antipsychotics are the psychotropic drugs that helps in reducing and controlling the psychotic symptoms.

2. ANTIPSYCHOTICS

3. COLLEGE OF NURSING BERHAMPUR
Presented by: SMRUTIREKHA PARIDA
MSc nursing
ANTIPSYCHOTICS

4.  Antipsychotics are those psychotropic drugs, which are used
for the treatment of psychotic symptoms. These are also
known as neuroleptic drugs as they produce neurological
side effects, major tranquilizers, d2 receptor blockers and
anti-schizophrenic drugs.
 Antipsychotic medications cannot cure the illness, but they
can take away many of the symptoms or make them milder.

5. HISTORY
The first antipsychotic medications were introduced in the
1950s. The early antipsychotic medications often have
unpleasant side effects, such as muscle stiffness, tremor and
abnormal movements, leading researchers to continue their
search for better drugs.

6. The 1990s saw the development of several new drugs for
schizophrenia, called atypical antipsychotics. Because they
have fewer side effects than the older drugs, today they are
often used as a first line treatment.
In clinical trials, atypical antipsychotics were found to be
more effective than conventional or typical antipsychotic
medications in individuals with treatment resistant
schizophrenia.

7. CLASSIFICATIONS OF
ANTI-PSYCHOTICS

8. PHARMACOKINETICS
 Antipsychotics when administered orally are absorbed
variably from the gastrointestinal tract, with uneven blood
levels.
 They are highly bound to plasma as well as tissue proteins.
They easily enter areas with good blood supply such as brain,
lungs, kidneys, and fetus and accumulate there. They are not
dialyzable. Brain concentration is higher than plasma
concentration.
 They are metabolized in the liver and excreted mainly
through the kidneys. The elimination half-life varies from10-
24 hours

9.  Most of the antipsychotics tend to have a therapeutic
window. If the blood level is below this window, the
drug is ineffective. If the blood level is higher than the
upper limit of the window, it results in toxicity or the
drug is again ineffective

10. MECHANISM OF ACTION
Antipsychotic drugs block d2 receptors in the mesolimbic and
mesofrontal systems (concerned with emotional reactions).
Sedation is caused by alpha adrenergic blockade.
Anti-dopaminergic actions on basal ganglia are responsible
for causing EPS.

11. Atypical antipsychotics have antiserotonergic (5-
hydroxytryptamine or 5HT) antiadrenergic and
antihistaminergic actions. These are therefore, called as
serotonin-dopamine antagonists. These include Risperidone,
Quetiapine, olanzapine, amisulpride, Paliperidone, zotepine,
ziprasidone and Aripiprazole.

12. Clozapine is one such drug but it can cause agranulocytosis
and seizures.
Risperidone, olanzapine, Quetiapine, aripiprazole,
amisulpride and ziprasidone are currently being used widely as
typical antipsychotics, while paliperidone and zotepine are
also available in international market

17. INDICATIONS
Organic psychiatric disorders
 Delirium
 Dementia
 Delirium tremens
 Drug-induced psychosis
 other organic mental disorders

18. Non-organic psychotic disorders
Schizophrenia
Schizoaffective disorders
Paranoid disorders
Mood disorders
Mania
Major depression with psychotic symptoms

19. Childhood disorders
Attention deficit hyperactivity disorder
Autism
Enuresis
Conduct disorder
Neurotic and other psychiatric disorders
Anorexia nervosa
Intractable obsessive compulsive disorder
Severe, intractable and disabling anxiety

20. Medical disorders
Huntington’s chorea
Intractable hiccough
Nausea and vomiting
Tic disorder
Eclampsia
Heat stroke
Severe pain in malignancy
Tetanus

21. Contraindications
Liver damage
Coronary artery disease
Cerebrovascular disease
Parkinsonism
Bone marrow depression
Severe hypotension or hypertension
Coma
Severely depressed state

23. NURSE’S RESPONSIBILITY FOR A PATIENT RECEIVING
ANTIPSYCHOTICS
Instruct the patient to take sips of water frequently to
relieve dryness of mouth. Frequent mouth washes, use of
chewing gums, applying glycerin on the lips are also helpful.
A high fiber diet, increased fluid intake and laxatives, if
needed, help to reduce constipation.

24. Advise the patient to get up from the bed or chair very slowly.
Patient should sit on the edge of the bed for one full minute
dangling his feet, before standing up. Check BP before and
after medication is given. This is an important measure to
Differentiate between akathisia and agitation and inform the
physician. A change of drug may be necessary if side effects
are severe. Administer antiparkinsonian drugs as prescribed.
prevent falls and other complications resulting from
orthostatic hypotension.
Take all seizure precautions.

25. Patient should be warned about driving a car or operating
machinery when first treated with antipsychotics. Giving the
entire dose at bed time usually eliminates any problem from
sedation.
Advise the patient to use sunscreen measures (use of full
sleeves, dark glasses etc.) for photo sensitive reactions.
Teach the importance of drug compliance, side –effects of
drugs and reporting if too severe, regular follow ups. Give
reassurance and reduce unfounded fears and anxieties.

26. A patient receiving clozapine at risk for developing
agranulocytosis. Monitor TLC and DC essentially in the first few
weeks of treatment. Stop the drug if the WBC count drops to
less than 3000/mm3 of blood. The patient should also be told
to report if sore throat or fever develop, which might indicate
infection.
Seizure precautions should also be taken as clozapine reduces
seizure threshold. The dose should be regulated carefully and
the patient may also be put on anti- convulsants such as
eptoin.