Transcript Anti-psychotic Meds (CC)

Mental Health Nursing:
Pharmacology: Antipsychotic
Medications
C. Calzolari
2016
Antipsychotic Medications
 Antipsychotic medications treat the s/s of psychotic illnesses
such as schizophrenia, manic and delusional disorders.
 These drugs do not cure psychotic illnesses: they are effective
in managing symptoms as long as the patient takes them
consistently.
 There are many adverse side effects with this class of
medication.
 2 categories:
 Typical (First Generation) Antipsychotics (Neuroleptics)
 Atypical (Second Generation) Antipsychotics (Neuroleptics)
Typical Antipsychotic Medications
Phenothiazines
Phenothiazine –Type Drugs
Non phenothiazine Drugs
What is Phenothiazine?
Phenothiazine is an organic compound.
Its derivatives are used as antipsychotics.
They also have antiemetic properties.
They control the symptoms by blocking the
transmission of dopamine.
They have strong sedative properties.
Side Effects of Phenothiazine Derivatives
 Anticholinergic effects
 Sedation
 Hypotension
 Sexual Dysfunction
 Agranulocytosis
 Neuroleptic Malignant Syndrome (rare)
 Photosensitivity
 Extrapyramidal symptoms (EPS)
EXTRA… WHAT?!?!
Extrapyramidal symptoms (EPS) include:
Dystonia
Akathisia
Parkinsonism
Tardive Dyskinesia
Anticholinergic Effects
Typical symptoms include dry mouth,
constipation, urinary retention, bowel
obstruction, dilated pupils, blurred vision,
increased heart rate, and decreased
sweating.
Other symptoms that affect the CNS are:
impaired concentration, confusion,
attention deficit, and memory impairment.
Neuroleptic Malignant Syndrome
The combination of  Diaphoresis
hyperthermia, rigidity,  Dysphagia
 Tremor
and autonomic
 Incontinence
dysregulation that can  Delirium progressing to coma
occur as a rare but
 Labile blood pressure
serious complication  Pallor
of the use of
 Dyspnea
antipsychotic drugs.  Psychomotor agitation



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Rigidity
Hyperthermia
Tachycardia
Shuffling gait
FDA WARNING
In April 2005, FDA has alerted healthcare
professionals that both typical and atypical
antipsychotics are associated with an
increased risk of mortality in elderly
patients treated for dementia –related
psychosis.
Antipsychotics are not indicated for the
treatment of dementia-related psychosis.
Black Box Warnings
Patients with dementia-related psychosis
who are treated with antipsychotic drugs
are at increased risk for death, as shown
in short-term controlled trials; deaths in
these trials appeared to be either
cardiovascular (eg, heart failure, sudden
death) or infectious (eg, pneumonia) in
nature
This drug is not approved for treatment of
patients with dementia-related psychosis
Phenothiazines
Phenothiazine –Type Drugs
Thorazine (chlorpromazine)- introduced in
1954.
Permitil, Prolixin (fluphenazine)
Serentil (mesoridazine besylate)
Phenazine, Trilafon (perphenazine)
Prozine, Sparine (promazine)
Mellaril (thioridazine)
Stelazine (triflouperazine)
Phenothiazines
Phenothiazine –Type Drugs
 Thorazine is the oldest antipsychotic drug approved by
the FDA in 1954.
 Prolixin can cause photosensitivity.
 Mellaril is not to be taken if a person has irregular EKGs
and is on CVS drugs. This drug is not used as a first line
medicine.
 All drugs in the phenothiazine family should be used
with caution for patients with cardiovascular, liver or
renal disease.
 These drugs are not to be used along with CNS
depressants (this includes ETOH).
Non-phenothiazine Drugs
Taractan (chloroprothixene)
Haldol (haloperidol)
Loxitane (loxapine succinate)
Moban (molindone HCL)
Orap (pimozide)
Navane (thiothixene)
Non-phenothiazine Drugs
3rd category of TYPICAL antipsychotics
 This class of drugs was introduced with the hope that
there would be less side effects.
 Unfortunately, the side effects of nonphenothiazines are
identical to those of phenothiazines.
 They may have less sedative effects and less anticholinergic effects, BUT there is a higher incidence of
EPS symptoms.
 Orap is used for Tourette’s disorder.
Atypical Antipsychotic Medications
2nd generation of antipsychotics
Clozaril (clozapine) –1st introduced in 1990.
Abilify (aripiprazole)
Zyprexa (olanzapine)
Seroquel (quetiapine fumarate)
Risperdal (risperidone)
Geodon (ziprasidone)
Atypical Antipsychotic Medications
 Although the claims are that this class of
antipsychotics cause less side effects, there are still
significant ones to be aware of:
Neuroleptic Malignant Syndrome
Tardive Dyskinesia – can be irreversible
Significant weight gain
Altered temperature regulation
Orthostatic hypotension
Increased glucose levels
CVA in the elderly
High cholesterol and triglyceride levels
Myocarditis and agranulocytosis with Clorazil
Irregular heart rhythms with Geodon
Increased Prolactin Levels
Seen with Typical and some atypical (esp.
Risperdal) antipsychotics.
Clinical manifestations of
prolactin
levels:
Menstrual irregularities
Sexual dysfunction
Tender breasts
OP
Weight Gain
Other Side Effects:
Sedation
Orthostatic Hypotension
Weight Gain
Patient Education
 These drugs have many interactions with other
drugs.
 Instruct the patient to keep a list of all
prescription and non-prescription drugs,
including herbs, supplements, teas, etc.
 Many of these drugs require frequent blood tests
and MD visits.
 These drugs do not cure the disease. The
patient must continue taking them even if they
feel better.
 Teach patient how to recognize symptoms of
EPS and NMS.
Patient Education
 The patient must inform the physician before
undergoing any procedure or surgery that
involves CNS depressants.
 The patient should not consume ETOH or street
drugs while taking these medications.
 Monitor caffeine use.
 Teach patient to avoid extreme temperatures.
 Teach the patient how to avoid orthostatic
hypotension.