3Outlines:*Definition *Clinical Indications *Classifications *Action *Side effect and complications *Contraindications *Nursing management of patient receiving *antipsychotic drugs
4Definition:Antipsychotic drugs are drugs used to treat symptoms of psychotic disorders, such as delusion and hallucinations.
5Clinical Indications for Antipsychotic Drugs *Primary Indication: Schizophrenia *Schizoaffective disorder *Manic *Other Indications: ^Tourette's syndrome ^disturbed behavior: senile dementia associated with Alzheimer's disease *Inappropriate Use: ^Management of drug withdrawal syndromes (e.g. opioids) ^Anxiety relief -- not appropriate given availability of specific anxiolytic agents *Nonpsychiatric Indications: ^antiemesis ^relief of puritis ^neuroleptanesthesia
6Standard (traditional) Antipsychotics Action: Classifications: Standard (traditional) Antipsychotics. Atypical Antipsychotics.Standard (traditional) AntipsychoticsAction:Standard Antipsychotic drugs act by blocking dopamine type2 (D2) receptor in the nigrostriatal area of basal ganglia. Thus. These drugs referred to as dopamine receptor antagonists.
7Type of Standard Antipsychotic routeDosage(adult)Trade nameGeneric nameO , IMIMO,IM,IVO,IM25mg IMO40-8008-406-201-20ThorazinePromacidNeurazineLargactilSparineTrilafonStelazineProlixinProlixin,medicateDecanoate(long acting)mellarilPhenothiazinesChlorpromazine Promazine Perphenazine Trifluoperazine FluphenazineThioridazine
8route Dosage (adult) Trade name Generic name Continue>>> O,IM 50-100mgIMO100mg IM6-20105-51-10HaldolHaldol decanoate (long acting)safinaceOrapClopixolDecanoate(long acting)ButyrophenonesHaloperidolOther drugsPimozideclopenthizol
9Side effects: *Extrapyramidal side effect(EPS) :CNS acute onset of EPS: it occurs within few days,weeks or months.Acute dystonic reaction:Eye : oculogyric crisis in which the eyes are pulled up or to the side.Neck: pulling the head to one side(torticollis) or pulling the head back (retrocollis).Tongue: involuntary protrusions of tongue.Body: torsion spasm.
10Pseudo-parkinsonism(parkinsonian like syndrome): It is characterized by:Hypokinesia: it is loss of movement, and may present asslowing or difficulty initiating movement, as well as decreased or absent arm swing when walking.Rigidity all over the body.Masked like face.Short shuffling gait.Drippling of saliva.Monotonous and slurred speech.Loss of postural reflexes which leads to fall.
11Akathisia: Subjective feeling of restlessness and irritability. It is characterized by:Subjective feeling of restlessness and irritability.Inability to sit still.Crossing and uncrossing legs frequently.Inability to relax.
12late onset of EPS: Sedation Epileptogenic effect. Tardive dyskinesia: it occurs at least 6-24 months.Tardive dyskinesia:is a jerky irregular movements affecting primarily the lower face, extremities and trunk.SedationEpileptogenic effect.
13Autonomic side effect(anti-cholinergic side effect): Dry mouth, blurring of vision, urinary retention, constipation.Cardiovascular system:Orthostatic hypotension, light headedness,dizziness accompanied by tachycardia,palpitation and arrhythmia.Respiratory system:Nasal congestion especially with Mellaril which may lead to ulceration.Dermatological effect:Allergic reaction with rashes.dermatitis.
14Complications: Agranulocytosis: White cell count drop to very low levels,the symptoms include: high fever, sore throat, mouth sores and malaise.Neuroleptic malignant syndrome: (lead to death)It is rare and It is characterized by:Hyperthermia: up to 107F, autonomic dysfunction ,hypertension, tachycardia.Allergic obstructive jaundice:Abdominal pain, anorexia, nausea, fever, bilirubin in urine and increase in serum bilirubin.
15Contraindication: Cardiovascular diseases (myocardial infraction) Hypotension or hypertension, bone marrow disease, epilepsy, liver disease, pulmonary disease, pregnant women 1st trimester.
16Atypical Antipsychotics Definition:It is a novel antipsychotics that have lesser extra pyramidal side effects and greater efficacy in the treatment of negative symptoms of schizophrenia compared with typical antipsychotics.Action:atypical Antipsychotics blocks both serotonin and dopamine receptors.Advantage:They cause little or no extra pyramidal side effect.Effective in short term.disadvantage:Very expensive
17Types of atypical Antipsychotics: DosageTrade nameGeneric nameTablets mg\dayAmpoule 2ml\day1mg to 3-6mg\dayLeponex, Clozaril,ClozapexRisperdal,ApexidoneClozapineRisperidone
18Side effect of Clozapine: *Agranulocytosis*Seizure*It can be sedating, cause hypotension and tachycardia.Contraindication:*Hypersensitivity to drugs*History of drug induced agranulocytosis*Alcoholic patient*Severe cardiac disease*Impaired bone marrow function
19Side effect of Risperidone: Common: insomnia anxiety and headacheLess: fatigue, dizziness, constipation, abdominal pain, weight gain.Contraindication:Patient with known hypersensitivity to the product.
20Role of nurse: general rules r\t psychotropic medication: ensure the patient receives his medication, instruct the patient to continue to take medication, reassure the patient that side effects will be temporary and subside.nurses' role toward compliance to medication:assist client in acquiring knowledge about medications, explain natures of and time span for onset of therapeutic results, provid written and verbal instructions to reinforce compliance, including family members in education process
21nurses' role toward side effect: important part of psychiatric nurse's role is to minimize, identify and intervene in side effect experienced by patient as a result of their medication.nurses' role toward complications:report occurrence of any of the side effect & complications to physician immediately.
22THANK YOU REFERNCE: www.WHO.org www.mentalhealthdrugs.com