ANTIPSYCHOTIC DRUGS or major tranquilizer .pptx

ANTI PSYCHOTIC
MEDICATION
MS.POOJA SEN
NURSING LECTURER (MHN)

PSYCHOSIS REFERS TO AN ABNORMAL CONDITION OF THE MIND
DESCRIBED AS INVOLVING A “LOSS OF CONTACT WITH REALITY”
PEOPLE EXPERIENCING PSYCHOSIS MAY EXHIBIT SOME PERSONALITY
CHANGES & THOUGHT DISORDER. BUT MAINLY INDIVIDUAL STRUGGLE
WITH DELUSION,HALLUCINATION & IMPAIRED INSIGHT.
PSYCHOSIS

1. ANTIPSYCHOTIC DRUGS
 Anti psychotic drugs are also known as neuroleptic drugs or major tranquilizer.
 It primarily used to treat schizophrenia, but they are also effective for psychotic
state.
 Antipsychotic drugs are not curative and not eliminate the chronic thought
disorder but they decrease the intensity of hallucination & delusions .
 Antipsychotic drugs used in modern medicine more than 50 years.
 Chlorpromazine & Reserpine were the first drugs found to be useful in
schizophrenia.

1. ANTIPSYCHOTIC DRUGS
The antipsychotic drugs are broadly defined as the drugs ,which are used to treat the
psychiatric disorder.
The drugs are also called as neuroleptic agents as they reduce the agitation ( a state
of anxiety) & disturbed behavior associated with delusion & hallucination.

1. ANTIPSYCHOTIC DRUGS TYPES
 TYPICAL ANTIPSYCHOTIC DRUGS – Are a class of antipsychotic drugs ,first
developed in the 1950s and used to treat psychosis. Also called as a first
generation drugs.
 Clozapine 50-450 mg/day (oral dose)
 Risperidone 0.5-50 mg/day (oral dose)
 Olanzapine 10-20 mg/day (oral dose)
 Quetiapine 175-750 mg/day (oral dose)
 Ziprasidone
 Asenapine

1. ANTIPSYCHOTIC DRUGS TYPES
 ATYPICAL ANTIPSYCHOTIC DRUGS – Also called as a second generation
antipsychotic drugs .
 Phenothiazines – Chlorpromazine 300- 1500 mg/day(oral dose
Triflupromazine 100-400 mg/day(oral dose)
 Thioxanthene's – Flupenthixol 3-40 mg/day (oral dose)
 Butyrophenones – Haloperidol 5-100 mg/day ( oral dose)
 Dibenzoazepine's – Loxapine 25-100 mg (oral dose)

MECHANISM OF ACTION
Anti psychotic medication drugs block
the D2 receptors in the mesolimbic &
mesofrontal system.
Sedation caused by alpha-adrenergic
blockade.
Anti dopaminergic action on basal
ganglia are responsible for causing EPS (
extra pyramidal symptoms.)

INDICATION
 Antipsychotic is mainly treat for acute & chronic type of psychosis
 Organic Disorder- delirium, dementia, delirium tremors.
 Functional Disorders – Schizophrenia , schizoaffective disorder
 Mood Disorder – Mania, major depression with psychotic symptoms.
 Childhood disorder- ADHD, Autism, enuresis, conduct disorder
 Neurotic disorder- Anorexia nervosa, OCD ,Anxiety.
 Medical Disorder – Huntington's Chorea , eclampsia ,tic disorder

CONTRA INDICATION
 Hypersensitivity
 Not to be used when CNS depression
 Parkinson's diseases
 Elder, severely ill or respiratory insufficiency ,prostatic hypertrophy or
intestinal obstruction.

SIDE EFFECT
 Dry mouth
 Blurred vision
 Constipation
 Skin rash
 Sedation & drowsiness
 Photosensitivity
 Orthostatic hypertension
 Wight gain

These are serious neurological symptoms and major side effects of antipsychotic
drugs, blockade of D2 receptor in the mid brain region of the brain stem is
responsible for the development of EPS.
Typical antipsychotic cause grater incidence of EPS then atypical antipsychotic.
There are serious neurological changes which represent the following symptoms.
EXTRA PARAMEDIAL SYMPTOMS

Neuroleptic induced parkinsonism – Symptoms include rigidity,
tremors, bradykinesia (Slowness of movements & speed), ataxia
(impaired balance & coordination),akinesia(inability to move one’s
muscles voluntarily).
Acute dystonia- dystonic movement result from a slow sustained
muscular spasm that lead to an involuntary movement. dystonia
can involve the neck, jaw, tongue and the entire body
(opisthotonos).There is also involment of the eye known as
oculogyric crisis .

Akathisia – Akathisia is a subjective feelings of muscular
discomfort that can cause patient to be agitated, restlessness and
feel generally dysphoric.
Tardive Dyskinesia- It is a delayed adverse effect of antipsychotic.
It consist of abnormal ,irregular movements of the muscles of the
head, limb and trunk. It is characterized by chewing, sucking ,
grimacing and perioral movements.

Neuroleptic malignant syndrome – This is a rare but serious
disorder occurring in a small minority of patients taking
neuroleptics ,especially high potency compounds.
The onset is often but not invariably in the first 10 days of treatment
.the clinical picture includes the rapid onset (usually over 24-72
hours) of severe motor, mental & autonomic disorders.

Autonomic side effect – dry mouth, constipation, cycloplegia,
mydriasis , urinary retention , orthostatic hypertension , impotence
and impaired ejaculation.
Agranulocytosis
Seizure
Sedation
Wight gain

NURSES RESPONCIBILITY
Instruct the patient to take sips of water frequently to relieve
dryness of mouth. Frequently use of mouth wash, use of chew
gum applying glycerin on the lips are also helpful.
A high fiber diet ,increased fluid intake and laxatives if needed
help to reduce constipation.
Advice patient to get up from the bed or chair very slowly.
Patient should sit on the edge of the bed for one min. dangling his
feet before standing up.

Check BP before or after medication is given. This is an important
measure to prevent falls and other complications resulting from
orthostatic hypertension.
Observe patient regularly for abnormal movements.
Take all seizure precautions.
Patient should be warned about driving a car or operating
machinery when first treated with the antipsychotic drugs.

Giving entire dose at bed time usually eliminate any problem from
sedation.
Advice patient to use sunscreen measures ( use of full sleeves
,dark glasses) for photosensitive reactions.
Teach the importance of drug compliance, side effect of drugs and
reporting if too severe ,regular follow up .
Give reassurance and reduce unfounded fears and anxiety.

Stop the drugs if the WBS count drops to less than 3000/mm3 of
blood.
Seizure precautions should also be taken .
The dose should be regulated carefully and the patient may also
be put on anticonvulsants drugs.

ANTIPSYCHOTIC DRUGS or major tranquilizer .pptx

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