Anti-Psychotics

Subject: Mental Health (Theory)

Overview

Other names for antipsychotic medications include schizophrenic medications, D2 receptor blockers, strong tranquilizers (since some of them can sedate and tranquilize), and neuroleptics (because they have neurological adverse effects). However, the term "antipsychotic" is the most suitable. Since their introduction, these treatments have significantly enhanced the quality of life for patients with schizophrenia, but they do not treat the condition. Dopamine receptor antagonists and serotonin-dopamine antagonists are two categories of antipsychotic medications. The adverse effects of these medications include parasympathetic paralysis of the cranial nerve system (PNS), impaired vision, constipation, nausea, skin rashes and dermatitis, galactorrhea, dystonia, sedation, and others. Antacid use should be discouraged in order to reduce the absorption of antipsychotic medications. Tell the patient to keep using contraception because amenorrhea does not mean ovulation has stopped. Patients with a history of seizures should be watched carefully. In the event of a seizure, antipsychotic medication may need to be stopped.

Other names for antipsychotic medications include schizophrenic medications, D2 receptor blockers, strong tranquilizers (since some of them can sedate and tranquilize), and neuroleptics (because they have neurological adverse effects). However, the term "antipsychotic" is the most suitable.

Since the middle of the 1950s, antipsychotic medicines have been accessible. Since their introduction, these treatments have significantly enhanced the quality of life for patients with schizophrenia, but they do not treat the condition.

Indications

  • Functional
    • Schizoaffective disorders
    • Schizophrenia
    • Paranoids disorders
  • Organic psychiatric disorder
    • Delirium
    • Dementia
    • Delirium tremens
    • Drug-induced psychosis
  • Mood disorder
    • Mania
    • Major depression with psychotic symptoms
  • Childhood disorder
    • Attention deficit hyperactivity disorder
    • Autism
    • Conduct disorder
    • Enuresis
    • Neurotic and other physical disorders
    • Mental disorder with behavioral problem
  • Medical disorder
    • Intractable hiccough
    • Nausea and vomiting
    • Tic disorder
    • Eclampsia
    • Severe pain in malignancy
    • Tetanus

Mechanism of action

Unknown is the precise mechanism of action. These medications are thought to function by obstructing dopamine receptors in the brain's dopamine pathways. Dopamine produced along these routes therefore has less of an impact. The suppression of dopamine-mediated transmission of brain impulses at synapses may also contribute to antipsychotic effects. The excess dopamine activity in the brain that leads to schizophrenia is suppressed by blocking the receptors. The dopamine treatment consists of these two essential elements:

  • Psychosis is induced by increased levels of dopamine activity
  • Most antipsychotic drugs block synaptic dopamine receptors

Alpha-adrenergic blockade, anti-dopaminergic activities on basal ganglia, and sedative medications like chlorpromazine and thioridazine are what produce sedation. Atypical antipsychotics have effects on the 5-HT receptor, the adrenergic system, and the histaminergic system.

Classification of anti-psychotic drugs

  • Dopamine receptor antagonist:
    • The dopamine antagonists include the older antipsychotic drugs such as haloperidol (Haldol), chlorpromazine (Thorazine), and fluphenazine (Prolixin).
  • Serotonin-dopamine antagonists:
    • The serotonin dopamine antagonists also called atypical antipsychotics are newer medications that include clozepine (clozaril), risperidence ( risperdal), and olanzapine (zyprexa).

Daily adult dosage of antipsychotic drugs

  • Chlorpromazine= 300-1500 mg/day
  • Thioridazine= 300-800 mg/day
  • Haloperidol= 15-16 mg/day
  • Pimozide= 4-12 mg/day
  • Triflupromazine= 100-400 mg/day
  • Prochlorperazine= 15-150 mg/day
  • Flupenthixol= 3-10 mg/day
  • Loxapine= 25-100 mg/day
  • Colzapine= 25-450 mg/day
  • Resperidone= 2-8 mg/day

Nursing intervention

Side effects:

  • Peripheral nervous system (PNS) effects are result of blocking of cranial nervous with parasympathetic components.
  • Blurred vision
  • Constipation
  • Nausea
  • Skin rashes and dermatitis
  • Sedation
  • Tachycardia
  • Retrograde ejaculation
  • Enlarged breast in men and women
  • Menstrual dysfunction
  • Galactorrhea
  • Weight gain
  • Seizure
  • Akinesia
  • Dystonia
  • Oculogyric
  • Torticollis
  • Writer's cramp
  • Akathisia

Nursing Implications:

  • Encourage the patient to sip water often.
  • Inform the patient to refrain from doing anything risky.
  • If it's not contraindicated, promote high dietary fiber consumption and increased hydration intake.
  • Increase your physical activity.
  • When a desire strikes, encourage frequent urination and restraint.
  • Antacid use should be discouraged in order to reduce the absorption of antipsychotic medications.
  • A contact dermatitis may result from spilling any of the liquid concentrates on your skin.
  • Encourage the patient to take sun protection precautions.
  • Give the patient the advice to avoid operating risky machinery or driving while sedated.
  • Explain the effects and reassure the audience that they are reversible.
  • Boost patient's confidence.
  • Tell the patient to keep using contraception because amenorrhea does not mean ovulation has stopped.
  • Patient with weight every other day.
  • Patients with a history of seizures should be watched carefully. In the event of a seizure, antipsychotic medication may need to be stopped.
  • Keep an eye out for signs of a fever, lethargy, and a sore throat. If any, report it to the doctor.
  • If these symptoms manifest, the complete blood count should be tracked.
  • Verify if the patient is getting pacitane. 2 mg of pacitane may be used for mild EPS.
  • Examine the three main symptoms of parkinsonism: stiffness, drooling, and tremors.
  • Stop taking neuroleptics.
  • When the patient is experiencing this terrifying period, stay by their side and provide comfort and support.
  • Keep track of intake, output, and level of awareness.
  • Regularly check for tremor, stiffness, and other related system issues.
Things to remember
  • Antipsychotic drugs are also called major tranquilizers ( because some of them can tranquilize and sedates) and neuroleptics ( as they produce neurological side effects), schizophrenics drugs, and D2 receptors blockers, but the term antipsychotic is the most appropriate.
  • These drugs have greatly improved the lives of patients with schizophrenia since their first development , but these medications do not cure the disease.
  • Classification of antipsychotic drugs are dopamine receptor antagonist and serotonin-dopamine antagonists.
  • The side effects of this drugs are peripheral nervous system (PNS) effects are result of blocking of cranial nervous with parasympathetic components,blurred vision, constipation,nausea,skin rashes and dermatitis,galactorrhea,menstrual dysfunction,dystonia,sedation, etc.
  • Patient should be discouraged to take antacids and there will be decreased absorption of antipsychotic drugs.
  • Instruct patient to continue use of contraception as amenorrhea does not indicate cessation of ovulation.
  • Closely observe patients with a history of seizures. If a seizure occurs discontinuing antipsychotic may be necessary.
Questions and Answers

Classification of antipsychotic drugs

  • Older antipsychotic medications including haloperidol (Haldol), chlorpromazine (Thorazine), and fluphenazine are dopamine receptor antagonists (Prolixin).
  • Anti-serotonin-dopamine drugs: The more recent drugs, known as atypical antipsychotics or serotonin dopamine antagonists, include clozepine (Clozaril), risperidence (Risperdal), and Olanzapine (zyprexa).

Adult daily antipsychotic medication dose

  • 300–1500 mg of chlorpromazine per day
  • 300-800 mg/day of thioridazine
  • 15–16 mg of haloperidol per day
  • 4–12 mg/day of pimozide
  • 100–400 mg of triflupromazine per day
  • 15–150 mg/day of prochlorperazine
  • 3–10 mg of flupenthixol per day
  • 25-100 mg/day of loxapine
  • 25–450 mg/day of colzapine
  • 2–8 mg/day of resperidone
  • Effects on the peripheral nervous system (PNS) are caused by parasympathetic components obstructing the cranial neural system.
  • Distorted vision
  • Constipation
  • Nausea
  • Dermatitis and skin eruptions
  • Sedation
  • Tachycardia
  • Backward ejaculation
  • Male and female breast enlargement
  • Dysfunctional menstruation
  • Galactorrhea
  • Gaining weight
  • Seizure
  • Akinesia
  • Dystonia
  • Oculogyric
  • Torticollis
  • Author's cramp
  • Akathisia
  • Encourage the patient to sip water often.
  • Inform the patient to refrain from doing anything risky.
  • If it's not contraindicated, promote high dietary fiber consumption and increased hydration intake.
  • Increase your physical activity.
  • When a desire strikes, encourage frequent urination and restraint.
  • Antacid use should be discouraged in order to reduce the absorption of antipsychotic medications.
  • A contact dermatitis may result from spilling any of the liquid concentrates on your skin.
  • Encourage the patient to take sun protection measures.
  • Give the patient the advice to avoid operating risky machinery or driving while sedated.
  • Explain the effects and reassure the audience that they are reversible.
  • Give the patient reassurance.
  • Tell the patient to keep using contraception because amenorrhea does not mean ovulation has stopped.
  • Patient with weight every other day.
  • Patients with a history of seizures should be watched carefully. In the event of a seizure, antipsychotic medication may need to be stopped.
  • Keep an eye out for signs of a fever, lethargy, and a sore throat. If any, report it to the doctor.
  • If these symptoms manifest, the complete blood count should be tracked.
  • Verify if the patient is getting pacitane. 2 mg of pacitane may be used for mild EPS.
  • Examine the three main symptoms of parkinsonism: stiffness, drooling, and tremors.
  • Stop taking your neuroleptics.
  • When the patient is experiencing this terrifying time, stay by their side and provide comfort and support.
  • Keep track of your intake, output, and level of awareness.
  • Regularly check for tremor, rigidity, and other similar system issues.

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