antipsychotics, antipsychotic drugs, major tranquilizers, tranquilizers

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  • ClassificationTypical antipsychoticsPhenothiazines Chlorpromazine: 40-800 mgPerphenazine: 12-64 mgFluphenazine: 1-40 mgThioridazine: 150-800 mg ThioxanthenesThiothixene: 6-30 mgButyrophenonesHaloperidol: 1-100 mgDibenzothiazepineQuetiapine: 150-750 mg

    Atypical antipsychotics Clozapine: 300-900 mgRisperidone: 4-16 mgOlanzapine: 5-20 mg

  • IndicationsAcute and chronic psychoses, particularly when accompanied by increased psychomotor activity.Selected agents used as antiemetics (Chlorpromazine, perpohenazine, prochlorperazine)Interactable hiccoughs (chlorpromazine, perphenazine)Tics and vocal utterances in Tourettes disorder (haloperiod, pimozide)

  • ActionThe exact mechanism is not known.Blocking postsynaptic dopamine receptors in the basal ganglia, hypothalamus, limbic system, brainstem, and medulla.Newer medications may exert antipsychotic properties by blocking action on receptors specific to dopamine, sertonin, and other neurotransmitters.Inhibition of Dopamine mediated transmission of neural impulses

  • ContraindicationsKnown hypersensitityShould not be used when CNS depression is evident.Blood dyscrasiasParkinson diseaseLiver/renal/cardiac insufficiencies.

    Caution:Elderly, severely ill or debilitatedDiabetic, respiratory insufficiency, prostatic hypertrophy, or intestinal obstruction.Safety in pregnancy and lactation has not been established.

  • InteractionsAdditive anticholinergic effects are observed when antipsychotics are taken concurrently with other drugs that produce these properties.Additive hypotensive effect with beta-adrenergic blockers.Antacids and antidiarrheals may decrease absoption of antipsychotics.Barbiturates may increase metabolism and decrease effectiveness of antipsychotics.Additive CNS depression with alcohol, sedative hypnotics and anxiolytics.

  • Nsg diagnosisRisk for other-directed violence related t panic anxiety and mistrust of others.Risk for injury related medication side effectsRisk for activity intolerance related to medication side effects of sedation, blurred vision and weaknessNoncompliance with medication regimen related to suspiciousness and mistrust of others.

  • Side effectsAnticholinergic effectsDry mouthBlurred visionConstipationUrinary retentionNauseaSkin rashSedationOrthostatic hypotensionPhotosensitivityHormonal effectsDecreased libido, retrograde ejaculation, gynecomastia, Amenorrhea, weight gain.

  • Side effects (contd..)ECG changes: prolongation of the QT interval, are possible with most of the antipsychotics.Caution: patient with arrhythmiasReduction of seizure threshold.AgranulocytosisClozapine: weekly/biweekly blood investigation.Hypersalivation (clozapine)

  • Extrapyramidal symptoms (EPS)PseudoparkinsonismTremor, shuffling gait, drooling, rigidity.1-5 days after initiation of antipsychoticsAkinesiaAkathisia (50-60 days after initiation of therapy)DystoniaMen;
  • Side effects (contd..)Neuroleptic malignant syndrom (NMS)Severe parkinsonian muscle ridigidityUpto 1070C, tachycardia, tachypneaFluctuations in blood pressure, diaphoresis, and rapid deterioration of mental status to stupor and coma.This is rare but potentially fatal complication of treatment with neuroleptic drugs.Within hours year after drug initiation.]Discontinue neuroleptic immediately.Bromocryptine or dantrolene

  • Antiparkinsonian agentsAnticholinergicsBenztropine: 0.5-9mgBiperiden: 2-8 mgProcyclidine: 5-20 mgTrihexyphenidyl: 1-15 mgAntihistamines:Diphenhydramine: 10-400 mgDopaminergic agents: Amantadine: 200-400 mgBromocriptine: 10-40 mg

  • IndicationsIndicated for the treatment of all forms of parkinsonism and for the relief of drug-induced extrapyramidal reactions.

  • ActionsRestoring the natural balance of two major neurotransmitters in the CNS: Ach, Dopamine.Deficiency in dopamine results in excessive cholinergic activity.Anticholinergics or dopaminergic agonists.

  • Contraindications/precautionsHypersensitityAngle-closure glaucomaPyloric or duodenal obstructionPeptic ulcers,Prostatic hypertrophyBladder neck obstruction, megacolon.Myasthenia gravis.

    CautionTachycardia, cardiac arrhythmias, hypertension, hypotension, and tendency toward urinary retention.Elderly, hepatic/renal/cardiac insufficiency

  • Side effectsAnticholinergic effectsDry mouth, blurred vision, constipation, paralytic ileus, Urinary retention, tachycardiaNausea, GI upsetSedation, drowsiness, dizziness.Exacerbation of psychoses.Orthostatic hypotension.

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