ANTIPSYCHOTICS

Penothiazines
 INDICATIONS AND COMMON ADVERSE NURSING
NAME OF DRUG MECHANISM OF ACTION
CONTRAINDICATIONS EFFECTS RESPONSIBILITIES
BRAND NAME: • Block dopamine receptors in INDICATIONS: •CNS: neuroleptic malignant • Assess mental status prior to
Thorazine the brain; also alter dopamine •Acute and chronic psychoses, syndrome, sedation, and periodically during therapy.
release and turnover. particularly when accompanied by extrapyramidal reactions, tardive • Monitor BP and pulse prior to
GENERIC NAME: • Prevention of seizures increased psychomotor activity. dyskinesia and frequently during the period
Chlorpromazine Nausea and vomiting. •CV: hypotension (increased with of dosage adjustment. May cause
• Also used in the treatment of IM, IV) QT interval changes on ECG.
PREPARATIONS: intractable hiccups. •EENT: blurred vision, dry eyes, • Observe patient carefully when
PO 10-25mg 2=4 times daily; lens opacities administering medication, to
may increase every 3-4 days CONTRAINDICATIONS: • GI: constipation, dry mouth, ensure that medication is actually
(usual dose is 200ng/day; up to • Hypersensitivity. anorexia, hepatitis, ileus taken and not hoarded.
1g/day) •Cross-sensitivity may exist • GU: urinary retention •Monitor I&O ratios and daily
among phenothiazines. Should not • Hematologic: agranulocytosis, eight. Assess patient for signs and
CLASSIFICATION: be used in narrow-angle glaucoma. leukopenia symptoms of dehydration.
Antipsychotics •Should not be used in patients • Skin: photosensitivity, pigment • Monitor for development of
who have CNS depression. changes, rashes neuroleptic malignant syndrome
(fever, respiratory distress,
tachycardia, seizures,
diaphoresis, hypertension or
hypotension, pallor, tiredness,
severe muscle stiffness, loss of
bladder control.
 INDICATIONS AND
NAME OF DRUG MECHANISM OF ACTION
CONTRAINDICATIONS
BRAND NAME: Perphenazine has actions at all INDICATIONS:
Trilafon levels of the central nervous Perphenazine is indicated for use
system, particularly the in the treatment of schizophrenia
hypothalamus. However, the site and for the control of severe
GENERIC NAME: and mechanism of action of nausea and vomiting in adults.
Perphenazine therapeutic effect are not known. Perphenazine has not been shown
effective for the management of
Preparation: behavioral complications in
Tablets-2,4,8,16mg; concentrate- patients with mental retardation.
16mg/5ml; injection-5mg/ml
CONTRAINDICATIONS:
Adults- 4-8mg PO rid, IM 5-10 contraindicated in comatose or
mg q 6 hr greatly obtunded patients and in
patients receiving large doses of
central nervous system depressants
CLASSIFICATION: (barbiturates, alcohol, narcotics,
Antipsychotics analgesics, or antihistamines); in
the presence of existing blood
dyscrasias, bone marrow
depression, or liver damage; and in
patients who have shown
hypersensitivity to perphenazine
tablets, their components, or
related compounds.
contraindicated in patients with
suspected or established
subcortical brain damage, with or
without hypothalamic damage.
NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND
COMMON ADVERSE
EFFECTS
CNS: opisthotonus, trismus,
torticollis, retrocollis, aching and
numbness of the limbs, motor
restlessness, oculogyric crisis,
hyperreflexia, dystonia
CV: postural hypotension,
tachycardia (especially with
sudden marked increase in
dosage), bradycardia, cardiac
arrest, faintness, and dizziness
Autonomic: dry mouth or
salivation, nausea, vomiting,
diarrhea, anorexia, constipation,
obstipation, fecal impaction,
urinary retention, frequency or
incontinence,
COMMON ADVERSE
NURSING
RESPONSIBILITIES
•Dilute oral concentrate only
woth water, saline,
homogenizes milk, carbonatesd
ornage drink and pineapple;use
60 ml of diluents for each 16mg
(5ml) of concentrate.
•Give IM injections only to
seated or recumbent patients
and observe for adverse effects
•Monitor pilse and BP
continuously during IV
administration.
•Avoid skin contact with oral
solutions; contact dermatitis has
occurred
•Discontinue druf if serum
creatinine, BUN, become
abnormal or if WBG count is
depressed.
•Monitor elderly patients for
dehydration, and institute
remedial measures promptly.
NURSING
 CONTRAINDICATIONS EFFECTS RESPONSIBILITIES
BRAND NAME: Mechanism not fully understood: INDICATIONS: • Autonomic: Dry mouth, • Arrange for discontinuation of
Prolixin antipsychotic drugs block Management of manifestations of salivation, nasal congestion, drug if serum creatinine, BUN
psychotic disorders; the longer acting
postsynaptic dopamine receptors parenteral dosage forms, fluphenazine
nausea, vomiting, anorexia, fever, become abnormal or if WBC
in the brain, depress the RAS, enanthate and fluphenazine decanoate, pallor, flushed facies, sweating, count is depressed.
GENERIC NAME: including the parts of the brain indicated for management of patients constipation, paralytic ileus, • Monitor elderly patients for
Fluphenazine involved with wakefulness and (chronic schizophrenics) who require • CNS: Drowsiness, insomnia, dehydration, institute remedial
emesis; anticholinergic, prolonged parenteral therapy vertigo, headache, weakness, measures promptly. Sedation and
Management of behavioral complications
PREPARATION: antihistaminic (H 1), and alpha- in patients with mental retardation
tremor, ataxia, slurring, cerebral decreased sensation of thirst
Adults adrenergic blocking activity also (fluphenazine decanoate) edema, seizures, related to CNS effects can lead to
Individualize dosage, begin with may contribute to some of its CONTRAINDICATIONS: • CV: Hypotension, orthostatic severe dehydration.
low dosage, gradually increase. therapeutic (and adverse) actions. • Contraindicated with coma or severe hypotension, hypertension, • Consult physician regarding
• Oral CNS depression, bone marrow tachycardia, bradycardia, cardiac appropriate warning of patient or
depression, blood dyscrasia, circulatory
0.5–10 mg/day in divided doses collapse, subcortical brain damage,
arrest, CHF, cardiomegaly, patient's guardian about tardive
q 6–8 hr; usual daily dose is less Parkinson's disease, liver damage, refractory arrhythmias, dyskinesias.
than 3 mg. Give daily doses cerebral arteriosclerosis, coronary pulmonary edema • Consult physician about dosage
greater than 20 mg with caution. disease, severe hypotension or • Hematologic: Eosinophilia, reduction, use of anticholinergic
When symptoms are controlled, hypertension; pregnancy. leukopenia, leukocytosis antiparkinsonian drugs
• Use cautiously with respiratory
gradually reduce dosage. (controversial) if extrapyramidal
disorders (“silent pneumonia”);
• IM glaucoma, prostatic hypertrophy effects occur.
Average starting dose is 1.25 mg (anticholinergic effects may exacerbate
(range 2.5–10 mg) glaucoma and urinary retention); epilepsy
or history of epilepsy (drug lowers
seizure threshold); breast cancer
(elevations in prolactin may stimulate a
CLASSIFICATION: prolactin-dependent tumor.
Phenothiazine
Dopaminergic blocking agent
Antipsychotic

NAME OF DRUG
BRAND NAME:
Mellaril
GENERIC NAME:
Thioridazine
PREPARATION:
Adult dose for Thioridazine
tablets - Initially 50–100mg
three times daily; may increase
gradually to max 800mg/day in
2–4 divided doses.
Children's dosing
for Thioridazine tablets -
Initially 0.5mg/kg per day in
divided doses; may increase
gradually to max 3mg/kg/day
CLASSIFICATION:
Antipsychotic Agent
Typical
Phenothiazine
MECHANISM OF ACTION
Mechanism of action not fully
understood.; blocks postsynaptic
dopamine receptors in the brain, but
this may not be necessary and
sufficient for antipsychotic activity;
depresses the RAS, including parts of
the brain involved with wakefulness
and
emesis;anticholinergic,antihistaminic
and alpha-adrenergic blocking
activity also may contribute to some
of its effects.
INDICATIONS AND
CONTRAINDICATIONS
INDICATIONS:
Schizophrenia unresponsive to
(preferably 2) other antipsychotic
drugs.
CONTRAINDICATIONS:
History of arrhythmias.
Congenital long QT syndrome.
QTc interval >450msec.
Concomitant drugs that prolong
QTc interval, CYP2D6 inhibitors
(eg, fluoxetine within past 5
weeks, paroxetine), or others that
inhibit thioridazine metabolism
(eg, duloxetine, fluvoxamine,
propranolol, pindolol). Reduced
CYP2D6 activity. Coma. CNS or
bone marrow depression. Severe
hyper- or hypotensive heart
disease.
COMMON ADVERSE
EFFECTS
Drowsiness, other CNS effects,
anticholinergic effects, QT
prolongation, arrhythmias,
hyperprolactinemia, amenorrhea,
ejaculation inhibition, edema,
tardive dyskinesia, neuroleptic
malignant syndrome, blood
dyscrasias, jaundice,
gynecomastia, weight gain,
pigmentary retinopathy,
orthostatic hypotension,
hyperpyrexia, paradoxical
reaction.
NURSING
RESPONSIBILITIES
• Ensure that the patoent has
not responded to other
antipsychotic drugs.
• Arrange for ophthalmologic
examination before and
during drug therapy
• Ensure that patients baseline
ECG shows a QTc interval
<450msec; stabilize
potassium levels before
administering.
• Do not change brand names
• Avoid skin contact with oral
concentrations
• Monitor elderly patients for
dehydration

NAME OF DRUG MECHANISM OF ACTION
BRAND NAME: Pharmacological studies in
Serentil laboratory animals have
established that mesoridazine has
a spectrum of pharmacological
activity comparable to
GENERIC NAME: thioridazine, except that its
Mesoridazine effects, other than cataleptic
which is weaker, are more
pronounced.
DOSAGE: Following oral administration,
100-400mg/day mesoridazine is well absorbed
with peak blood levels occurring
at 4 hours.
ROUTE: Approximately 30 to 40% of a
PO dose is recovered in the urine and
25 to 30% is recovered in the
feces, even after i.m.
administration.
CLASSIFICATION:
Antipsychotic
INDICATIONS AND
CONTRAINDICATIONS
INDICATIONS:
The treatment of both the acute and the most prevalent adverse
chronic states of schizophrenia;
organic brain syndrome and mental
retardation associated with psychotic
symptoms or where psychomotor
disturbances are predominant;
treatment of some patients with
symptoms of alcohol withdrawal.
CONTRAINDICATIONS:
Severe CNS depression, comatose
states, blood dyscrasias, bone marrow reduction in dosage. In mild
depression, liver damage,
hypersensitivity to mesoridazine;
cross sensitivity to other
phenothiazines may occur.
Hypertension or hypotensive heart
disease of extreme degree.
COMMON ADVERSE
EFFECTS
Drowsiness and hypotension are
effects encountered. Sedation,
hypotension and other autonomic
effects tend to occur more
frequently early in the treatment
or when initial high doses are
used.
When these reactions occur they
can usually be controlled by a
cases of hypotension, the head
down position may be adequate.
In severe cases of hypotension, a
pressor agent such as levarterenol
bitartrate may be used.
Epinephrine should not be
administered, since it may result
in a further fall of blood pressure
NURSING
RESPONSIBILITIES
Before Administration:
• Check for right patient
• Check for medication
• Assess weight
• Assess bowel function
• Check blood pressure
During Administration:
• Instruct patient to take
medication as directed
• Observe patient when
administering to ensure
swallowing
• Check for any reaction of
the medication
• Administer medication
with food.
After Administration:
• Instruct patient to avoid
alcohol
• Advise patient to change
position slowly
• Instruct patient to
frequently mouth rinse
• Advise patient to continue
follow-up
 INDICATIONS AND COMMON ADVERSE NURSING
NAME OF DRUG MECHANISM OF ACTION
CONTRAINDICATIONS EFFECTS RESPONSIBILITIES
BRAND NAME: Precise mechanism(s) of INDICATIONS: Drowsiness, dizziness, skin • Given the likelihood that some
Stelazine antipsychotic action not effective for the short-term reactions, rash, dry mouth, patients exposed chronically to
determined, but may be treatment of generalized non- insomnia, amenorrhea, fatigue, neuroleptics will develop
principally related to psychotic anxiety. For the muscular weakness, anorexia, tardive dyskinesia, it is advised
antidopaminergic effects. management of schizophrenia. lactation, blurred vision and that all patients in whom
neuromuscular (extrapyramidal) chronic use is contemplated be
GENERIC NAME: Exhibits weak anticholinergic and CONTRAINDICATIONS: reactions. given, if possible, full
Thifluoperazine sedative effects and strong A known hypersensitivity to information about this risk.
extrapyramidal effects and phenothiazines, comatose or Dystonia
antiemetic activity. greatly depressed states due to • Warn patients to report the
central nervous system depressants Motor Restlessness sudden appearance of sore
and, in cases of existing blood throat or other signs of
PREPARATION: dyscrasias, bone marrow Pseudo-parkinsonism infection. If white blood cell
depression and pre-existing liver and differential counts indicate
Adult dose for Trifluoperazine damage. Tardive Dyskinesia cellular depression, stop
treatment and start antibiotic
1–2mg twice daily; max and other suitable therapy.
6mg/day.
• Since certain phenothiazines
have been reported to produce
retinopathy, the drug should be
CLASSIFICATION: discontinued if
Antipsychotics ophthalmoscopic examination
Phenothiazine or visual field studies should
demonstrate retinal changes.
 ANTIPSYCHOTICS
Thioxanthene

NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND COMMON ADVERSE NURSING

 CONTRAINDICATIONS EFFECTS RESPONSIBILITIES
BRAND NAME: Alters the effect of dopamine in INDICATIONS: CNS: NEUROLEPTIC • Monitor patient’s mental status
Navane the CNS. Management of psychotic MALIGNANT SYNDROME, (delusions, hallucinations, and
disorders. extrapyramidal reactions, behavior) prior to and
Therapeutic Effects: sedation, tardive dyskinesia, periodically throughout therapy.
GENERIC NAME: Diminished signs and symptoms CONTRAINDICATIONS: seizures. • Observe patient carefully when
Thiothizene of psychoses. Hypersensitivity to thiothixene or EENT: blurred vision, dry eyes, administering medication to
other phenothiazines (cross- lens opacities. ensure that medication is
DOSAGE and ROUTE: sensitivity may occur). Circulatory CV: hypotension, tachycardia, actually taken and not hoarded.
Capsules: 1 mg, 2 mg, 5 mg, 10 collapse. Blood dyscrasias. Central non-specific ECG changes. • Assess patient for level of
mg, 20 mg. Concentrated oral nervous system depression. GI: constipation, dry mouth, sedation following
solution: 5 mg/ml in 30- and 120- Use Cautiously in: Geriatric or anorexia, ileus, nausea. administration.
ml containers. debilitated patients (initial dosage GU: urinary retention. • Monitor for tardive dyskinesia
reduction may be required). Derm: photosensitivity, pigment (uncontrolled rhythmic
PO (Adults): Mild conditions—2 Diabetes mellitus. Respiratory changes, rashes. movement of mouth, face, and
mg tid (up to 15 mg/day if disease. Prostatic hypertrophy. Endo: breast enlargement, extremities; lip smacking or
necessary; severe conditions—5 CNS tumors. Epilepsy. Intestinal galactorrhea. puckering; puffing of cheeks;
mg bid (up to 20–30 mg/day; not obstruction. Pregnancy, lactation, Hemat: leukocytosis, uncontrolled chewing; rapid or
to exceed 60 mg/day). or children (safety not established). leukopenia. worm-like movements of
Metab: hyperpyrexia. tongue). Notify physician or
CLASSIFICATION: Misc: allergic reactions. other health care professional
Antipsychotics immediately if these symptoms
Thioxanthenes occur, as these side effects may
be irreversible.
 ANTIPSYCHOTICS
Butyrophenones

NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND COMMON ADVERSE NURSING

 CONTRAINDICATIONS EFFECTS RESPONSIBILITIES
BRAND NAME: Alters the effect of dopamine in INDICATIONS: CNS: Extrapyramidal reactions, Before Administration:
Haldol the CNS. Also has Acute and chronic psychotic confusion, drowsiness, • Check for right patient
anticholinergic and alpha- disorders including: schizophrenia, restlessness • Check for medication
adrenergic blocking activity manic states, drug – induced EENT: Blurred vision, dry eyes • Assess mental Status
GENERIC NAME: psychoses. Schizophrenia, patients Resp: Respiratory depression • Assess bowel function
Haloperidol who requires long term parenteral CV: Hypotension, tachycardia • Check blood pressure
antipsychotic therapy. GI: Constipation, dry mouth, During Administration:
weight gain
• Instruct patient to take
DOSAGE: CONTRAINDICATIONS: GU: Urinary retention
medication as directed
4-40mg/day Hypersensitivity, angle-closure Derm: Diaphoresis,
glaucoma, bone marrow photosensitivity, rashes • Observe patient when
depression, CNS depression, Endo: Galactorrhea, amenorrhea administering to ensure
ROUTE: severe liver or cardiovascular Hema: Anemia swallowing
PO disease Metab: Hyperpyrexia • Check for any reaction of
the medication
• Administer medication
CLASSIFICATION: with food
Antipsychotic After Administration:
• Instruct patient to avoid
alcohol
• Advise patient to change
position slowly
• Instruct patient to
frequently mouth rinse
• Advise patient to continue
follow-up

NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND COMMON ADVERSE NURSING

 CONTRAINDICATIONS EFFECTS RESPONSIBILITIES
BRAND NAME: Unknown. Tranquilizers, INDICATIONS: CNS: SEIZURES, • Caution patient to change
Inapsine sedates, and provides antiemetic indicated to reduce the incidence extrapyramidal reactions, positions slowly to minimize
effects without affecting reflex of nausea and vomiting associated abnormal EEG, anxiety, orthostatic hypotension
alertness ; also cause mild alpha with surgical and diagnostic confusion, dizziness, excessive
GENERIC NAME: blockade. procedures. sedation, hallucinations, • Medication causes drowsiness.
Droperidol Alters the action of dopamine in hyperactivity, mental depression, Advise patient to call for
the CNS CONTRAINDICATIONS: nightmares, restlessness, tardive assistance during ambulation and
• Hypersensitivity dyskinesia. transfer
DOSAGE: • Known intolerance CV: ARRHYTHMIAS
Adult dosage: 2.5 mg IM or slow • Angle-closure glaucoma (INCLUDING TORSADES DE
IV • Bone marrow depression POINTES) , QT prolongation.
Children's dosage: 2-12 y.o - • CNS depression EENT: blurred vision, dry eyes.
0.1 mg/kg, taking into account the • Severe liver or cardiac disease Resp: bronchospasm,
patient's age and other clinical • Known or suspected QT laryngospasm.
factors. prolongation CV: hypotension, tachycardia.
GI: constipation, dry mouth.
ROUTE: Misc: chills, facial sweating,
IM, slow IV shivering.

CLASSIFICATION:
Antipsychotic
 ANTIPSYCHOTICS
Dibenzazepine

NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND COMMON ADVERSE NURSING

 CONTRAINDICATIONS EFFECTS RESPONSIBILITIES
BRAND NAME: This dibenzoxazepine INDICATIONS: CNS: drowsiness, sedation, • Give with food, milk, or water
Loxitane C, Loxitane IM antipsychotic is chemically Manifestations of psychotic dizziness, syncope, EEG changes, to reduce possibility of stomach
distinct from other antipsychotics. disorders paresthesias, staggering gait, irritation
Its exact mode of action is less
GENERIC NAME: muscle weakness, extrapyramidal • Monitor baseline BP pattern
than that produced by
Loxapine chlorpromazine, but CONTRAINDICATIONS effects, akathisia, tardive prior and during therapy
anticholinergic effects may be Severe drug induced CNS dyskinesia, neuroleptic malignant • Observe carefully for
DOSAGE: more intense. Also has antiemetic depression; comatose states, syndrome. extrapyramidal effects
Adult- 20-60 mg/day; 12.5-50 mg activity; lowers seizure threshold children <16y. Safe use during CV: orthostatic hypotension, • Discontinue therapy and report
or IV for acute states in patients with history of pregnancy (category C) or hypertension, tachycardia. promptly to physician the first
convulsive disorders. lactation is not established. GI: constipation, dry mouth. signs of impending tardive
ROUTE: dyskinesia when pt. is on long
PO, IM, IV term treatment
• Monitor I&O and bowel
CLASSIFICATION: elimination patterns and check
Antipsychotic for bladder distention
• Do not change dosage regimen
in any way without physician
approval
• Stay out of bright sun; cover
exposed skin with sunscreen
 ANTIPSYCHOTICS
Dihydorindolone

NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND COMMON ADVERSE NURSING

 CONTRAINDICATIONS EFFECTS RESPONSIBILITIES
BRAND NAME: Tranquilizer structurally unrelated INDICATIONS: CNS: transient drowsiness, • Take drug as prescribed;
Moban but pharmacologically similar to Management of manifestation of insomnia, extrapyramidal do not alter dose regimen or
the piperazine phenothiazines; psychotic disorders symptoms (dose crelated), stop medication without
thought to block postsynaptic consulting physician
GENERIC NAME: euphoria, neuroleptic malignant
dopamine receptors in the brain. CONTRAINDICATIONS: • Monitor bowel pattern and
Molindone Has less sedative but comparable Known hypersensitivity to syndrome
urinary output
anticholinergic activity and molindone or to phenothiazines; • Be alert early during
DOSAGE: GI: dry mouth , constipation,
greater incidence of severe CNS depression; comatose treatment to onset of
Adult- 50-75 mg/day, extarpyramidal adverse effects states; children <12y. Safety hepatotoxicity
parkinsonism symptoms
maintenance at 5-25 mg t.i.d. to than chlorpromazine. EEG studies during pregnancy (category C) or • Dizziness during early
CV: tachycardia
q.i.d. suggest ascending reticular lactation is not established. therapy usually disappears as
system is chief site of action. ENDOCRINE: heavy menses, treatment continues
ROUTE: amenorrhea, galatorrhea, • Avoid alcohol and self-
PO gynecomastia, increased libido, medication with other
premature ejaculation. depressants during therapy
• Avoid overexertion
CLASSIFICATION: (patient with angina) and
Antipsychotic Phenothiazine report increase in frequency
of precordal pain
 ANTIPSYCHOTICS
Atypical Antipsychotic

NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND COMMON ADVERSE NURSING

 CONTRAINDICATIONS EFFECTS RESPONSIBILITIES
BRAND NAME: Mechanism is not defined. INDICATIONS CV: Orthostatic hypotension, • Drug is usually withdrawn
Fazclo Interferes with binding of Indicated only in the management tachycardia, ECG changes, gradually over 1-2 wk if therapy
dopamine to D1 and D2 receptors of severely ill schizophrenic increased risk of myocarditis must be discontinued
in the limbic region of brain. It patients who have failed to • Store the drug away from heat
GENERIC NAME: especially during first month of
binds primarily to respond to other neuroleptic or light.
Clozapine nondopaminergic sites(e.g., agents. therapy, pericarditis, pericardial
• Monitor for seizure activity;
alpha-adrenergic, serotonergic, effusion, cardiomyopathy, heart
seizure potential increases at the
DOSAGE: and cholinergic receptors.) CONTRAINDICATIONS failures, IM, mitral insufficiency higher dose level
Adult- 25-50 mg/day and titrate Severe CNS depression, blood • Closely monitor for recurrence
to a target dose of 350- 450 dyscrasia, history of bone marrow GI: nausea, dry mouth,
of psychotic symptoms if the
mg/day depression; patients with constipation, hypersalivation drug is being discontinued
myeloproliferative disorders, • Monitor cardiovascular status,
uncontrolled epilepsy; clozapine- CNS: Seizures, transient fever,
ROUTE: especially during the first month
induced agranulocytosis, severe sedation neuroleptic malignant
PO of therapy.
granulocytosis, con current syndrome (rare), dystonic • Report promptly S&S of CHF
administration of benzodiazepines reactions (rare) and other potential cardiac
CLASSIFICATION: or other psychotropic drugs;
problems
Antipsychotic pregnancy (category B), lactation UROGENITAL: Urinary
• Do not use OTC drugs or
retention
alcohol without permission of
physician
 INDICATIONS AND COMMON ADVERSE NURSING
NAME OF DRUG MECHANISM OF ACTION
CONTRAINDICATIONS EFFECTS RESPONSIBILITIES
BRAND NAME: Binds to dopamine receptors in INDICATIONS: CNS: Seizure, dizziness, Before Administration:
Clozaril the CNS. Also anticholinergic Schizoprenia unresponsive to or sedation • Check for right patient
and alpha – andrenergic blocking intolerant of standard therapy with EENT: Visual disturbance • Check for medication
activity. Produces fewer other antiphsycotics. To reduce CV: Hypotension, tachycardia, • Monitor blood pressure
extrapyramidal reactions and less recurrent suicidal behavior in ECG changes, hypotension • Assess weight and BMI
GENERIC NAME: tardive dyskinesia than standard schizophrenic patients GI: Constipation, dry mouth, • Assess bowel movement
Clozapine antipsychotic but carries high increased in salivation, nausea , During Administration:
risk of hematologic CONTRADICTIONS: vomiting
• Instruct patient to take
abnormalities. Hypersensitivity, bone marrow Derm: Rash, Sweating
medication as directed
suppression, severe CNS Endo: Hyperglycemia
DOSAGE: suppression, uncontrolled epilepsy, • Observe patient when
200- 900mg/day granulocytopenia administering to ensure
swallowing
• Check for any reaction of
the medication
ROUTE: • Administer medication
PO with food
After Administration:
• Instruct patient to avoid
alcohol
CLASSIFICATION: • Advise patient to change
Antipsychotic position slowly
• Instruct patient to
frequently mouth rinse
• Advise patient to continue
follow-up
 INDICATIONS AND COMMON ADVERSE NURSING
NAME OF DRUG MECHANISM OF ACTION
CONTRAINDICATIONS EFFECTS RESPONSIBILITIES
BRAND NAME: May act by antagonizing Indications: CNS: Aggressive behavior, Before Administration:
Risperdal dopamine and serotonin in the Schizoprenia in adults and increased dreams, increase sleep • Check for right patient
CNS. adolescences age 13-17 yrs. duration, sedation • Check for medication
Bipolar mania in adults and EENT: Pharyngitis, rhinitis, • Assess mental Status
children 10- 17 yrs in adults and visual disturbance • Check blood pressure
GENERIC NAME: children 10-17 yrs: can be used Resp: Cough , dyspnea • Assess weight and BMI
Risperidone with lithium or valproate. CV: Arrhythmias. Tachycardia During Administration:
Treatment of irritability associated GI: Constipation, diarrhea, dry,
• Instruct patient to take
with autistic disorder In children mouth, nausea, abdominal pain,
medication as directed
age 5- 16 yrs. anorexia.
DOSAGE: GU: Decreased libido, difficulty • Observe patient when
2-8 mg/day Contraindications: urinating administering to ensure
Hypersensitivity, lactation swallowing
• Check for any reaction of
the medication
ROUTE: • Administer medication
PO with food
After Administration:
• Instruct patient to avoid
alcohol
CLASSIFICATION: • Advise patient to change
Antipsychotic position slowly
Pharmacologic: benziosaxazoles • Instruct patient to
frequently mouth rinse
• Advise patient to continue
follow-up
 INDICATIONS AND COMMON ADVERSE NURSING
NAME OF DRUG MECHANISM OF ACTION
CONTRAINDICATIONS EFFECTS RESPONSIBILITIES
BRAND NAME: Antagonize dopamine and INDICATIONS: CNS: Dizziness Before Administration:
Zyprexa serotonin type 2 in the CNS Also Psychotics disorders: Acute manic Restlessness, weakness, dystonia, • Check for right patient
has anticholinergic, antihistamine episodes associated with bipolar speech impairment • Check for medication
and anti – alpha – adrenergic disorder, long term maintenance EENT: Amblyopia, Rhinitis • Assess bowel function
effect. therapy of bipolar disorder, long Resp: Cough , dyspnea • Check blood pressure
GENERIC NAME: term treatment/ maintain ace of CV: Orthostatic hypotension • Assess weight and BMI
Olanzapine schizophrenia, agitation due to GI: Constipation, dry mouth, During Administration:
schizophrenia or mania. abdominal pain, increase thirst
• Instruct patient to take
GU: Urinary incontinence
medication as directed
CONTRAINDICATIONS: Derm: Photosensitivity
DOSAGE: Hypersensitivity, lactation MS: Hypertonia, joint pain • Observe patient when
5-20 mg/day administering to ensure
swallowing
• Check for any reaction of
the medication
ROUTE: • Administer medication
PO with food
After Administration:
• Instruct patient to avoid
alcohol
CLASSIFICATION: • Advise patient to change
Antipsychotic position slowly
• Instruct patient to
frequently mouth rinse
• Advise patient to continue
follow-up

NAME OF DRUG MECHANISM OF ACTION
BRAND NAME: Antagonizes multiple
Seroquel neurotransmitter receptors in the
brain including serotonin as well
as dopamine D1 and D2
GENERIC NAME:
receptors. Mechanism of action is
Quetiapine unknown, however, antipsychotic
properties thought to be related to
DOSAGE: antagonized responses.
25 mg b.i.d., up to 300- 400 Antagonizes in possible
mg/day somnolence, and adrenergic
alpha1 and alpha2 receptors
which may lead to orthostatic
ROUTE:
hypotension.
PO
CLASSIFICATION:
Antipsychotic
INDICATIONS AND
CONTRAINDICATIONS
INDICATIONS:
• Adjunct or monotherapy for
the treatment of manic
episodes associated w/ bipolar
disorder
CONTRAINDICATIONS:
• Hypersensitivity to
quetiapine; lactation; alcohol
use.
COMMON ADVERSE
EFFECTS
CNS: Dizziness, headache,
somnolence
CV: Postural hypotension,
tachycardia, palpitations
GI: Dry mouth, dyspepsia,
abdominal pain, constipation,
anorexia
RESPIRATORY: Rhinitis,
pharyngitis, cough, dyspnea
NURSING
RESPONSIBILITIES
• Reassess need for continued
treatment periodically
• Withhold the drug and
immediately report S&S of
tardive dyskinesia or
neuroleptic malignant
syndrome
• Monitor ECG periodically in
those with known
cardiovascular disease
• Monitor patients with a history
of seizures for lowering of the
seizure threshold
• Avoid alcohol consumption
and activities that may cause
overheating and dehydration.

NAME OF DRUG MECHANISM OF ACTION
BRAND NAME: Unrelated to phenothiazine or
Geodon butrophenone antipsychotic
agents. Exhibits high in vitro
binding affinity for the following
GENERIC NAME:
receptors: dopamine D2 and D3,
Ziprasidone serotonin 5HT2A, 5HT2C,
5HT1A, 5HT1D, and the alpha-
DOSAGE: 1-adrenergic receptors, and
20-80 mg b.i.d.; rapid control of moderate affinity for the
as stated behavior: 10-20 mg, histamine H1 receptor.
maximum dose 40 mg/day Antagonist at the D2, 5HT2A and
5HT1D receptors and an
antagonist at the 5HT1A
ROUTE: receptor. Additionally, inhibits
PO, IM synaptic reuptake of serotonin
and norepinephrine. Antagonism
CLASSIFICATION: at other receptors may explain
Antipsychotic some of the other therapeutic and
adverse effects.
INDICATIONS AND COMMON ADVERSE NURSING
CONTRAINDICATIONS EFFECTS RESPONSIBILITIES
INDICATIONS: CNS:Somnolence, akathisia, • Give with food
Treatment of schizophrenia dizziness, extrapyramidal effects, • Monitor S&S of torsade
Treatment of acute manic and dystonia, hypertonia, agitation, depointes, tardive dyskinesia
mixed episodes of bipolar especially in older adult women
tremor, dyskinesias, hostility,
disorders and with prolonged therapy, and
paresthesia, confusion, vertigo,
the appearance of an
CONTRAINDICATIONS: hypokinesia, hyperkinesias, unexplained rash. Withhold
Hypersensitivity to ziprasidone; abnormal gait, oculogyric crisis, drug and report to physician
history of QT prolongation hypesthesia, ataxia, amnesia, immediately if any of these
including congenital long QT cogwheel rigidity, delirium, develop
syndrome or with other drugs hypotonia,akinesia, dysarthria, • Monitor I&O ratio and pattern
known to prolong the QT interval; • Monitor BP lying, sitting, and
withdrawal syndrome,
recent MI or uncompensated heart standing. Report orthostatic
failure; bradycardia; neuroleptic buccoglossal syndrome,
hypotension to physician
malignant syndrome and tardive choreoathetosis, diplopia,
• Monitor for loss of seizure
dyskinesia; dehydration or incoordination, neuropathy
control, especially with a
hypovolemia; pregnancy (category history of seizures or dementia.
C), lactation. Safety and efficacy CV: Tachycardia, postural
in children are not established. hypotension, prolonged QTc
interval, hypertension
 ANTIPSYCHOTICS
New Generation Antipsychotic

NAME OF DRUG MECHANISM OF ACTION
BRAND NAME: Exhibits high affinity for
Abilify dopamine D2 and D3, serotonin
5-HT1A and 5-HT2A receptors,
moderate affinity for dopamine
GENERIC NAME:
D4, serotonin 5-HT2C and 5-
Aripiprazole HT7, alpha-1 adrenergic and
histamine H1 receptors, and
DOSAGE: moderate affinity for the
Adult- 10-15 mg/day serotonin reuptake site.
Functions as a partial agonist at
ROUTE: the dopamine D2 and the
serotonin 5-HT1A receptors, and
PO
as an antagonist at serotonin 5-
HT2A receptors.
CLASSIFICATION:
Antipsychotic
INDICATIONS AND
CONTRAINDICATIONS
INDICATIONS
• Treatment of schizophrenia
• Treatment of acute manic and
mixed episodes of bipolar
disorders
CONTRAINDICATIONS:
Hypersensitivity to aripiprazole;
lactation; pregnancy (category C).
COMMON ADVERSE
EFFECTS
CNS: Anxiety, insomnia,
lightheadedness, somnolence,
akathisia, tremor, extrapyramidal
symptoms, depression,
nervousness, increased salivation,
hostility, suicidal thought, manic
reaction, abnormal gait,
confusion, cogwheel rigidity.
CV: Hypertension, tachycardia,
hypotension, bradycardia.
GI: Nausea, vomiting,
constipation, anorexia
METABOLIC: Weight gain,
weight loss, increased creatine
kinase
RESPIRATORY: Rhinitis, cough
HEMATOLOGIC: Echymosis,
anemia
NURSING
RESPONSIBILITIES
• Monitor cardiovascular
status. Assess for and report
orthostatic hypotension.
• Monitor body temperature
in situation likely to elevate
core temperature
• Monitor for and report
signs of tardive dyskinesia
• Monitor for and
immediately report S&S of
neuroleptic malignant
syndrome(NMS)
• Avoid situations where
you are likely to become
overheated or dehydrated.