Antipsychotics
Classifications of Antipsychotics
- There are 3 main classifications of Antispsychotics: 1st, 2nd, 3rd generation
- Typical vs. Atypical
- All antipsychotics manage schizophrenia symptoms by blocking dopamine receptors.
- These drugs differ in the degree of antagonist action at the dopamine receptor sites
By: Carla Rasing, Manjot Gill, Sonayna Rana, Jasmine Sandhu, Natasha Bassi, Gurpreet Lally, Irene Sencio
Risperidone
Nursing Implications:
- monitor B/P with patient in sitting, standing, and lying position
- take pulse and respiration q4h during initial treatment
- assess for EPS (inability to sit still, no pattern movements), and check for severe orthostatic hypotension
- increase bulk and water in diet
Dietary restrictions:
Not compatible with cola or tea
Uses: Irritability associated with autism, bipolar disorder, mania, schizophrenia
Therapeutic Outcome: is used to decrease hallucinations & disorganized thoughts.
Contraindications: Hypersensitivity, seizure
Side Effects: agitation, anxiety, constipation, hypotension, sedation
Adverse Effects: EPS (extrapyramidal symptoms), orthostatic hypotension, headache, dizziness, drowsiness, feeling restless or anxious, stomach pain
3rd Generation
Antipsychotics
- Developed to reduce the weight gain side effects of 2nd Generation Antipsychotics
- Aripiprazole is the first 3rd generation atypical antipsychotic
- Aripiprazole is the first 3rd generation atypical antipsychotic
2nd Generation: Atypical Antipsychotics (AAP)
Signs & Symptoms
- Developed in the 1990’s
- Reduced neurological symptoms that were not reduced from first gen.
- Partial antagonist dopamine activity at specific receptor accounts for improved negative and cognitive symptoms
- Also acts as antagonist at specific Serotonin receptors
- Less extrapyramidal side effects
1st Generation: Typical Antipsychotics
3rd Generation
- Developed in the 1960-1970's
- Reduce positive symptoms: ex. hallucinations, delusions, thought disorders, bizarre behavior, disorganized speech
- Produced Extrapyramidal Side Effects (Movement disorder)
- The need for development of antipsychotic with fewer side effects -> led to the development of Atypical antipsychotics (2nd Generation)
- Developed to reduce the weight gain side effects of 2nd Generation Antipsychotics
- Aripiprazole is the first 3rd generation atypical antipsychotic
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized behaviour
5. Negative symptoms
Drowsiness, neuroleptic malignant syndrome (NMS), extrapyramidal symptoms (EPS), tardive dyskinesia, sedation, orthostatic hypotension, dizziness, blurred vision, nausea
dry mouth, constipation, urinary retention, rash, hyperpigmentation
- Atypical antipsychotics have fewer extrapyramidal symptoms (EPS) but the drugs have higher risk of metabolic side effects, such as diabetes and weight gain.
Contraindications:
- Allergies
- Brain damage
- Liver, kidney disease
- Seizure
- Parkinsonism
- Severe hypotension or hypertension
- Bone marrow
Thank You!
Here is visual example of Tardive Dyskinesia
Clozapine
Common Myths & Misconceptions
- MYTH: Schizophrenia refers to a "split personality" or multiple personalities.
- MYTH: Schizophrenia is a rare condition.
- MYTH: People with schizophrenia are dangerous.
- MYTH: People with schizophrenia can’t be helped.
Adverse Effects: agranulocytosis, dyphagia, orthostatic hypotension, bradycardia, myocarditis, seizures
Nursing Implications:
- Assess for myocarditis if suspected, discontinue; myocarditis usually occurs during first month of treatment
- Assess mental status: orientation, mood, behavior, presence of hallucinations, and type before initial administration and monthly; this product should significantly reduce psychotic behavior
- Check for swallowing of PO medication; check for hoarding or giving medication to other patients
- Monitor input and output ratio
- Assess sleep pattern disturbances
- Check for dizziness, faintness, tachycardia
- PO: Oral doses may be administered with food or milk to minimize GI irritation.
- Toxicity and Overdose: Overdose is treated with activated charcoal and supportive therapy. Monitor patient for several days because of risk of delayed effects.
Types of disorders Antipsychotics can treat
Clozapine
- Schizophrenia
- Schizoaffective Disorder
- Schizophreniform Disorder
- Brief Psychotic Disorder
- Delusional Disorder
- Mania caused by the onset of bipolar disorder
- Severe depression and anxiety disorders
- Genetic causes
- Environmental causes
- Abnormal brain structure
Some Examples of Antipychotics
Uses: managment of psychotic symptoms in schizophrenia patients for whom antipsychotics have failed, recurren suicidal behaviour
Therapeutic Outcome: to decrease psychotic behavior
Contraindications: hypersensitivty, severe granulocytopenia,coma
Side Effects: constipation, dizziness, headache, tachycardia, hypotension, dry mouth, fever, nausea, sedation, sweating
Typical
Atypical
- Clozapine
- Olanzapine
- Risperidone
- Quetiapine
- Ziprasidone
- Haloperidol
- Chorpromazine
- Loxapine
- Zuclopenthixol
- Methotrimeprazine
- Prephrenazine
- Trifluperazine
- Thioridazine