This document discusses antipsychotic medications and their use, side effects, and management. It covers both typical and atypical antipsychotics, their mechanisms of action, indications, contraindications, interactions, nursing diagnoses, and common side effects including extrapyramidal symptoms. It also reviews antiparkinsonian medications used to treat drug-induced extrapyramidal reactions.

1. Himalayan College of Nursing
Presenter: Mr. Muthuvenkatachalam S., D.Pharm, M.Sc (AIIMS), PhD Scholar (RGUHS)
Antipsychotic
agents

2. Classification
• 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

3. Indications
• Acute and chronic psychoses, particularly
when accompanied by increased
psychomotor activity.
• Selected agents used as antiemetics
(Chlorpromazine, perpohenazine,
prochlorperazine)
• Interactable hiccoughs (chlorpromazine,
perphenazine)
• Tics and vocal utterances in Tourette’s
disorder (haloperiod, pimozide)

4. 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, sertonin, and other
neurotransmitters.
• Inhibition of Dopamine mediated
transmission of neural impulses

5. Contraindications
• Known hypersensitity
• Should not be used when CNS depression is
evident.
• Blood dyscrasias
• Parkinson’ disease
• Liver/renal/cardiac insufficiencies.
Caution:
• Elderly, severely ill or debilitated
• Diabetic, respiratory insufficiency, prostatic
hypertrophy, or intestinal obstruction.
• Safety in pregnancy and lactation has not been
established.

6. Interactions
• Additive anticholinergic effects are observed when
antipsychotics are taken concurrently with other
drugs that produce these properties.
• Additive hypotensive effect with beta-adrenergic
blockers.
• Antacids and antidiarrheals may decrease
absoption of antipsychotics.
• Barbiturates may increase metabolism and
decrease effectiveness of antipsychotics.
• Additive CNS depression with alcohol, sedative
hypnotics and anxiolytics.

7. Nsg diagnosis
• Risk for other-directed violence related t
panic anxiety and mistrust of others.
• Risk for injury related medication side effects
• Risk for activity intolerance related to
medication side effects of sedation, blurred
vision and weakness
• Noncompliance with medication regimen
related to suspiciousness and mistrust of
others.

8. Side effects
• Anticholinergic effects
– Dry mouth
– Blurred vision
– Constipation
– Urinary retention
• Nausea
• Skin rash
• Sedation
• Orthostatic hypotension
• Photosensitivity
• Hormonal effects
– Decreased libido, retrograde ejaculation,
gynecomastia, Amenorrhea, weight gain.

9. Side effects (contd..)
• 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.
• Hypersalivation (clozapine)

10. Extrapyramidal
symptoms (EPS)
• Pseudoparkinsonism
– Tremor, shuffling gait, drooling, rigidity.
– 1-5 days after initiation of antipsychotics
• Akinesia
• Akathisia (50-60 days after initiation of therapy)
• Dystonia
– Men; <25
• Oculogyric crisis
– Treated as emergency
– Physician should be contacted immediately
– IV benztropine mesyulate
• Tardive dyskinesia

11. Side effects (contd..)
• Neuroleptic malignant syndrom (NMS)
– Severe parkinsonian muscle ridigidity
– Upto 1070
C, tachycardia, tachypnea
– Fluctuations in blood pressure, diaphoresis, and
rapid deterioration of mental status to stupor and
coma.
– This is rare but potentially fatal complication of
treatment with neuroleptic drugs.
– Within hours – year after drug initiation.]
– Discontinue neuroleptic immediately.
– Bromocryptine or dantrolene

12. Antiparkinsonian agents
• Anticholinergics
– Benztropine: 0.5-9mg
– Biperiden: 2-8 mg
– Procyclidine: 5-20 mg
– Trihexyphenidyl: 1-15 mg
• Antihistamines:
– Diphenhydramine: 10-400 mg
• Dopaminergic agents:
– Amantadine: 200-400 mg
– Bromocriptine: 10-40 mg

13. Indications
• Indicated for the treatment of all forms of
parkinsonism and for the relief of drug-
induced extrapyramidal reactions.

14. Actions
• Restoring the natural balance of two major
neurotransmitters in the CNS: Ach,
Dopamine.
• Deficiency in dopamine results in
excessive cholinergic activity.
• Anticholinergics or dopaminergic agonists.

15. Contraindications/precaut
ions
• Hypersensitity
• Angle-closure glaucoma
• Pyloric or duodenal obstruction
• Peptic ulcers,
• Prostatic hypertrophy
• Bladder neck obstruction, megacolon.
• Myasthenia gravis.
Caution
– Tachycardia, cardiac arrhythmias, hypertension,
hypotension, and tendency toward urinary retention.
– Elderly, hepatic/renal/cardiac insufficiency

16. Side effects
• Anticholinergic effects
– Dry mouth, blurred vision, constipation,
paralytic ileus, Urinary retention, tachycardia
• Nausea, GI upset
• Sedation, drowsiness, dizziness.
• Exacerbation of psychoses.
• Orthostatic hypotension.