Antipsychotic drugs

Antipsychotic drugs

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  Mr. Ashok Kumar Mscnursing 1st year (Pal college of nursing and medical science)
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  ANTI PSYCHOTIC AGENTS Anti psychotic agents are the one type of psychotropic drugs  Anti psychotic agents are also known as neuroleptics,major tranquillizer, or phenothaiazines  This group of drugs has a major clinical use in the treatment of psychosis  Psychosis is a state in which a person ability to recognize reality ,to communicate and to relate to other is severely impaired
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  INTRODUCTION Antipsychotic drugs areable to reduce psychotic symptoms in a wide variety of conditions, including schizophrenia, bipolar disorder, psychotic depression and drug induced psychosis. They have also been termed narcoleptics, because they suppress motor activity and emotionality. ** These drugs are not a cure ** Psychotic diseases are life long and it is preferable to prevent the psychotic episodes than to treat them.
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  Classification of antipsychoticdrugs Typical antipsychotics  Phenothiazines  Chlorpromazine: 40-800 mg  Perphenazine: 12-64 mg  Fluphenazine: 1-40 mg  Thioridazine: 150-800 mg  Thioxanthenes  Thiothixene: 6-30 mg  Butyrophenones  Haloperidol: 1-100 mg  Dibenzothiazepine  Quetiapine: 150-750 mg Atypical antipsychotics Clozapine: 300-900 mg Risperidone: 4-16 mg Olanzapine: 5-20 mg
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  INDICATION AND USE Antipsychoticagents are commonly used in following condition ;  schizophrenia disorder  paranoid disorder  mania  organic dementia  acute brain syndrome Symptoms for which antipsychotic or neuroleptic drugs are used include impaired communication, inability to relate to other, delusion ,hallucination and inability to identify reality, disordered thinking and emotional withdrawal
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  MECHANISM OF ACTION The 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, serotonin, and other neurotransmitters.  Inhibition of Dopamine mediated transmission of neural impulses
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  CONTRAINDICATION  Antipsychotic arecontraindicated in children under three years of age, comatose patient, patient with drugs hypersensitivity, severe depression and bone marrow depression  Antipsychotic agents should be used cautiously in patient with a history of epilepsy,pregnancy,parkinsons disease, peptic ulcer
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  SIDE EFFECT  Antcholinergic effects  Dry mouth  Blurred vision  Constipation  Urinary retention  Nausea  Skin rash  Sedation  Orthostatic hypotension  Photosensitivity
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  SIDE EFFECT  Hormonaleffects  Decreased libido, retrograde ejaculation, gynecomastia, Amenorrhea, weight gain.  ECG changes: prolongation of the QT interval, are possible with most of the antipsychotics.  Caution: patient with arrhythmias  Reduction of seizure threshold.  Agranulocytosis  Clozapine: weekly/biweekly blood investigation.  Hyper salivation (Clozapine)
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  EXTRA PYRAMIDAL SYMPTOMS(EPS)  Pseudo parkinsonism  Tremor, shuffling gait, drooling, rigidity.  1-5 days after initiation of antipsychotics  Akinesia-muscular weakness  Akathisia-continuous restlessness and fidgeting (50- 60 days after initiation of therapy)  Dystonia-involuntary muscular movement of face,arms,legs and neck  Men; <25
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  EXTRA PYRAMIDAL SYMPTOMS(EPS)  Hyperglycemia and diabetes –more common with atypical antipsychotic drugs  Oculogyric crisis- uncontrolled rolling back of the eyes  Treated as emergency  Physician should be contacted immediately  IV benztropine mesyulate
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  EXTRA PYRAMIDAL SYMPTOMS(EPS)  Tardive dyskinesia -This occurs due to abrupt termination or reduction of the antipsychotic drugs after long term high dose therapy .stereotyped movements, protrusion of the tongue, puffing of cheeks and involuntary movement of extremities and trunk  Neuroleptic malignant syndrome (NMS) Symptoms include-  Severe parkinsonian muscle ridigidity  Hyperpyrexia Up to 1070C, tachycardia, tachypnea  Fluctuations in blood pressure, diaphoresis, and rapid deterioration of mental status to stupor and coma.
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  NURSES ROLE Nurses isvery significant in the therapeutic effect of the drugs, early observation and prevention of complications  Close observation  Extra pyramidal reaction  Observe drowsiness  Record blood pressure  Accurate route of medication
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  NURSES ROLE  Drymouth may be reduced  Blurred and impaired vision causes anxiety encouraged to inform these symptoms immediately  Weight record  Intake and output chart  Protect his skin  Menstrual change  Reassurance to relatives
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  Thank you