Chlorpromazine ( Thorazine ) , are
prescribe primarily to for their efficacy in
decreasing psychotic symptoms . They do
not cure schizophrenia rather they are used
to manage symptoms.
Conventional antipsychotic medications are
These drugs are dopamine antagonists. They target positive
signs of schizophrenia such as delusions, hallucinations,
disturbed thinking and other psychotic symptoms.
Mellaril, Melleril, Novoridazine, Thioril
Nosinan, Nozinan, Levoprome
Droleptan, Dridol, Inapsine, Xomolix, Innovar (+Fentanyl)
Compazine, Stemzine, Buccastem, Stemetil, Phenotil
These drugs are dopamine and serotonin antagonists, they not
only diminish positive symptoms but also lessen the negative signs
of lack of volition and motivation, and social withdrawal.
Maintenance Therapy are available in
depot injection forms.
Two medications are available in depot injection
forms for maintenance therapy:
Fluphenazine (PROLIXIN) in decanoate
Haloperidol (HALDOL)in decanoate
The effects of medications are absorbed slowly over time
in the client’s system, the depot injection is sesame oil.
The effects of these medications last for 2-4 weeks,
eliminating the need for daily oral antipychotic medication.
The duration of action is 7-28 days for FLUPHENAZINE
4 weeks for HALOPERIDOL.
Serious neurologic side effects include :
Extrapyramidal side effects
Acute dystonic reactions
Parkinsonism/ Pseudo parkinsonism
Neuroleptic Malignant Syndrome
Extrapyramidal Side effects:
EPS are reversible movement disorders induced by
DYSTONIC reactions to antipsychotic medications appear
early in the course of treatment and are characterize by
spasms in discrete muscle groups such as the neck
muscles (Torticollis) or eye muscles (oculogyric crisis).
These spasms also may be accompanied by protrusion of
the tongue, dysphagia, laryngeal, pharyngeal spasms
that can compromise the client’s airway, causing medical
Acute treatment consists of diphenhydramine (Benadryl)
given either IM or IV, or Benzotropin (Cogentin) given IM.
includes shuffling gait, mask like
Facies, muscle stiffness or
cogwheeling rigidity and drooling.
Characterized by restless movement,
pacing, inability to remain still, and the
client’s report of inner restlessness.
Clients are very uncomfortable with
these sensations and may stop taking
the antipsychotic medication to avoid
these side effects.
Treatment: Betablockers such as
propanolol have been the most
effective in treating akathisia,
whereas Benzodiazepines have
provided some success as well.
A late appearing side effect of
antipsychotic medications, is
characterized by abnormal,
involuntary movements such as lip
smacking, tongue protrusion,
chewing, blinking, grimacing and
choreiform movements of the
limbs and feet.
These movements are
embarrassing for the clients and
may cause them to become more
socially isolated, decreasing or
discontinuing the medication can
arrest the progression.
has not been found to
cause this side effect,
so it often
clients who have
Screening clients for late appearing movement disorder – important!
ABNORMAL INVOLUNTARY MOVEMENT SCALE
* The client is observed for several positions
and the severity of symptoms is rated from 0-4.
* The AIMS can be administered every 3-6
If the nurse detects an increase in score on the
AIMS, indicating increased symptoms of tardive
dyskinesia, he or she should notify the physician
so that the client’s dosage of the drug can be
changed to prevent advancement of tardive
Seizures are an SEIZURE
infrequent side effect
associated with the
Seizures may be
associated with higher
doses of the
Treatment is a lowered
dosage or a different
Neuroleptic Malignant Syndrome
Is a serious and frequently
fatal condition seen in those
being treated with
Characterized by muscle
rigidity, high fever, increased
creatine phosphokinase), and
This can be treated by
medications. The clients ability
to tolerate other antipsychotic
medications after NMS varies
but use of another
antipsychotic appears possible
in most instances.
Clozapine has the potentially fatal
side effect of agranulocytosis
(failure of the bone marrow to
produce adequate white blood
Agranulocytosis suddenly develops
characterized by fever, malaise
ulcerative sore throat and
The drug must be discontinued
Must have weekly WBC counts.
• WBC must be assessed
weekly for the first 6
months of clozapine
therapy and every 2 weeks
• Clozapine is dispensed every
7-14 days only and evidence
of the WBC above
3000cells/mm3 is required
before a refill is furnished.