This is the outline of antipsychotic drugs, their mechanism of action, doses, indications, and contraindication which will help students to understand clearly.

2. ANTIPSYCHOTIC DRUGS
PRESENTED BY
Baishakhi Das
1st Year M.Sc Nursing Student
Apollo Gleneagles Nursing College

3. PSYCHOSIS
These are severe psychiatric illness with serious distortion of
thought, behaviour and capacity to recognise reality and of
perception (delusions and hallucinations). There is
inexplicable misperception and misevaluation; the patient is
unable to meet the ordinary demands of life.

4. SYMPTOMS OF PSYCHOSIS
SOCIAL &
OCCUPATIONAL
DYSFUNCION
NEGETIVE SYMPTOMS
Affective Flattening
Attentional Deficit
Alogia
Apathy
Anhedonia
MOOD SYMPTOMS
Dysphoria
Suicidality
Hopelessness
POSITIVE SYMPTOMS
Delusions
Hallucinations
Thought disorders
Disorganised Speech
Bizarre Behaviour
COGNITIVE SYMPTOMS
Memory
Decision making
Problem solving
Abstraction

5. ANTIPSYCHOTIC DRUGS
Antipsychotic drugs (also called neuroleptics or major tranquilizers)
are used primarily to treat schizophrenia (a biologic illness), but they
are also effective in other psychotic states, including manic states with
psychotic symptoms such as grandiosity, paranoia, and hallucinations,
and delusions.
Antipsychotic drugs are not curative and do not eliminate the chronic
thought disorder, but they often decrease the intensity of hallucinations
and delusions and permit the person with schizophrenia to function in
a supportive environment.

6. MECHANISM OF ACTION
OF
ANTIPSYCHOTIC DRUGS
Most antipsychotic drugs bind to D2 dopamine receptors and block
the action of dopamine. However, drug binding to the receptors
does not account for antipsychotic effects because binding occurs
within a few hours after a drug dose, and antipsychotic effects may
not occur until the drugs have been given for a few weeks.

8. CLASSIFICATION OF ANTIPSYCHOTIC DRUGS

9. PHARMACOKINETICS
DRUG NAME DOSE PER DAY
Atypical Antipsychotics
Clozapine ( Clozaril) 100-900 mg
Risperidone ( Risperdal) 2-8 mg
Olanzapine ( Zydis) 5-20 mg
Typical Antipsychotics
Chlorpromazine (Thorazine) 200-1000 mg
Thioxanthene ( Navane) 5-30 mg
Haloperidol ( Haldol) 2-20 mg
Loxapine ( Loxitane) 20-100 mg
Molindone ( Moban) 50-225 mg
Pimozide ( Orap) 2-6 mg

10. INDICATIONS FOR USE
Organic psychiatric Disorders like Delirium, Dementia, Drug
induced tremors.
Functional Disorders (schizophrenia, schizoaffective disorders)
Mood Disorders
Childhood Disorders (ADHD, Autism, Conduct disorder)
Neurotic and other psychiatric disorders

11. CONTRAINDICATIONS
 Liver damage
 Coronary artery disease
 Cerebrovascular disease
 Parkinsonism
 Bone marrow depression
 Severe hypotension or hypertension
 Coma
 Severely depressed states

12. ADVERSE EVENTS OF ANTIPSYCHOTICS
1. Extrapyramidal Syndrome:
ACUTE DYSTONIA
Facial Grimacing
Involuntary Eye Movements
Muscle spasm of tongue, face,
neck and back
Laryngeal spasm
AKATHISIA
Restlessness
Trouble in standing
Muscular discomfort
Feet in constant motion

13. CONT…
PSEUOPARKINSONISM
Bradykinesia
Stooped Posture
Rigidity
Tremors
Akinesia
TARDIVE DYSKINESIA
Choreo-athetoid movement of
muscles
Protrusion and rolling of tongue
Chewing motion
Peri-oral movements

14. CONT…
CNS: Drowsiness, lethargy, mental confusion, aggravation of seizures in
epileptics.
CVS: Postural hypotension, palpitation.
Anticholinergic: Dry mouth, blurring of vision, constipation.
Endocrine: Hyperprolactinemia. This can lower GH levels, but amenorrhoea,
infertility, gynaecomastia occur infrequently after prolonged treatment.
Metabolic effect: Elevation of blood sugar and triglyceride.
Hypersensitivity reaction: Cholesteric jaundice, myocarditis, agranulocytosis.

15. NURSING RESPONSIBILITY
 Observe the patient regularly for abnormal movements.
 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.
 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.
 A patient receiving clozapine is at risk for developing agranulocytosis. Monitor TC, 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 anticonvulsants such as
eptoin.

16. CONCLUSION
Antipsychotic drugs are used mainly for the treatment of psychosis, a severe
mental disorder characterized by disordered thought processes, blunted or
inappropriate emotional responses; bizarre behaviour, social withdrawal in
which a person pays less-than-normal attention to the environment and other
people; deterioration from previous levels of occupational and social
functioning (poor self-care and interpersonal skills); hallucinations; and
paranoid delusions. Antipsychotic drugs do not cure psychosis but they can
help to reduce and control many psychotic symptoms.