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BIO 301
1st introduced in the 1950s
Revolutionized changes in managing psychotic
1st psychiatric medication developed
___________; it did for psychiatry what PCN
did for medicine.
Antipsychotic Medications
AKA ______________ or ______________
Mainstay of tx for schizophrenia and other
psychotic disorders.
2 categories
First generation (FGA) [conventional] or
___________ antipsychotics
Second generation (SGA) [________________]
Differ in mode of action, side effects & potency as
compared to the typical antipsychotics
Antipsychotic Medications
First Generation [FGAs]
Block receptors for dopamine in the CNS
Cause more serious movement disorders
[EPS-extrapyramidal symptoms]
Classified as low, medium or high potency
Potency refers to the size of the dose
needed to elicit a given response
Antipsychotic Medications
Second generation
Moderate blockade or receptors for
dopamine & much stronger blockade of
receptors for serotonin.
Produce lower potential for EPS effects &
greater efficacy in negative symptoms,
cognitive symptoms & refractory illness.
Risk of metabolic effects
Antipsychotic Medications Indications
Treatment of psychosis which includes:
Schizophrenia, schizoaffective disorders &
delusional disorders.
Patient with psychosis from secondary
causes benefit from short-term
antipsychotic medications while the
underlying illness is being treated
Goals of Antipsychotic Therapy
Typical [FGA]: effective in reducing or alleviating
the _______________symptoms.
Atypical [SGA]: more effective in alleviating
____________________symptoms & other
symptoms related to psychosis.
Return the client to normal daily functional &
provision of self-care
Minimize side effects [use optimal dose w/least
possible side effect].
Help client manage side effects so that they will
remain complaint with medication regimen
Adverse Effects of Antipsycotics
High potency, conventional, FGA
[Typical]poses higher risk for
Spasms of the neck [Torticollis]
Spasms of the back [Retrocollis]
Spasms of the tongue [Glossospasm]
Dystonic reactions usually occur during the early
stages of treatment
Common post IM injections of antipsychotics
Risk factors include administration of high
potency agency, large doses & parenteral
Anticholinergic: benztropine [Cogentin] IM, IV
Characterized by symptoms that include:
Decrease movements [bradykinesia, akinesia]
Muscle rigidity [cog-wheeling, lead pipes
Resting tremor
Mask-like face
Stoop position
Shuffling gait
Treatment: reducing medication or a change
to an antipsychotic w/less potential for EPS
Anticholinergic: benzytropine [Cogentin],
diphenhydramine [Benadryl]
Characterized by the following symptoms:
Motor restlessness
Inability to sit still
Symptoms are dose related
Improves w/decreasing the dose or change to
low potency agent
Beta-blockers, Benzodiazepines, anticholinergics
Oculogyric Crisis
Involuntary upward deviation of the eyes
Spasms of eyeball
May occur in one eye or both
Do NOT confuse with seizure: NOT a seizure
Medication for EPS
Benztropine [Cogentin]
Trihexyphenidyl [Artane]
Diphenhydramine [Benadryl]
Dopamine antagonist
Amatadine [Symmetrel]
Tardive Dyskinesia
Involuntary choreoathetoid
Symptoms include
Abnormal movements of voluntary muscle groups
after a prolonged period
Commonly affected muscles:
Mouth, tongue
Grimacing, lip smacking, tongue poking/pling,
writhing movements of fingers, toes [pill rolling]
Tardive Dyskinesia
Risk factors include
Longer lengths of time of antipsychotic use
High doses
High potency drugs
Use of typical [conventional] FGA
No treatment for TD
Atypical have much lesser risk than FGA
Symptoms caught early, patient may have a
chance that TD will resolve
Most common: first days of treatment
Disappears in 1-2 weeks usually
Sedation: significant w/low potency, FGA:
chlorpromazine [Thorazine] & thioridazine
[Mellaril]: Phenothiazines
Avoid ETOH, antihistamines, sleeping aid
Take daily dose at hs to avoid this side effect
Warn against handling hazardous machinery,
Anticholinergic Side Effects
Side effects present as:
Nasal congestion
Ejaculatory inhibition
Most annoying but NOT serious
Cardiovascular Side Effects
Symptoms manifest as
Postural hypotension: dizziness
Arrhythmias, palpitations [Geodon]
Changes in QT intervals, ziprasidone
[Geodon]: Benzisoxazoles
Fatal FGA dysrhythmias
____________, _____________,
Neuroleptic Malignant Syndrome
Symptoms present as:
Decreased, acute change in mental status
Severe increase muscle tone [rigidity] Lead
Hyperpyrexia, labile hypertension,
tachycardia, tachypnea, diaphoresis,
drooling, renal failure
Risk factors
Past hx NMS
Poly-psychotropic meds
Rapid close titration
Use high potency antipsychotics in high doses
Young men are more at risk
Labs include: Elevated creatinine phosphokinase
Treatment for NMS
IMMEDIATE discontinuation: antipsychotic
Hydration w/fluids
Administer acetaminophen, cooling blankets
for hypothermia
Management of arrhythmias
IV dantrolene [direct-acting muscle relaxant]
Administering anticholinergic medications
Weight Gain
Clozapine [Clozaril] and olanzapine [Zyprexia]
have higher weight gain potential
Must monitor blood glucose levels
Screen for adult onset diabetes Type II
Excessive weight gain may cause a switch to a
different antipsychotic
Increase in cholesterol and triglycerides
A general term used to describe either the
common phototoxic response or the uncommon
photoallergenic reaction
Symptomatic present as:
Vesicular eruptions
Eczematous dermatitis
Treatment includes topical burn cream,
antihistamines, steroids indicated for
photoallergence reactions
Dermatologic Changes
Inability to regulate body temperature with
environment temperature
Neuroendocrine defedts:
Galactorrhea and Gynecomastia
Due to elevation of prolactin levels
FGA: reduce seizure threshold
Seizure precautions should be implemented
Sexual dysfunction
Suppression of libido: women
Erectile dysfunction: men
Decrease dose or switch to HP FGA
Clinical Use Dosage
Administered in divided doses
To minimize side effects
Determine the patients ability to tolerate the
Dosage regimen is usually simplified to a once
a day dose [improves compliance]
Do not need to monitor serum levels
Examples of Typical Antipsychotics
Chlorpromazine [Thorazine]: prototype
Fluphenazine [Prolixin]
Pherphenazine [Trilafon]
Thioridazine [Mellaril]
Trifluoperazine [Stelazine]
Haloperidol [Haldol]
Thiothixine [Navane]
Loxapine [Loxitane]
Prolixin [fluphenazine decanoate]
Haldo [haloperidol decanoate]
Long-acting Risperidone [risperdal]
[Respiridone microspheres]
Used to improve compliance for patients who
have difficulty following a PO regimen
Usually administered every 2 weeks
Given IM
Atpical Antipyschotics
Clozaril [Clozapine]
Clozaril [clozapine]: prototype
Blocks receptors for dopamine & serotonin; blocks
dopamine 2
Used for refractory illness
Titrated slowly to avoid side effects [sedation,
orthostatic hypotension, DROOLING
Must monitor WBCs as the medication causes
Patients at risk for agranulocytosis are those who are
Potential metabolic effects
Clozaril Side Effects
Sedation: common
Anticholinergic side effects
EPS: common
NMS: patient is at risk
CV: tachycardia, orthostatic [initial dose]
Weight gain: common
Hypersalivation: COMMON
Seizure: dose related
General tonic-clonic
Atypical Antipyschotics
Risperidone [Risperidol]
Effective in treating [+] and [-] s/s of
Side effects include
EPS: low incidence
TD: less than typical antipyschotics
CB: hypotension
Weight gain: not significant
Olanzapine [Zyprexa]
Effective in treating [+] and [-] symptoms of
schizophrenia psychosis associated w/bipolar
Side effects
Sedation/anticholinergic: common
Seizure: to avoid do not give with clomipramine
Hyperprolactinemia: high
Weight gain/Type II DM: common
Quetiapine [Seroquel]
Side effects
Sedation: common
CV: avoid in pt w/hx of CV disease
Weight gain: not significant
Cholesteraol/triglyceride elevation: common
Ziprazidone [Geodon]
Must take with food
Side effects
Prolongation of QT interval and fatal heart arrhythmia
GI discomfort: nausea, dyspepsia, constipation,
diarrhea, dry mouth
Atypical Agents
Clozapine [Clozaril]
Olanzapine [Zyprexa
Quetiapine [Seroquel]
Risperidone [Risperdal]
Ziprasidone [Geodon]