ANTIPSYCHOTICS

 Antipsychotics are a type of psychiatric medication which are available on prescription to treat
psychosis. They are licensed to treat certain types of mental health problems whose symptoms
include psychotic experiences.
 Some psychotics are also licensed to treat other health problems including;-

 Physical problems e.g persistent hiccups-problems with balance and nausea

 Agitation and psychotic experiences in dementia

-this is only recommended if you pose a risk to yourself or others or if you are severely
destressed.
TYPES OF ANTIPSYCHOTICS
Typical /1st generation –first to be made e.g
 chlorpromazine,
 flupentixol,
 haloperidol,
 levomepromazine,
 pericyazine,
 perphenazine,
 pinozide
CONT…..
Atypical /2nd generation-the newer types e.g
 Amisulpride,
 aripiprazole,
 clozapine,
 lurasidone,
 risperidone,
 olanzapine,
 paliperidone.

Clozapine
Clozapine works slightly differently to others. It is usually given to people who are treatment resistant. Treatment
resistant means other medication haven’t helped reduce or control symptoms.
CONT…..
 The main difference is in their side effects where the 1st gen has more side effects in terms of
body movements.
PHARMACODYNAMICS
 The first generation of antipsychotics work by inhibiting dopaminergic neurotransmission.
Their effectiveness is best when they block about 72% of the D2 dopamine receptors in the
brain. They also have noradrenergic cholinergic and histaminergic blocking action.
 The chemical structure of the various antipsychotics allow them to bind to dopamine receptors
without triggering the postsynaptic response that the binding of dopamine normally would.
PHARMACOKINETICS
 They can be prescribed to be taken in various different ways.
 Most commonly they are taken orally in tablets or liquid form. However some are prescribed
as depot injection.
 Most of the antipsychotics are very lipophilic and cross lipoidal membranes freely. When
administered orally, they are well absorbed and undergo substantial pre-systemic elimination.
 Bioavailability is 10-70%
 highly bound to plasma proteins 75-95%and tissues and are extensively distributed.
 Cytochrome P450 in the liver is responsible for metabolization of most antipsychotics
 Elimination is hepatic in form of metabolites.
INDICATIONS
 Bipolar disorder
 Depression
 Alzheimer’s disease
 Mood stabilizers in bipolar disorder
 Reducing anxiety in anxiety disorders
 Reducing tics in Tourette syndrome
CONTRAINDICATIONS
 Known hypertension
 When CNS depression is evident
 Blood dyscrasias (disorders)
 Parkinson’s disease
 Liver/renal/cardiac insufficiencies

 -use with caution

 Elderly, severely ill or debilitated(severely weak)
 Diabetic, respiratory insufficiency, prostatic hypertrophy, intestinal obstruction.
 Safety in pregnsncy and lactation has not been established.
SIDE EFFECTS
 Movement effects
 Dizziness
 Weight gain
 Diabetes
 Agitation
 Dry mouth
 Constipation
 Sedation
 Blurred vision
ADVERSE EFFECTS
 sedation,
 sexual dysfunction due to hormonal changes
 postural hypotension,
 cardiac arrhythmia, and
 sudden cardiac death
 Hyperprolactinaemia-production of milk In both male and female breasts
 Neuroleptic malignant syndrome-The neuroleptic malignant syndrome (NMS), clinically
manifested by hyperpyrexia(fever), mental status changes, muscular rigidity, and autonomic
dysfunction, is an idiosyncratic(distinctive) reaction to major neuroleptic pharmacologic agents.
 Tardive dyskinesia( involuntary movement of face and jaw)
NURSING CONSIDERAATIONS
 Patient safety
 Extrapyramidial syndromes- side effects
 Metabolic considerations-weight gain, glucose dysregulation
 Patient education
 Discontinuing therapy
DRUG TO DRUG
INTERACTION
 ACE inhibitors, beta-blockers, calcium channel blockers, and other blood pressure
drugs can interact with antipsychotics. Together, they may make your heart beat in an
abnormal rhythm or lower your blood pressure too much. Heart rhythm drugs.