Antipsychotic drugs ppt

psychopharmacology (antipsychotics)

1. ANTIPSYCHOTIC DRUGS BY MANJUNATH C PATIL MSc (N) 1 ST YEAR MENTAL HEALTH NURSING KAHER IONS ,BELAGAVI

2. HISTORY: In 1891 , paul ehrlich observed the antimalarial effects of methylene blue , a phenothiazine derivative . Later , the phenothiazines were developed for their antihistaminergic properties . Hamon and Delay extended the use of this treatment in psychiatric patients and uncovered its antipsychotic activity . Between 1954 and 1975 about 15 antipsychotics drugs were introduced in U.S and about 40 throughout the world .

3. INTRODUCTION : Antipsychotics also known as neuroleptics or major tranquilizers are a class of medications primarily used to manage psychosis principally in schizophrenia and bipolar disorder . First generation antipsychotics known as Typical antipsychotics were discovered in the 1950s . Second generation drugs known as A typical antipsychotics , first atypical antipsychotics was discovered in 1960s and introduced clinically in the 1970s .

4. DEFINITION : Antipsychotic drugs are a class of medicines used to treat psychosis and other mental and emotional conditions .

5. Classification : Class Examples of DRUGS TRADE Name ORAL Dose mg/day Parenteral Dose (mg) Phenothiazines Chlorpromazine Triflupromazine Thioridazine Trifluoperazine Fluphenazine decanoate Megatil Largactil Tranchlor Siquil Thioril , melleril Ridazin Espazine prolinate 300-1500 mg 100- 400mg 300-800mg 15-60mg -------- 50-100 IM only 30-60 IM only 1-5 IM only 25-50 IM every 1-3 weeks

6. CLASS Examples of DRUGS TRADE NAME ORAL DOSE mg/day Parenteral dose (mg) Thioxanthenes Butyrophenones Diphenylbutyl Piperidines Indolic derivatives Dibenzoxazepines Atypical antipsychotics Flupenthixol Haloperidol Pimozido Penfluoridol Molindone Loxapine Clozapine Fluanxol Senorm , serenace Relinace Orap Flumap Mobam Loxapac Sizopin , lozapin 3-40 mg 5-100mg 4-20mg 20-60 mg weekly 50-225 mg 25- 100mg 50—450mg 5-20 IM only

7. CLASS EXAMPLES OF DRUGS TRADE NAME ORAL DOSE (mg/day) Parenteral dose (mg) Others Risperidone Olanzapine Quetiapine Ziprasidone Reserpine Sizodon , sizomax Oleanz Qutan Zisper Serpasil 2-10mg 10-20mg 150-750mg 20-80mg 0.5-50mg

8. Indications : Antipsychotics are mainly used in the treatment of acute and chronic psychosis ,particularly when accompanied by increased psychomotor activity. a) Organic psychiatric disorder : delirium, D ementia, Delirium tremens, etc b) Functional disorders : schizophrenia, schizoaffective disorders,etc c) M ood disorders : mania , major depression with psychotic symptoms

9. Childhood disorders : Attention-deficit hyperactivity disorder, autism. Neurotic and other psychiatric disorders : Anorexia nervosa , intractable OCD , disabling anxiety . Medical disorders : H untingtons chorea, nausea and vomiting, eclampsia , heat stroke.

10. Pharmacokinetics: Antipsychotics when administered orally are absorbed by gastrointestinal tract with uneven blood levels. They are highly bound to plasma as well as tissue proteins . They are metabolized in the liver and excreted mainly through the kidneys . The elimination half life varies from 10-24 hrs.

11. Mechanism of action : Antipsychotic drugs block D 2 receptors in the mesolimbic and mesofrontal systems. Sedation is caused by alpha-adrenergic blockade. Anti- dopaminergic actions on basal ganglia are responsible for causing EPS (extrapyramidal symptoms). Atypical antipsychotics have anti-serotonergic anti- adregenic and antihistamine actions .

12. Contraindications: Hypersensitivity(cross sensitivity may exist among phenothiazines ). Not to be used when CNS depression is evident when blood dyscrasias exist , in patients with parkinson ” s disease , liver, renal or cardiac insufficiency. elder, severely ill or respiratory insufficiency, prostatic hypertrophy, or intestinal obstruction

13. Side effects and nursing implications: Anticholinergic effects : a) Dry mouth- provide sugarless candy , ice and frequent sips of water. strict oral hygiene. b) Blurred vision: subsides within few minutes. don’t drive. clears small items from pathways.

14. C onstipation : Increase fluid intake , higer fiber diet , increased physical activity. d) U rinary retention: Monitor intake and output ,report to if difficulty while urinating . 2) Nausea ,gastrointestinal tract : Administer fruit juice and concentrate must be diluted with other liquids.

15. 3) Skin rash : Report appearance of any skin rash avoid spilling of liquid concentrate on skin. 4) Sedation : A dminister drug at bedtime. Don’t drive or work while drowsy or after using sedatives Low dosage.

16. 5) Orthostatic hypertension: R ise slowly from a lying or sitting position, monitor BP document and report if any changes. 6) Photosensitivity : W ear protective sunscreens, clothing and sunglasses while spending time outdoors.

17. 7) Weight gain : Weigh patient alternate day. Calorie controlled diet provide exercise instruction.

18. Reduction of seizure threshold: C lose observation of patient with history of seizure. Note : THIS IS IMPORTANT WITH PATIENTS TAKING CLOZAPINE. REPORTEDLY SEIZURES AFFECT 1% TO 5% OF INDIVIDUALS WHO TAKE THIS DRUG . Agranulocytosis : Relatively rare with most of the antipsychotics drugs. usually occurs within the first 3 months of R X

19. Observe for symptoms of sore throat fever and malaise. Monitor CBC if symptoms appear. 10) Extrapyramidal symptoms : Pseudo-parkinsonism : (tremor, shuffling gait, drooling, rigidity). & b) Akinesia (muscular weakness): Symptoms may appear 1to5 days following initiation of antipsychotic medication. occurs most often in women ,the elderly and dehydrated patients.

20. c) Akathesia (continuous restlessness and fidgeting): occurs most frequently in women ; symptoms may occur 50-60 days following initiation of therapy. Dystonia (involuntary muscular movements[spasms] of face, arms , legs and neck): occurs most often in men and patients younger than 25 years of age .

21. 11) Tardive dyskinesia (bizarre facial and tongue movements, stiff neck and difficulty swallowing): Long term therapy patients are at risk. Symptom are potentially irreversible. Drug should be withdrawn at first sign(vermiform movements of tongue) 12) Neuroleptic malignant syndrome : A rare, but potentially fatal, complication with neuroleptic drugs. monitor temperature and observation for parkinsonian symptoms.

22. Onset can occur within hours or even years after drug initiation. Symptoms include severe parkinsonian muscle rigidity , hyperpyrexia upto 107 degree F , tachypnea , tachycardia , fluctuations in blood pressure ,rapid deteriiration of mental status.. Discontinue neuroleptic medicaton immediately. Monitor vital signs , degree of muscle rigidity, intake and output and level of consciousness. Physician may order bromocriptine ( parlodel ) or dantrolene ( dantrium ) to counteract the effects.

23. Patient/Family Education : = P atient should: Be cautious while driving and operating dangerous machinery. Don’t stop medication after long time use. use sunscreens and wear protective clothing while spending time outside. Report occurrence of symptoms like sore throat, severe headache , rapid heart rate, difficulty in urinating, twitching tremors, darkly coloured urine ,yellow skins or eyes , skin rash or seizures.

24. Rise slowly from sitting position to prevent sudden drop in BP. Take frequent sips of water , chew sugarless gum and maintain oral hygiene. Consult physician regarding smoking while on neuroleptic therapy. Dress warmly in cold weather and avoid extended exposure to very high or low temperature. Body temperature is harder to maintain with this medications.

25. Stop alcohol. Don’t consume other medications, without physician approval. Beware of risks with neuroleptic during pregnancy. Beware of side effects of neuroleptic drugs. Don’t discontinue medications immediately after feeling well. Carry card or other Identification at all times prescribed medication being taken.

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