychotic Drugs *Primary Indication: Schizophrenia *Schizoaffective disorder *Manic *Other Indications: ^Tourette's syndrome ^disturbed behavior: senile dementia associated with Alzheimer's disease *Inappropriate Use: ^Management of drug withdrawal syndromes (e.g. opioids) ^Anxiety relief -- not appropriate given availability of specific anxiolytic agents *Nonpsychiatric Indications: ^antiemesis ^relief of puritis ^neuroleptanesthesia

Standard (traditional) Antipsychotics Action: Classifications: Standard (traditional) Antipsychotics. Atypical Antipsychotics. Standard (traditional) Antipsychotics Action: Standard Antipsychotic drugs act by blocking dopamine type2 (D2) receptor in the nigrostriatal area of basal ganglia. Thus. These drugs referred to as dopamine receptor antagonists.

Type of Standard Antipsychotic route Dosage(adult) Trade name Generic name O , IM IM O,IM,IV O,IM 25mg IM O 300-800 40-800 8-40 6-20 1-20 200-700 Thorazine Promacid Neurazine Largactil Sparine Trilafon Stelazine Prolixin Prolixin,medicate Decanoate(long acting) mellaril Phenothiazines Chlorpromazine  Promazine  Perphenazine  Trifluoperazine  Fluphenazine Thioridazine

route Dosage (adult) Trade name Generic name Continue>>> O,IM 50-100mg   IM O 100mg IM 6-20 105-5 1-10 Haldol Haldol decanoate (long acting) safinace Orap Clopixol Decanoate(long acting) Butyrophenones Haloperidol Other drugs Pimozide clopenthizol

Side effects: *Extrapyramidal side effect(EPS) :CNS acute onset of EPS: it occurs within few days,weeks or months. Acute dystonic reaction: Eye : oculogyric crisis in which the eyes are pulled up or to the side. Neck: pulling the head to one side(torticollis) or pulling the head back (retrocollis). Tongue: involuntary protrusions of tongue. Body: torsion spasm.

Pseudo-parkinsonism(parkinsonian like syndrome): It is characterized by: Hypokinesia: it is loss of movement, and may present asslowing or difficulty initiating movement, as well as decreased or absent arm swing when walking. Rigidity all over the body. Masked like face. Short shuffling gait. Drippling of saliva. Monotonous and slurred speech. Loss of postural reflexes which leads to fall.

Akathisia: Subjective feeling of restlessness and irritability. It is characterized by: Subjective feeling of restlessness and irritability. Inability to sit still. Crossing and uncrossing legs frequently. Inability to relax.

late onset of EPS: Sedation Epileptogenic effect. Tardive dyskinesia: it occurs at least 6-24 months. Tardive dyskinesia: is a jerky irregular movements affecting primarily the lower face, extremities and trunk. Sedation Epileptogenic effect.  

Autonomic side effect(anti-cholinergic side effect): Dry mouth, blurring of vision, urinary retention, constipation. Cardiovascular system: Orthostatic hypotension, light headedness,dizziness accompanied by tachycardia,palpitation and arrhythmia. Respiratory system: Nasal congestion especially with Mellaril which may lead to ulceration. Dermatological effect: Allergic reaction with rashes. dermatitis.

Complications: Agranulocytosis: White cell count drop to very low levels,the symptoms include: high fever, sore throat, mouth sores and malaise. Neuroleptic malignant syndrome: (lead to death) It is rare and It is characterized by: Hyperthermia: up to 107F, autonomic dysfunction ,hypertension, tachycardia. Allergic obstructive jaundice: Abdominal pain, anorexia, nausea, fever, bilirubin in urine and increase in serum bilirubin.

Contraindication: Cardiovascular diseases (myocardial infraction) Hypotension or hypertension, bone marrow disease, epilepsy, liver disease, pulmonary disease, pregnant women 1st trimester.

Atypical Antipsychotics 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: Very expensive

Types of atypical Antipsychotics: Dosage Trade name Generic name Tablets 25-100mg\day Ampoule 2ml\day   1mg to 3-6mg\day Leponex, Clozaril, Clozapex Risperdal,Apexidone Clozapine Risperidone

Side effect of Clozapine: *Agranulocytosis *Seizure *It can be sedating, cause hypotension and tachycardia. Contraindication: *Hypersensitivity to drugs *History of drug induced agranulocytosis *Alcoholic patient *Severe cardiac disease *Impaired bone marrow function

Side effect of Risperidone: Common: insomnia anxiety and headache Less: fatigue, dizziness, constipation, abdominal pain, weight gain. Contraindication: Patient with known hypersensitivity to the product.

Role of nurse: general rules r\t psychotropic medication: 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. nurses' role toward compliance to medication: assist client in acquiring knowledge about medications, explain natures of and time span for onset of therapeutic results, provid written and verbal instructions to reinforce compliance, including family members in education process

nurses' role toward side effect: important part of psychiatric nurse's role is to minimize, identify and intervene in side effect experienced by patient as a result of their medication. nurses' role toward complications: report occurrence of any of the side effect & complications to physician immediately.

THANK YOU REFERNCE: www.WHO.org www.mentalhealthdrugs.com http://www.pharmacology2000.com/Central/psychotics/Antipsy_obj1.htm