Documente Academic
Documente Profesional
Documente Cultură
Antipsychotics are defined as drugs used for the
treatment of psychotic symptoms.
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
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.