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Antipsychotics, antipsychotic drugs, major tranquilizers, tranquilizers

introduction, indication, contraindications and side effects of antipsychotic drugs are explained.
Antipsychotic drugs used in the treatment of schizophrenia including psychosis is described.
Chlorpromazine, Clozapine

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Antipsychotics, antipsychotic drugs, major tranquilizers, tranquilizers

  1. 1. Himalayan College of Nursing Presenter: Mr. Muthuvenkatachalam S., D.Pharm, M.Sc (AIIMS), PhD Scholar (RGUHS) Antipsychotic agents
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 13. Indications • Indicated for the treatment of all forms of parkinsonism and for the relief of drug- induced extrapyramidal reactions.
  14. 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. 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. 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.

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