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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)

Schizophrenia

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

Side Effects

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

ECG

62

bpm

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