AL-Zaytoonah University of Jordan

Faculty of NursingAntipsychotic Drug

Prepared by: alaa ali alabbade.

Alosh al hmrany.Ms:-Doaa

MS :-Hamza

Outlines •Definition of antipsychotic drugs.• the meaning of psychosis and nurosis.•Negative and positive symptoms.•Classification of antipsychotic• comparasion between typical and atypical antipsychotic drug.• Typical antipsychotic drug ( the drugs, indication , mechanism of action , side effect ).• Atypical antipsychotic drug ( the drugs, indication , mechanism of action , side effect ).• Nursing intervention of side effect.• Nursing roles.• Summary.• References .

Definition of Antipsychotic Drug :

Antipsychotic term refers to neouroliptic drugs & tranquilizers , The term

antipsychotic is drug used to treat psychosis .

psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving

a "loss of contact with reality ."

Psychotic illness characterized by:Positive symptomsDelusions .

Hallucination .

Disorganized thinking .

Agitation .

Bizarre behaviors .

Negative symptoms:Social withdrawal Apathy emotional Unresponsiveness 'Anhedonia

Poverty of speech Lack of drive or initiative

Indication:• Schizophrenia.• bipolar disease.• Organic psychoses (mental disturbances caused by head injury, alcoholism, or other kinds of organic disease).• Affective disorders (e.g. depression, mania).• agitation associated with Alzheimer's disease.

Definition of schizophrenia:

Severe mental disorder that affects about 1% of the population, Schizophrenic patients are typically unable to filter sensory stimuli and may have enhanced perceptions of sounds, colors, and other features of their environment

there is no single cause for this illness. Rather, it is the result of a complex group of genetic, psychological, and environmental factors

Classification of antipsychotic:

Atypical antipsychotics Typical antipsychotics

Typical Antipsychotic

1 -Typical antipsychotics:The older, typical neuroleptics are effective antipsychotic agents with neurologic side effects involving the extrapyramidal motor system such as:(rigidity, unusual body

movement, muscle spasm, restlessness).

They target predominantly the positive symptoms of schizophrenia

Typical neuroleptics block the dopamine-2 receptor.

Mechanism of Action of Typical antipsychotic

The typical antipsychotic drug blocked the D2 receptor in normal individuals, acetylcholineand dopamine systems work in opposition in the basal ganglia (a brain area that is very involved in motor control). This permit much of the fine motor control humans can do.

•Typical antipsychotics block D2 receptors and even though they block ACh receptors to some extent, this causes the balance of DA/ACh to change so that ACh is less opposed. therefor the side effect appear (specially EPS)

The Typical antipsychotic block

the D2 receptor

Typical antipsychotics:

Generic nameGeneric nameTrade name Trade name Daily dosageDaily dosage

trifluoperazinestelazine4-40/mg

Chlorpromazine

Thorazin 40-400/mg

fluphenazineprolixin2.5-10/mg

mesoridazineserentil30-400/mg

perphenazinetrilafon12-64/mg

prochlorperazincompazin15-150/mg

thioridazinemellaril150-800/mg

loxapineloxitane20-250/mg

haloperidolhaldol1-100/mg

molindonemoban15-225/mg

pimozideorap1-10/mg

thiothixenenavane6-30/mg

Side Effect Of Typical Antipsychotic drug 1 -Extrapyramidal Side Effects (EPS):

•pseudoParkinson: –Resting tremor, muscular rigidity, shuffling gait ,

bradykinesia (loss and slowing of voluntary motor activity)

•Akathisia: –Person experiences inner restlessness, and an irresistible

impulse to move: paces, rocks and moves in a repetitive Manner

•Acute Dystonias: –Involuntary and uncontrolled muscle spasms and body

postures, prolonged muscle contractions of head and neck

•Tardive Dyskinesia (TD): –Involuntary movements of tongue and face (e.g., sucking or

smacking), and in more severe cases, trunk or limb

2 -Anticholinergic effect ( dry mouth, blurred vision , constipation , urinary retention,photosensitivity )

3 -hypersalivation 4 -Sedation ‑ initially considerable; tolerance usually

develops after a few weeks of therapy; dysphoria

5 -Postural hypotension ‑ results primarily from adrenergic blockade; tolerance can develop

6 -Neuroleptic malignant syndrome: Catatonia, stupor, fever, unstable blood pressure, muscle rigidity; hyperkalemia , renal failure.

Contraindication:• pregnancy. The weeks 4 to 10 are particularly dangerous.• poorly controlled seziure.•Sever CNS depression.• sever cardio vascular disease.• bone marrow depression.

Atypical Antipsychotic

Atypical Antipsychotic:Definition: It is a novel antipsychotics that have lesser extra pyramidal side effects and greater efficacy in the treatment of negative symptoms of schizophrenia compared with typical antipsychotics.

Action: atypical Antipsychotics blocks both serotonin and dopamine receptors.

Advantage: They cause little or no extra pyramidal side effect.Effective in short term.

disadvantage: Expenssive

Mechanism of action :

Newer medication may exert antipsychotric properties by

blocking action on postsytsnaptic receptor specific to dopamine D2 ,

serotonin 5-HT2 .

Generic nameTrade nameDaily dosage

clozapineclozaril300-900/mg

risperidonerisperidal1-6/mg

olanzapinezyprexa5-20/mg

quetiapineseroquel150-750/mg

ziprasidonegeodon40-160/mg

aripiprazoleabilify10-30/mg

Atypical antipsychotic

Side effect for atypical antipsychotic: 1 -Weight gain

weight gain now attributed to ratio of binding to D2 and 5-HT2 receptors; possibly also histamine (for newer antipsychotics anyway)

2 -Sexual dysfunction

result from NE blockade erectile dysfunction in 23-54% of men retrograde ejaculation in loss of libido and anorgasmia in men and women

3 -Neuroleptic malignant syndrome

combination of motor rigidity, hyperthermia, and autonomic dysregulation of blood pressure and heart rate (both go up)

4 -Risk for developing DM type 2

5 -Risk for hyperlipidemia

6 -Increase the risk of cardic death

Comparison between Typical and Atypical Antipsychotic Drugs

Typical antipsychotics Atypical antipsychotics

Mechanism of action –Generally block D2Receptors

Generally block 5-HT2Receptors more the D2 receptors blocked

Side Effect -Extrapyramidal Side Effects (EPS)( pseudoparkinsonism , akathisia , dystonia, tardive dyskinesia)

-Anticholinergic effect ( dry mouth, blurred vision , constipation , urinary retention)

-Neuroleptic malignant syndrom ( NMS)

- hypersalivation -Sedation

-Postural hypotension

-Weight gain

- sexual dysfunction

-Neuroleptic malignant syndrom (NMS)-

-Risk for developing DM type 2 -Risk for hyperlipidemia

-Increase the risk of cardic death

- (atypical were less likely than typical antipsychotic to cuse EPS

effect )ant treat negative symptom more than typical

antipsychotic drug .

Nursing intervention for side effect of antipsychotic drug

Side effectNursing interventionAnticholinergic effect :

-Dry mouthFrequent sips of water and sugarless candy or gum

-Urinary retention Check voiding, try to warm towel on abdomen. Consider catheterization if this does not work.

-constipationUse stool softener, assess for adequate water intake.

-photo sensitivity: Sever sunburn

Lower dose , use sunscreen and wear clothing on exposed area, use topical to relief

sunburn .

Side effectNursing intervention

Extrapyramidal Side Effects (EPS):

-pseudoparkinsonism

Decrease antipsychotic drug doses if possible, and add an anticholinergic drug(dopamine agonist)

)Patient must have good renal function to avoid amantadine (dopamine

agonist) toxicity.(

-Acute dystonic reactionAdminister antipsychotic drugs parentally rout work more rapidly than orally, have respiratory support equipment

available .

Side effectNursing intervention -AkathisiaHealth care provider may

change antipsychotic agent or give antiparkinsonian agent. Tolerance does not

develop to akathesia .

-Tardive dyskinesia (TD)Providing soft food, soft shoes for feet movement.

There is no treatment for TD (irreversible) especially if not discover early or cannot stop antipsychotic drugs.

Side effectNursing interventionCardiovascular side effect:

-Hypotension

Check blood pressure before giving , advise client to dangle feet before getting out of bed to prevent dizziness and falls.

Behavioral: - Sedation, fatigue:

Change to an antipsychotic drug with a lower sedation profile.

Side effectNursing interventionNeuroleptic malignant syndrome:

-Discontinue all drugs immediately.

-Maintain hydration with oral and IV fluid.

-Cool body to reduce fever.

-Correct electrolyte imbalance.

-Renal dialysis for renal failure.

Nursing Roles • Ensure the patient receives his

medication.• instruct the patient to continue to

take medication.• Reassure the patient that side effects

will be temporary and subside.• Assist client in acquiring knowledge

about medications.• Explain natures of and time span for

onset of therapeutic results.• Provide written and verbal instructions

to reinforce compliance.• -Including family members in

education process

minimize, identify and intervene in side effect experienced by patient as a result of their medication.

report occurrence of any of the side effect & complications to physician immediately.

Note :- the nurse should tell the pt and family about the medication side effect and complication and to know that the medication will take about month to take a therapeutic effect therefor it’s important to observe the pt from souside behavior

Summary • The antipsychotics drug are a group of medication

that use to treat psychosis ( that include schizophrenia , mania .. And reduce the negative and positive symptom

• It is classifcate to typical antipsychotic drug (that block D2 receptor )and atypical antipsychotic drug( that block 5-HT2 receptor more than D2 receptor)

• However each medication has many side effect when taken for a lengthy period this effect may produce physical illness like EPS wt gain …

• Nursing intervention may include care for clints treat with antipsychotics .

References • Psychatric Mental Health Nursing ,

Mohar , sixth edition

• Pharmacology For Nursing Care . Fifth edition

• Clinical Pharmacology For Nurses , John Trounce, 17 edition