Anti-psychotics

Also known as neuroleptics or major tranquilizers.They are drugs which help to alleviate severe anxiety
by quietening disturbed patients whatever may be the psychopathology, without impairing
consciousness and without causing paradoxical excitement. Examples are:

Haloperidol (Haldol, Serenace)

Group: A major tranquilizer, anti-psychotic

Mode of action: It blocks the action of certain amines on the brain, thereby producing sedation and
abolishing psychoses.

Indications : Schizophrenia, Mania, Manic depressive disorders, Agitation in psychotic illness.

Dosage : Mania 1.5-6mg twice daily orally and 5-10mg parenterally

Route of administration : Orally,IM,IV

Side effects : Jaundice, ataxia, confusion, dermatitis, Anaemia, drowsiness, hypotension, urinary
retention,visual disturbances.

Contra-indications : Comatose states, parkinsonism,lactating mother's

Nursing responsibilities

.Parenteral administration must be given slowly to prevent hypotension.

.Watch out for any side effects.

.Assess emotional status carefully, since there may be a rapid mood swings from Mania to depression

Thioridazine ( Melleril, Melleril)

Group : Major tranquilizer

Mode of action : It blocks the action of certain amines on the brain thereby producing sedation and
abolishing psychoses.

Indications : Anxiety, tension, Agitation, Schizophrenia, severe neuroses, alcohol withdrawal syndrome.

Dosage: Adult 25-600mg per day

Children 1 -4mg per kg body weight daily in divided doses.

Route of administration : Orally.

Side effects : Sedations, dry mouth, vertigo, nasal stuffiness, skin rashes, urinary incontinence,
ejaculation disturbance

Contra-indications : Hypersensitivity to phenothiazines, comatose states, severe CNS depression, blood

dyscrasia.

Nursing responsibilities

. Patient should not drive or operate machinery because of the likely side effects of disturbances of
accommodation.

.Do not administer to groups of people mentioned under 'contra-indications' above.

Chlorpromazine (Largactil)

Group: Anti-psychotic

Mode of action: It blocks dopaminergic receptors in the CNS and also has selective inhibitory effects on
the chemoreceptor trigger zone in the medulla oblongata

Indications : Schizophrenia, Mania, psychomotor Agitation, violent behavior, adjunct in severe anxiety,
autism

Dosage: Adult, initial dose 25mg T.d.s(or 75 mg at night), maintenance dose of 75-300mg daily.

Children (1-5 yrs) 40mg maximum daily.

Route of administration : Orally, IM,IV,Rectally.

Side effects: Depression, Jaundice, rashes, postural hypotension, cardiac arrhythmias.

Contra-indications : Bone marrow depression,impaired consciousness due to CNS depression,

Phaeochromocytoma.

Nursing responsibilities

.Avoid subcutaneous injection.

.Give with full glass of water, milk or with food to reduce GI upset.

.Teach patient not to involve in strenuous exercise or stand still for long periods to avoid fainting.

.Observe for orthostatic hypotension, especially with parenteral administration

.Teach patient to rise from sitting or lying position slowly as orthostatic hypotension is common.
 *Orthostatic hypotension is a form of low blood pressure that happens when standing from sitting or
lying down.

Atypical anti-psychotics

They are anti-psychotic drugs which may be better tolerated than the other anti-psychotics since the
extrapyramidal symptoms may be less frequent.

Clozapine( Clozaril, denzapine,zaponex)

Group: Anti-psychotic/major tranquilizer/antidepressant

Mode of action :It works by blocking receptors in the brain for several neurotransmitters (chemicals
that nerves use to communicate with each other) including dopamine type 4 receptors, serotonin type 2
receptors, norepinephrine receptors, acetylcholine receptors, and histamine receptors.

Indications: Schizophrenia, patient intolerant to conventional anti-psychotics.

Contra-indications : diabetes,excessive fat in the blood,low amount of magnesium in the

blood,dehydration,low amount of potassium in the blood,overweight,decreased function of bone
marrow.

Route of administration : Orally in tablet form.

Dosage : Schizophrenia (over 16years of age)= 12.5mg once or twice on the first day, 25-30mg on the
second day.Then increased gradually (if well-tolerated) in steps of 25-50mg daily over 2-3weeks up to
300mg daily in divided doses. For psychosis in Parkinsonism= 12.5mg at bedtime, then increased in steps
of 12.5mg up to twice weekly

Side effects: fever, flu-like symptoms, extreme weaknes,mouth sores, skin sores,new or worsening
cough, trouble breathing,pain or burning when you urinate ,vaginal itching or discharge

Nursing responsibilities

.Monitor white blood cells and differential blood counts

.Give close medical supervision during the commencement of treatment to avoid risk of collapse
because of hypotension.

Olanzapine( Zyprexa)

Group: Atypical anti-psychotic

Mode of action: It works by blocking receptors in the brain for several neurotransmitters (chemicals
that nerves use to communicate with each other) including dopamine type 4 receptors, serotonin type 2
receptors, norepinephrine receptors, acetylcholine receptors, and histamine receptors.

Indications: Schizophrenia,Mania,Control of Agitation and disturbed behavior in schizophrenia and

mania.

Route of administration: Orally, Intramuscularly

Dosage: Schizophrenia (adult over 18years of age)= 10mg daily, adjusted to usual range of 5-20mg
daily.Mania(adult over 18 years of age)= 15mg daily adjusted to usual range of 5-20mg daily.Control of
agitation or disturbed behavior (adult over 18years of age)= 5-10mg initially as single dose
Intramuscularly followed by 5-10mg after 2 hours if necessary.

Contraindications: Breastfeeding,acute myocardial infarction, unstable angina, severe hypotension or

bradycardia,recent heart surgery.

Side effects: Weight gain, dizziness, oedema, drowsiness, pyrexia, blood disorders, hallucination,
increased appetite.

Nursing responsibilities

.Monitor white blood cells and differential blood counts

.Give close medical supervision during the commencement of treatment to avoid risk of collapse
because of hypotension.