This document discusses antipsychotic drugs, including their history, classification, indications, side effects, and nursing implications. It notes that the first antipsychotic drugs were discovered in the 1950s and includes a table classifying examples of first and second generation antipsychotic drugs. The document outlines the mechanisms of action, contraindications, pharmacokinetics, and important considerations for patient education when taking antipsychotic medications.

1. ANTIPSYCHOTIC DRUGS
RITARANI NAYAK
ASSISTANT
PROFESSOR
SUM NURSING
COLLEGE

2. 1.HISTORY:
 In 1891 , paul ehrlich observed the antimalarial
effects of methylene blue , a phenothiazine
derivative .
 Later , the phenothiazines were developed
for their
antihistaminergic properties .
 Hamon and Delay extended the use of this
treatment in psychiatric patients and uncovered
its antipsychotic activity .
 Between 1954 and 1975 about 15 antipsychotics
drugs were introduced in U.S and about 40

3. 2.INTRODUCTION :
 Antipsychotics also known as neuroleptics or major
tranquilizers are a class of medications primarily
used to manage psychosis principally in
schizophrenia and bipolar disorder .
 First generation antipsychotics known as Typical
antipsychotics were discovered in the 1950s .
 Second generation drugs known as Atypical
antipsychotics, first atypical antipsychotics was
discovered in 1960s and introduced clinically in the
1970s .

4. 3.DEFINITION:
 Antipsychotic drugs are a class of medicines
used to treat psychosis and other mental and
emotional conditions .
Antipsychotics are those psychotropics drugs
,which are used for the treatment of psychotic
symptoms. These are also known as
neuroleptics as they produce neurological side
effects, major tranquilizers,D2-receptor
blockers and anti schizophrenic drugs.

5. 4.Classification
:Class Examples
of
DRUGS
TRADE Name ORAL
Dose
mg/day
Parentera
l Dose
(mg)
Phenothiazines Chlorpromazin
e
Triflupromazine
Megatil
Largactil
Tranchlo
r Siquil
300-1500 mg
100- 400mg
50-100
IM only
30-60
IM only
Thioridazine Thioril, melleril
Ridazin
300-800mg
Trifluoperazine Espazine 15-60mg 1-5
IM only
Fluphenazin
e
prolinate -------- 25-50 IM every
1-3 weeks

6. CLASS Examples
of
DRUGS
TRADE
NAME
ORAL DOSE
mg/day
Parenter
al dose
(mg)
Thioxanthenes Flupenthixol Fluanxol 3-40 mg
Butyrophenones Haloperidol Senorm
,
serenac
e
5-100mg 5-20 IM
only
Relinace
Diphenylbutyl Pimozido Orap 4-20mg
Piperidines Penfluoridol Flumap 20-60 mg
weekly
Indolic derivatives Molindone Mobam 50-225 mg
Dibenzoxazepines Loxapine Loxapac 25- 100mg
Atypical
antipsychotics
Clozapine Sizopin ,
lozapin
50—450mg

7. CLASS EXAMPLES
OF DRUGS
TRAD
E
NAM
E
ORAL
DOSE
(mg/day)
Parenter
al dose
(mg)
Risperidone Sizodo
n,
sizoma
x
2-10mg
Olanzapine Oleanz 10-20mg
Quetiapine Qutan 150-750mg
Ziprasidone Zisper 20-80mg
Others Reserpine Serpasil 0.5-50mg

8. 5.INDICATIONS:
• Antipsychotics are mainly used in the
treatment of acute and chronic psychosis
,particularly when
accompanied by increased psychomotor
activity.
a)Organic psychiatric disorder:
delirium, Dementia, Delirium tremens, etc
b) Functional disorders:
schizophrenia, schizoaffective disorders,etc
c) Mood disorders:
mania , major depression with
psychotic symptoms

9. • Childhood disorders:
Attention-deficit hyperactivity
disorder, autism.
• Neurotic and other psychiatric disorders:
Anorexia nervosa , intractable OCD ,
disabling anxiety .
• Medical disorders:
Huntingtons chorea, nausea and
vomiting, eclampsia, heat stroke.

10. 6.Pharmacokinetics:
• Antipsychotics when administered orally
are absorbed by gastrointestinal tract with
uneven blood levels.
• They are highly bound to plasma as well as
tissue proteins .
• They are metabolized in the liver and
excreted mainly through the kidneys .
• The elimination half life varies from 10-24
hrs.

11. 7.Mechanism of action:
• Antipsychotic drugs block D2 receptors in
the mesolimbic and mesofrontal
systems.
• Sedation is caused by alpha-adrenergic
blockade.
• Anti- dopaminergic actions on basal
ganglia are responsible for causing EPS
(extrapyramidal symptoms).
• Atypical antipsychotics have anti-
serotonergic anti-adregenic and

12. 7.Contraindications:
• Hypersensitivity(cross sensitivity may
exist among phenothiazines).
• Not to be used when CNS depression is
evident when blood dyscrasias exist , in
patients with parkinson” s disease , liver,
renal or cardiac insufficiency.
• elder, severely ill or respiratory
insufficiency, prostatic hypertrophy, or
intestinal obstruction

13. 8.Side effects and nursing
implications:
1) Anticholinergic effects :
•
•
a) Dry mouth-
provide sugarless candy , ice and frequent
sips of water.
strict oral hygiene.
•
•
•
b) Blurred vision:
subsides within few
minutes. don’t drive.
clears small items from
pathways.

14. c) Constipation:
• Increase fluid intake , higer fiber
diet , increased physical activity.
d) Urinary retention:
• Monitor intake and output ,report to
if difficulty while urinating .
2) Nausea ,gastrointestinal tract:
Administer fruit juiceand concentrate
must be diluted with other liquids.

15. 3) Skin rash :
•Report appearance of any skin rash
avoid spilling of liquid concentrate on
skin.
4) Sedation :
• Administer drug at bedtime.
• Don’t drive or work while drowsy or
after using sedatives
• Low dosage.

16. 5) Orthostatic hypertension:
• Rise slowly from a lying or sitting
position, monitor BP document and
report if any
changes.
6) Photosensitivity:
• Wear protective sunscreens, clothing
and sunglasses while spending time
outdoors.

17. 7) Weight gain:
• Weigh patient alternate day.
• Calorie controlled diet provide
exercise instruction.

18. 8) Reduction of seizure
threshold:• Close observation of patient with history
of seizure.
Note : THIS IS IMPORTANT WITH PATIENTS
TAKING CLOZAPINE. REPORTEDLY SEIZURES
AFFECT 1% TO 5% OF INDIVIDUALS WHO TAKE
THIS DRUG.
9) Agranulocytosis:
• Relatively rare with most of
the antipsychotics drugs.
• usually occurs within the first 3
months of RX

19. • Observefor symptoms of sore throat fever
and malaise.
• Monitor CBC if symptoms appear.
10) Extrapyramidal symptoms:
a) Pseudo-parkinsonism :
(tremor,
shuffling
gait, drooling,
rigidity).
&b) Akinesia(muscular weakness):
• Symptoms may appear 1to5 days
following initiation of antipsychotic
medication.
• occurs most often in women ,the elderly
and dehydrated patients.

20. c)Akathesia (continuous restlessness and
fidgeting)
:
• occurs most frequently in women ;
symptoms may occur 50-60 days
following initiation of therapy.
d) Dystonia (involuntary muscular movements[spasms] of
face, arms , legs and neck):
• occurs most often in men and patients
younger than 25 years of age .

21. 11) Tardive dyskinesia (bizarre facial and
tongue movements, stiff neck and difficulty
swallowing):
• Long term therapy patients are at risk.
• Symptom are potentially irreversible.
• Drug should be withdrawn at first
sign(vermiform movements of tongue)
12) Neuroleptic malignant syndrome:
• A rare, but potentially fatal, complication
with neuroleptic drugs.
• monitor temperature and observation
for parkinsonian symptoms.

22. • Onset can occur within hours or even years after
drug initiation.
• Symptoms include severe parkinsonian muscle
rigidity , hyperpyrexia upto 107 degree F
,tachypnea, tachycardia , fluctuations in blood
pressure ,rapid deteriiration of mental status..
• Discontinueneuroleptic medicaton immediately.
• Monitor vital signs , degree of muscle rigidity,
intake and output and level of
consciousness.
• Physician may order bromocriptine(parlodel)
or dantrolene (dantrium) to counteract the
effects.

23. 9.Patient/Family Education:
= Patient should:
• Be cautious while driving and operating
dangerous machinery.
• Don’t stop medication after long time use.
• use sunscreens and wear protective clothing
while spending time outside.
• Report occurrence of symptoms like sore throat,
severe headache , rapid heart rate, difficulty in
urinating, twitching tremors, darkly coloured urine
,yellow skins or eyes , skin rash or seizures.

24. • Rise slowly from sitting position to
prevent sudden drop in BP.
• Take frequent sips of water , chew sugarless
gum and maintain oral hygiene.
• Consult physician regarding smoking
while on neuroleptic therapy.
• Dress warmly in cold weather and avoid
extended exposure to very high or low
temperature. Body temperature is harder to
maintain with this medications.

25. • Stop alcohol.
• Don’t consume other medications, without
physician approval.
• Beware of risks with neuroleptic during
pregnancy.
• Beware of side effects of neuroleptic drugs.
• Don’t discontinue medications immediately
afte
r feeling well.
• Carry card or other Identification at all
times prescribed medication being
taken.