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ANTIPSYCHOTIC

• Antipsychotic medications, sometimes referred to as neuroleptics or major tranquilizers, are prescribed to treat
schizophrenia and to reduce the symptoms associated with psychotic conditions such as bipolar, psychotic
depression, senile psychoses, various organic psychoses, and drug-induced psychoses.
• People experiencing psychosis are sometimes, but not always, a danger to themselves and others.
• Antipsychotic medications have both a short-term sedative effect and the long-term effect of reducing the chances
of psychotic episodes.

CLASSIFICATION OF ANTIPSYCHOTICS
1. Typical Antipsychotics, or First Generation Antipsychotic Drugs : were first developed in the 1950s.
• Are divided into two Phenothiazines and non-phenothiazines.
• Haldol (haloperidol) and Thorazine (chlorpromazine) are the best known typical antipsychotics.
• useful in the treatment of severe psychosis and behavioral problems when newer medications are
ineffective
• medications do have a high risk of side effects, some of which are quite severe
• INDICATION for schizophrenia and manifestations of other psychotic disorders including hyperactivity,
combative behavior, and severe behavioral problems. Some antipsychotics are approved for treatment
of bipolar disorder.
• THERAPEUTIC ACTION: Block dopamine receptors, preventing dopamine from stimulating the
postsynaptic neurons.
o They also have anticholinergic, antihistaminic, and alpha-adrenergic blocking effects, all of
which are related to its dopamine-receptor blocking action.
o Other than that, they depress the RAS to limit the stimulation entering the brain.
o Cause several adverse effects including hypotension, anticholinergic effects, and extrapyramidal side
effects (EPS)
2. Atypical Antipsychotics, or Second Generation Antipsychotic Drugs.
• new medications were approved for use in the 1990s. Clozapine (Clozaril), RIsperidone (Risperdal),
Olanzapine (Zyperea) and Quetiapine (Seroquel)
• Clozapine was categorized as the first atypical antipsychotic drug. This category of drugs has also been
of great value in studying the pathophysiology of schizophrenia and other psychoses.
• INDICATION: are used for treatment of severely ill patients with schizophrenia but are unresponsive to
standard drugs. It also reduces the risk of recurrent suicidal behaviors in patients with schizophrenia and
schizoaffective disorders.
• Risperidone is commonly used for treatment of irritability and aggression in children and adolescents
with autism
• THERAPEUTIC ACTION: Block both dopamine and serotonin receptors.
o This dual blocking action help relieve neurological adverse effects associated to typical
antipsychotics( may alleviate son of the unpleasant neurologic effects)

SIDE EFFECTS AND ADVERSE DRUG REACTIONS

People who take antipsychotic medications may experience negative side effects, such as:
• Extrapyramidal Effects: Dystonias, akathisia, tardive dyskinesia, Parkinson’s-like symptoms, unwanted
movements, ataxia, muscle breakdown, rigidity, tremors, and seizures are some major effects of this category
of drugs. Neuroleptic malignant syndrome may occur as well.
• Effects on the Central Nervous System: Drowsiness, sedation, and hypnosis occur. Confusion, vertigo,
syncope, disturbed sleep, nightmares, and agitation are also reported by various studies. Dementia, amnesia,
and loss of memory are some adverse effects. Suicidal ideation in old and young with
increased mania, anxiety, agitation, violent behavior, and depression can also be seen in people taking these
drugs.
• Effects on the Cardiovascular System: Cardiomyopathy is noted in nine out of every 100,000 people using
clozapine. Alteration in electrocardiogram (ECG) readings, chest pain, angina, myocarditis, palpitation,
tachycardia, edema, phlebitis, and arrhythmias are serious adverse effects. Myocardial infarction (heart
attack) occurs in only 1% of people using this category of drug. Orthostatic hypotension—the medical name
for the fuzzy feeling you get when standing up to quickly—is very common.

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 • Hepatic (Liver) Effects: These agents increase the serum concentration of alkaline aminotransferase.
Reversible liver cell hyperplasia, increase in bilirubin, jaundice, drug induced hepatitis, and necrosis have
been recorded in studies.
• Gastrointestinal Effects: Constipation, dry mouth, anorexia, weight gain, increases in pancreatic enzymes,
epigastric distress, abdominal cramps, dyspepsia, heartburn, and nausea are some common adverse effects.
• Genitourinary (Urinary and Reproductive) Effects: Impotence, delayed and premature ejaculation, testicular
swelling, priapism, increased or decreased libido, virginal itching, enuresis, polyuria, breast engorgement,
galactorrhea, and anorgasmia have been reported.
• Other Effects: Cases of blurred vision, hot flashes, dry throat, nasal congestion, severe hyperglycemia,
numbness, chills, glaucoma, leukopenia, neutropenia, hyperlipidemia, agranulocytosis, and respiratory
depression have been reported.
• Pregnancy and Lactation: Antipsychotic drugs can be used in pregnant females since they have shown no
teratogenic (development of the fetus or embryo) effects in animal studies. Drugs like clozapine and
olanzapine have shown no harm to the fetus. However, during lactation, the metabolites may be disturbed in
the milk and could harm the newborn.

CONTRAINDICATION
• Presence of diseases that can be exacerbated by dopamine-blocking effects.
• CNS depression, circulatory collapse, Parkinsons’ disease, coronary disease, severe hypotension, bone
marrow suppression, blood dyscrasias. Exacerbated by drug effects.
• QTc interval prolongation. Contraindicated to mesoridazine, thioridazine, and ziprasidone; can lead to serious
cardiac arrhythmias.
• Dementia. Use is associated with increased risk of CV events and death.
• Glaucoma, peptic ulcer, urinary or intestinal obstruction. Exacerbated by anticholinergic effects of
antipsychotics.
• Seizure disorders. Possible severe neurosensitivity can lower seizure threshold in patients with thyrotoxicosis.
• Active alcoholism. Antipsychotics can potentiate CNS depression.
• Immunosuppression, cancer. Caution is applied because antipsychotics can result to bone marrow suppression
and blood dyscrasias.
• Pregnancy, lactation. Potential adverse effects on the fetus or neonate.
• Caution is used in children younger than 12 years of age who have chicken pox or a CNS infection because
children are more likely to develop dystonia and this could cause confusion in the diagnosis of Reye’s syndrome.

DRUG INTERACTIONS
Antipsychotics cannot be used with the following substances:
• Anti-anxiety drugs and other central nervous system depressants
• Antidepressants
• Hypotensive agents
• Anticholinergic agents
• Anticoagulants
• Levodopa
• Carbidopa
• Alcohol
• Valproic acid
• Lithium
• Drugs affecting seizure threshold
• Smoking

NURSING RESPONSIBILITIES
• Do not allow patient to crush or chew sustained-release capsules as this will speed up absorption and may
cause toxicity.
• Keep patient in recumbent position for 30 minutes if administering parenteral forms to reduce risk of orthostatic
hypotension.
• Monitor CBC results to arrange to discontinue the drug at signs of bone marrow suppression.
• Monitor blood glucose levels with long-term use to detect development of glucose intolerance.
• Provide comfort measures (e.g. positioning of legs and arms for dyskinesia, sugarless candy and ice chips for
dry mouth, voiding before taking drugs for urinary hesitancy or retention, etc.) to help patient tolerate drug
effects.

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 • Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.
• Educate client on drug therapy to promote understanding and compliance.

WITHDRAWAL SYMPTOMS
Withdrawal from antipsychotics should be slow and gradual. A period of at least 15–30 days should be considered
for this purpose. Nausea, vomiting, psychotic symptoms, hypertension, and sleep disturbances might come back if
sudden discontinuation of therapy occurs.

ANXIOLYTICS
Therapeutic Actions
o Act in the limbic system and the RAS
o Make GABA more effective
o Cause interference with neurons firing
o Lower doses cause anxiolytic effects
o Higher doses cause sedation and hypnosis

Indications
o Anxiety disorders
o Alcohol withdrawal
o Hyperexcitability and agitation
o Preoperative relief of anxiety and tension

Pharmacokinetics
o Well absorbed from the GI tract
o Peak levels achieved in 30 minutes to 2 hours
o Lipid soluble and well distributed throughout the body
o Cross placenta
o Enter breast milk
o Metabolized in the liver
o Excretion is primarily in the urine

Contraindications & Cautions

o Allergy to benzodiazepines
o Psychosis
o Acute narrow angle glaucoma
o Shock
o Coma
o Acute alcohol intoxication
o Pregnancy

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Adverse Effects
o Sedation
o Drowsiness
o Depression
o Lethargy
o Blurred vision
o Confusion
o Dry mouth
o Constipation
o Nausea
o Vomiting
o Hypotension
o Urinary retention

Drug-to-Drug Interactions
o Increase CNS depression when taken with alcohol
o Increase in effect when taken with cimetidine, oral contraceptives, or disulfiram
o Decrease in effect if given with theophylline or ranitidine

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