Bsc NURSING 3RD YR

2. Antipsychotics drugs are used to control psychosis,
which is the ability to perceive and interpret reality
accurately, think clearly, respond correctly and function
in a socially appropriate manner. Antipsychotic drugs
are also referred to as neuroleptics or major
tranquillizers

3. The antipsychotics are classified into two main categories they
are:
I. Typical or classical antipsychotics:
A)Phenatiazines
1. Aliphatics –chlorpromazine, triflupromazine
2. Piperidines- mesoridazine, thioridazine
3. Piperazine-fluphenazine, prochlorperazine, trifluoperazine
B)Thioxanthanes
1.Aliphatics-chlorprothixene
2. Piperazine-fluphentioxol, thiothexene

4. C) Butyrothenones- haloperidol, trifluperidol
D) Diphenylbutylpiperidines-
penfluridol,pimozede
E) Indolic derivatives-molindone
F) Dibenzozapines -loxapane

5. II. Atypical antipsychotic drugs: They are also called
“Novel antipsychotics”
A)Dibenzodiazepines-clozapine
B)Substituted benzamides-amisulpride, sulperide
C)Benzisoxales-hoperidone, paliperidone, resperidone
D)Benzisothiazolyi-ziprasidone
E)Thienobenzodiazepine-olanzapine
F) Dibentiazipine-quetiapine
G)Partial agonists-aripiparazone,bifeprounox
H)Dibenzothiepin-zotepine
I)Dibenzozapinopyrrone-asenapine

6.  The exact mechanism of action is not known. The
typical antipsychotics are thought to work by blocking
postsynaptic dopamine receptors in the basal ganglia,
hypothalamus, limbic system, brain stem and medulla.
 The atypical or novel anti psychotics may exert
antipsychotic properties by blocking action on
receptors specific to dopamine, serotonin and other
neurotransmitters

7. Organic psychotic disorders
 Delirium
 Dementia
 Delirium tremors
 Drug induced psychosis
Functional psychosis
 Schizophrenia
 Schizoaffective disorder
 Acute psychosis
 Mania
 Major depression
 Hypochondriasis

8. Childhood disorders
 Hyperactivity
 Autism
 Enuresis
 Conduct disorders
Neurotic disorders
 Anxiety
 OCD
 Anorexia nervosa
 Conversion disorder

9. Medical conditions
 Migraine
 Nausea and vomiting
 Hiccoughs
 Heat stroke
 Huntington’s chorea
 Tic disorders
 Severe pain

10.  When taken orally it is absorbed variably
from GI tract with uneven blood levels
 Highly bound to plasma proteins and
tissue protiens
 Brain concentration is higher than plasma
concentration
 Metabolised in liver and excreated
through the kidneys
 Action lasts for 6-8 hours
 Plasma half-life is 18- 30 hours

11. 1. Anticholinergic effects
a) Dry mouth: Provide the client with sugarless candy, ice, and
frequent sips of water and ensure that the client practices strict oral
hygiene
b) Blurred vision: Explain that symptom will most likely subside
after a few weeks and advise client not to drive until vision clears
c) Constipation: Order foods high in fiber; encourage increase in
physical activity and fluid intake if not contraindicated
d) Urinary retention: Instruct client to report any difficulty
urinating; monitor intake and output

12. 2.Nausea; GI upset: Tablets or capsules may be administered with
food to minimize GI upset
3.Skin rash: Report appearance of any rash on skin to the physician
and avoid spilling any of the liquid concentrate on skin
4.Sedation: Discuss with the physician the possibility of
administering the drug at bedtime and a possible decrease in
dosage or an order for a less sedating drug. Instruct client not to
drive or use dangerous equipment while experiencing sedation
5.Orthostatic hypotension: Instruct the client to rise slowly from a
lying or sitting position; monitor blood pressure (lying and
standing) each shift; document and report significant changes
6.Photosensitivity: Make sure that the client wears protective
sunscreens, clothing, and sunglasses while spending time outdoors

13. 7. Hormonal effects
a) Decreased libido; retrograde ejaculation; gynecomastia
(men): Provide an explanation of the effects and
reassurance of their reversibility
b) Amenorrhea (women)- Offer reassurance of reversibility,
and instruct the client to continue the use of contraception
as amenorrhea does not indicate cessation of ovulation
c) Weight gain: Weigh client every other day; order calorie
controlled diet, provide opportunity for physical exercise;
provide diet ad exercise

14. 8.Reduction of seizure threshold: Closely observe clients with
history of seizures.This is particularly important with clients taking
clozapine (Clozaril). Reportedly, seizures affect 1 to 5 percent of
individuals, who take this drug, depending on the dosage
9.Agranulocytosis: Relatively rare with most of the antipsychotiv
drugs except clozapine. Agranulocytosis occurs in 1 - 2 % of patients
taking clozapine and occurs during first 3 months of treatment.
Observe for symptoms of sore throat fever, and malaise. A complete
blood count should be monitored weekly if these symptoms appear
If the WBC count falls below 3000 mm3 or the granulocyte count
falls below 1500 mm3, clozapine therapy is discontinued. The disorder
is reversible if discovered in the early stages
10.Salivation (with c1ozapine): A significant number of clients
receiving clozapine (Clozaril) therapy experience extreme salivation.
Offer support to the client, as this may be an embarrassing situation.

15. 11.Extra pyramidal symptoms: Observe for symptoms and report;
administer anti parkinsonian drugs
a.Pseudoparkinsonism (tremor, shuffling gait, drooling, rigidity):
Symptoms may appear 1 to 5 days following initiation of
antipsychotic medication. They occur most often in women, the
elderly and dehydrated clients

16. b.Akinesia (muscular weakness)
c.Akathisia (continuous restlessness and fidgeting): This
occurs most frequently in women; symptoms may occur
50 to 60 days following initiation of therapy

17. d.Dystonia (involuntary muscular movements/spasms) of
face, arms, legs, and neck. This occurs most often in men and
in clients younger than 25 years of age

18. e.Oculogyric crisis (uncontrolled rolling back of the
eyes): This may appear as part of the syndrome
described as dystonia. It may be mistaken for seizure
activity. Dystonia and oculogyric crisis should be
treated as an emergency situation. The physician
should be contacted, and intravenous benztropine
(Cogentin) is commonly administered. Sit with the
client and offer reassurance and support during this
frightening time

19. f) Tardive dyskinesia (bizarre facial and tongue movements, stiff
neck, and difficulty swallowing)
 All clients receiving long - term (months or years) antipsychotic
therapy are at risk
 Symptoms are potentially irreversible
 Drug should be withdrawn at the first sign, which is usually
vermiform movements of the tongue: prompt action may prevent
irreversibility

20. g) Neuroleptic malignant syndrome
 This is rare, but potentially fatal complication of treatment with neuroleptic
drugs. Routine assessments should include temperature and observation for
Parkinsonian symptoms
 Onset can occur within hours or even years after drug initiation, and
progression is rapid over the following 24 to 72 hours
 Symptoms include severe Parkinsonian muscle rigidity, hyperpyrexia upto
107 F, tachycardia, tachypnea, fluctuations in blood pressure, diaphoresis,
and rapid deterioration of mental status to stupor and coma

21.  Discontinue neuroleptic medication immediately
 Monitor vital signs, degree of muscle rigidity, intake and
output, and level of consciousness
 The physician may order bromocriptine (Parlodel) or
dantrolene (Dantrium) to counteract the effects of neuroleptic
malignant syndrome

22.  Early observation and prevention of complications.
Limiting the complications are the main role of nurses.
 Close observation: - when antipsychotics are just started
look for possible side effects like:Extra pyramidal reaction
that is Parkinsonism, akathisia, dystonia and tardive
dyskinesia.
 Observe drowsiness: - medicine should be administered at
bed time. Report if the drowsiness persists for a very long
time. Observe for sore throat, fever due to agranulocytosis.
 Record blood pressure. If BP drops by 20 to 30 mm Hg
intervention should be done.

23.  Dry mouth may be reduced by encouraging the patient to
rinse his or her mouth frequently. Give a piece of lemon or
chewing gum. Good oral hygiene should be also
maintained.
 Blurred or impaired vision in patient causes anxiety and
annoyance to him. Blurred vision or brown colored vision,
night blindness can be permanent due to pigmentary
retinopathy.
 Weight record should be maintained. Encourage on a low
salt and planned caloric diet.

24.  The patient may complain of gastric irritation. He
should be discouraged to take antacids as there will be
decreased absorption of antipsychotic drugs.
 An intake and out put chart should be maintained
especially for male patient who is bedridden with
prostate hypertrophy. Encourage at least 2500 ml of
intake.
 The patient should be advised to protect his skin.
 Find out menstrual changes

25.  The patient should be explained not to increase or
decrease or stop taking drugs without discussing with his
doctor. The drugs should be withdrawn slowly to avoid
nausea or seizures.
 Explain to female patient that menstrual changes may
occur.
 Give reassurance to relatives that desired effect will be
achieved after weeks of medication.
 The patient should be made aware of the possibility of
dizziness and injuries after receiving medications and
injection due to orthostatic hypotension.

26.  Encourage frequent mouth wash.
 Explain that weight gain and sedation are the side
effects of drugs.
 Instruct to maintain intake and output.
 Instruct to avoid exposure to sunlight because of risk
of dermatitis.