anti psychotic drugs Brief overview of anti psychotic for nurses.

1. PRESENTED BY IHSAN DANISH RN 23
FACULTY ,, SIR KAMRAN ADIL
SUBJECT ,, MHN
PRESENTED TO SEMESTER 6TH STUDENTS
DATED ,, 27/09/2022

2. OBJECTIVES
 Define psychosis
 Definition of schizophrenia
 • Dopamine hypothesis
 • Pharmacological effects of antipsychotics
 Side effect
 • Adverse actions
 • Contraindication and cautions
 Nursing consideration
 • Drug drug interaction.
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3. psychosis
 Psychosis is when people lose some contact with reality. This might
involve seeing or hearing things that other people cannot see or
hear (hallucinations) and believing things that are not actually true
(delusions).
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4. schizophrenia
 Schizophrenia is a psychosis characterized by a clear
consciousness but a
marked thinking disturbance (delusion and hallucination) and
associated
with aggressiveness, agitated behavior (positive schizophrenics)
or with
emotional blunting, poor socialization, and cognitive deficit
(negative
schizophrenics).
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5. SCHIZOPHRENIA
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6. DOPAMINE HYPOTHESIS
 In general, they mostly act by blocking dopaminergic D2-receptors
in the mesocortical-mesolimbic area of the brain and as such the
disorders of schizophrenia and delusion are explained as hyperactivity
of dopamine neurotransmitter in the said area (dopamine hypothesis of
psychosis).

However, the hypothesis is far from complete or unequivocal and
involvement of other neurotransmitters like serotonin and aspartic acid
are gaining emphasis.
Besides their predominant effect on dopamine receptors, most of
the useful antipsychotics, particularly the old typical ones, also block
cholinergic muscarinic, histaminergic H1 and alpha-adrenergic receptors
and can produce wide range of pharmacological effects.
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7. Dopamine pathways
 Dopamine pathways are neuronal connections in which dopamine travels to
areas of the brain and body to convey important information such as executive
thinking, cognition, feelings of reward and pleasure, and voluntary motor
movements.
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8. Dopamine pathways
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9. Mesolimbic pathway
Project from the dopaminergic cell bodies in the
ventral tegmentum (brain stem) to the limbic
system.
 This pathways is where the positive symptoms
come from (hallucination , delusion, and thought
disorder).
 Problem herein a psychotic patient is there too
much dopamine.
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10. MESOCORTICAL PATHWAY
 Projects from the ventral tegmentum (brain stem) to
the cerebral cortex.
 This pathways is felt to be where the negative
symptoms and cognitive disorder (lack of executive
function) arise.
 Problem here for psychotic patient is too little
dopamine.
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11. NIGROSTRIATAL
 Project from the dopaminergic cell bodies in the
substantia nigra to the basal ganglia.
 This pathways is involved in movement regulation.
 Remember that the dopamine suppresses acetylcholine
activity.
 Dopamine hypoactivity can cause parkinsonism i.e.
rigidity bradykinesia , tremors, akathisia, and dystonia.
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12. TUBEROINFUNDIBULAR
 Projects from the hypothalamus to the anterior pituitary.
 Remember that dopamine release inhibits/regulates prolactine
release.
 Blocking dopamine in this pathway will predispose your patient to
hyperprolactemia
 (gynecomastia ,glalactorrhea ,decrease libido /menstrual
dysfunction).
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13. CLASSES OF ANTIPASYCHOTICS
Fist generation (CONVATIONAL)
•High potency or low potency
Second generation (ATYPICAL)
•ATYPICAL ANTI PSYCHOTIC
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14. FIRST GENERATION
(low potency)
0
 Also called conventional
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CHLOPROMAZINE
•Generic name
THIORIDAZINE
•Generic only

15. First generation
(high potency)
Generic name Brand name DOSE
mg/day
fluphenazine Generic only 50-20
Haloperidol HALDOL 1-10
LOXAPINE Generic only 60-100
MOLINDONE Generic only 5-50
PHERPHENAZINE Generic only 50-300
PIMOZIDE ORAP 5
PROCHLORPERAZINE COMPRO,PROCOMP 30-60
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16. SECOND GENERATION (ATYPICAL)
GENERIC NAME BRAND NAME DOSE
ARIPIPRAZOLE ABILIFY,ARISTADA 10-15mg/day
ASESNAPINE SAPHRIS 800,mg/day
BREXIPIPRAZOLE REXULTI 1-4mg/day
CARIPRAZINE VRAYYLAR 1.5-6mg/day
CLOZAPINE CLOZARIL,FAZACL
O
300-900mg/day
ILOPERIDONE FANAPT 2-24mg/day
LURASIDONE LATODA 2-24mg/day
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17. MECHANISIM OF ACTION
 The first-generation antipsychotics work by inhibiting dopaminergic
neurotransmission; their effectiveness is best when they block about 72% of the D2
dopamine receptors in the brain. They also have noradrenergic, cholinergic, and
histaminergic blocking action.
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18. M O A
 Second-generation antipsychotics work by blocking D2 dopamine
receptors as well as serotonin receptor antagonist action. 5-HT2A
subtype of serotonin receptor is most commonly involved.
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19. PHARMACOLOGICAL EFFECTS OF
ANTIPSYCHOTICS
 1. Antipsychotic—By suppression of D2-receptors produce relief of
schizophrenia. It is the fundamental weapon against schizophrenia.
 2. Antiadrenergic effects—Some antipsychotics can block α1-receptors
and can produce orthostatic hypotension.
 3. Antiserotoninergic action—Particularly Clonazepine has strong
5-HT
2 blocking effect.
 4. Antihistaminic action.(sedation)
 5. Antimuscarinic action—It is produced by blocking the muscarinic
receptors.
 6. Antiemetic action—It is due to DA blocking effect chiefly in CTZ.

7. Quinidine like action—Thioridazine can cause ECG abnormalities ventricular
arrhythmias or heart block even sudden cardiac death.
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20. PHARMACOLOGICAL EFFECTS OF
ANTIPSYCHOTICS
 8. Arrhythmic action—Sertindole causes prolongation of QT wave in
 ECG and thus can cause dangerous cardiac arrhythmia.
 9. Local anesthetic action.
 10. Diuretic effects.
 12. Antipruritic effects—Promethazine HCl is used chiefly against
allergic conditions – Antipruritic effect.(inhibit the itching)
 13. Anticonvulsant effects is seen in eclampsia.
 14. Preanesthetic medication—It is due to antimuscarinic + antiemetic
+ antihistaminic effects
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21. SIDE EFFECT
Neuroleptic Malignant Syndrome (NMS)
 Hyperthermia, muscular rigidity, tachycardia, hyper or hypotension,
autonomic instability, rhabdomyolysis, confusion
 Increased creatine phosphokinase and leukocytes
 More common in first weeks of treatment
 Increased risk with higher doses, multiple drugs, male, and young
 Can lead to loss of consciousness and death
 Misdiagnosis: catatonia, EPS, serotonin syndrome, infectious disease
 Supportive management and stop drug
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22. ADVERSE REACTIONS
Origin +adverse effect MECHANISM
CNS
Akathisia
It is an uncomfortable motor restlessness
like parkinsonism
It occurs due to conventional drugs.
Urinary retention Antimuscarinic action
Loss of libido in
males
cause decrease of sex appetite
(libido) and gynecomastia while in
female it causes galactorrhea and
amenorrhea
Cholestatic jaundice Due to hypersensitivity reaction
Galactorrhea
Hyperprolactinemia. Hyperprolac
tinemia in the male can
amenorrhea
Due to DA blockade by neuroleptics
leads to
B. CVS—Orthostatic hypotension and fall of BP alpha blocking action
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23. CONTRAINDICATIONS AND CAUTIONS
 Antipsychotics should be used with caution in patients with—
 1. Hepatic disease
 2. Cardiovascular disorder
 3. Glaucoma
 4. Brain damage
 5. History of seizure
 6. Elderly patients
 7. Pregnant women
 8. Lactating mother. It is contraindicated in children with CNS infection,
chickenpox, gastroenteritis and dehydration.
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24. DRUG INTERACTION
 1. Chlorpromazine + Riboflavin = increased urinary
excretion of
riboflavin due to metabolic inhibition of riboflavin.
2. It (Chlorpromazine) reverses the Amphetamine-induced
psychosis.
3. Chlorpromazine + ACE inhibitor = Severe postural
hypotension.
4. It potentiates the CNS depression by alcohol and sedative
hypnotic.
5. Anticholinergic action is potentiated if it is
coadministered with
Atropine.
6. Decrease the hypoglycemic effect of antidiabetics.
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25. Nursing consideration
 Elderly patients with dementia-related psychosis treated
with antipsychotic drugs should be closely monitored for
signs and symptoms of cardiovascular events or infections
such as pneumonia.
 Haloperidol is contraindicated in patients with Parkinson’s
disease or dementia with lewy bodies.
 Patients who are concurrently taking lithium and
antipsychotics should be monitored closely for
neurotoxicity (weakness, lethargy, fever, tremulousness,
confusion, and extrapyramidal symptoms) and symptoms
should be immediately reported.
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26. Nursing consideration
 Assess for the mentioned cautions and contraindications
(e.g. drug allergies, CNS depression, CV disorders, glaucoma,
respiratory depression, etc.) to prevent any untoward
complications.
 Perform a thorough physical assessment (other
medications taken, CNS, skin, respirations, and laboratory
tests like thyroid, liver, and renal functions tests and
complete blood count or CBC) to establish baseline data
before drug therapy begins, to determine effectiveness of
therapy, and to evaluate for occurrence of any adverse
effects associated with drug therapy.
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