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objectives

At the end of this presentation students will be able to:


Identify the antipsychotics medication. Know the classifications types of this medication. Identify first generation antipsychotic (Mechanism of action , Indications, side effects) Identify second generation antipsychotic (Mechanism of action , Indications, side effects)

Identify third generation antipsychotic (Mechanism of action , Indications, side

effects)

Know the drug interactions.


Explore nursing care and patients education

Identify Anti cholinergic medications

Definition

Antipsychotic drugs are those having primary effects on

psyche (mental processes) and are used for treatment of

Psychiatric disorders.
These are severe psychiatric illness with serious

distortion of thought, behavior, capacity to recognize

reality and of perception (delusions and hallucinations).

Types:
Antipsychotic drug are also known as Neuroleptics,

Ataractic, Major Tranquilizer and Anti-Schizophrenic drugs.


A first generation of antipsychotics, known as Typical

antipsychotics, was discovered in the 1950s.


Most of the drugs in the second generation, known

as Atypical antipsychotics, have been developed more recently.


Third generation Was approved in the U.S. in late 2002

Classification:
Typical Antipsychotics (first generation):
1)

Phenothiazines:

Chlorpromazine, Fluphenazine, Perphenazine, Prochlorperazine, Thioridazine, Trifluoperazine

2) 3)

Thioxanthenes:

Thiothixene

Phenylbutylpiperadines: Haloperidol, Pimozide

Atypical Antipsychotics (second generation):


1. 2. 3. 4.

Dihydroindolones: Dibenzepines:

Molindone, Ziprasidone.

Loxapine, Clozapine, Olanzapine, Quetiapine. Risperidone, Paliperidone.

Benzisoxazole: Quinolinones:

Aripiprazole.

Third generation:
apiprazadole

Typical first generation

Mechanism of action
Antipsychotic work by blocking

postsynaptic dopamine
receptors in the brains Dopaminergic pathway (basal

ganglia, hypothalamus, limbic


system, brainstem and medulla)
They also demonstrate varying

affinity for cholinergic, alpha1 adrenergic and histaminic receptors.

Indications

Bipolar mania

Schizophrenia
pediatric behavioral disorder Psychotic disorder. Tourettes disorder.

Side effects
Extra pyramidal symptom
Pseudoparkinsonism (tremor, shuffling gait, drooling, rigidity)
*Symptoms may appear 1 to 5 days following initiation of antipsychotic medication; occurs most often in women, the elderly. Akinesia (muscular weakness) Akathisia (continuous restlessness and fidgeting) *This occurs most frequently in women; symptoms may occur 50 to 60 days following initiation of therapy. Dystonia (involuntary muscular movements [spasms] of face, arms, legs, and neck) *This occurs most often in men and in people younger than 25 years of age. Oculogyric crisis (uncontrolled rolling back of the eyes) *This may appear as part of the syndrome described as dystonia. It may be mistaken for seizure activity. Dystonia and oculogyric crisis should be treated as an emergency situation.

Tardive dyskinesia
(bizarre facial and tongue movements, stiff neck, and difficulty swallowing) All clients receiving long-term (months or years) antipsychotic therapy are at risk. The symptoms are potentially irreversible. The drug should be withdrawn at the first sign, which is usually vermiform movements of the tongue; prompt action may prevent irreversibility.

Neuroleptic malignant syndrome (NMS)

include severe parkinsonian muscle rigidity, tachycardia, tachypnea, fluctuations in blood pressure, diaphoresis, and rapid deterioration of mental status to stupor and coma. This is a rare, but potentially fatal, complication of treatment with neuroleptic drugs. Routine assessments should include temperature and observation for parkinsonian symptoms. Onset can occur within hours or even years after drug initiation, and progression is rapid over the following 24 to 72 hours. Discontinue neuroleptic medication immediately. Monitor vital signs, degree of muscle rigidity, in- take and output, level of consciousness.

Nausea - Gi upset Skin rash Sedation Photosensitivity Hormonal effects


Decreased libido Amenorrhea (women) Weight gain

Atypical second generatio

Atypical second generation

Newer.

Produce few or no extrapyramidal

symptoms.
Target the negative as well as the positive

symptoms of schizophrenia.

Mechanism of action:

functions as a partial agonist at dopamine receptors,

reducing dopamine activity in the mesolimbic pathway.10,11 Antagonism of serotonin type 2 (5-HT2) receptors increases the release of endogenous dopamine.
This increase in dopamine decreases the likelihood of

extrapyramidal motor symptoms and elevated prolactin levels without significantly reducing the beneficial effects against positive symptoms of psychosis.

Indications

schizophrenia.

Recurrent suicidal behavior.


Bipolar mania

Side effects

Drowsiness, dizziness, sedation Nausea and vomiting Dry mouth, blurred vision. Seizure. Salivation Tachycardia Constipation Orthostatic hypotension

Weight gain Hyperglycemia Headache Restlessness Anxiety Agitation insomnia

Third generation

Third generation

Was approved in the U.S. in late 2002

The newest third-generation drugs include apiprazadole

(brand name: Abilify)


Same of second generation >>

do not produce particular side effect which first generation cause.

Mechanism of action:

The single third-generation drug works through a significantly different mechanism: partial agonism at D2 receptors. when levels of dopamine are high, aripiprazole blocks dopamine receptors, reducing dopaminergic activity. When levels of dopamine are low, the drug boosts the sensitivity of the receptors to the dopamine that is available. The same relationship is true for aripiprazoles interaction with specific types of serotonin receptors.

Drug interactions

Citalopram >> elevation of clozapine levels. Benzodiazepines >>respiratory arrest. lithium >> implicated in several cases of neuroleptic malignant syndrome. Antacids and antidiarrheal >> decrease absorption of antipsychotics. Barbiturates >> increase metabolism and decrease the effectiveness of antipsychotics. beta-adrenergic blocking agents >> Additive hypotensive effects

Nursing care and patients education

Nursing care

For all side effect can be appear.

Patient education

Do not stop taking the drug abruptly. Protect himself from sunlight. Report weekly blood test. Report occurrence of any symptoms to the physician. Rise slowly from a sitting to prevent.. take frequent sips of water. Consult the physician regarding smoking.

Patient education (con.)

Avoid extended exposure to very high or low

temperature.
Do not drink alcohol. Do not consume others medication.

Carry card or other identification at all times describing

medications being taken.

Anti cholinergic medications

Additive anticholinergic effects are observed when

antipsychotics are taken concurrently with other drugs that produce these results (e.g., antihistamines, antidepressants, antiparkinsonian agents).

Side effects
Dry mouth
Blurred vision Constipation

Urinary retention

S S S S S

Foundations of psychiatric mental health nursing Nursing diagnosis in psychiatric nursing. http://www.ashp.org/DocLibrary/BestPractices/TPS_Antipsychotic.aspx. http://www.acnp.org/g4/gn401000123/ch121.html http://www.psych.org/MainMenu/PsychiatricPractice/ManagingYourPractic e/QuickPracticeInfo/microsoft%20word%20%20access%20to%20meds_schizophrenia.aspx?FT=.pdf www.psych.ufl.edu