Antipsychotics

• Antipsychotics is also called neuroleptics or major tranquilizers
• Antipsychotics

  MOA: decreases dopamine
• 1st generation Antipsychotics MoA: Blocks dopamine receptor
• Highest potency 1st gen Antipsychotics is  Haloperidol
• 1st generation aka Typical Antipsychotics 


  "zine" - except Loxapine, Molindine, Haloperidol
• First typical antipsychotic - Chlorpromazine
• Chlorpromazine changed into haloperidol because it is less hypotensive and not hepatotoxic
• 2nd generation Antipsychotics MoA: regulates the dopamine receptor
• 2nd generation aka Atypical Antipsychotics 


  "pine" "done"
• 3rd generation Antipsychotics MoA: stabilizes dopamine receptors
• 3rd generation Antipsychotics aka New generation and Dopamine System Stabilizers


  "piprazole"
• Extra Pyramidal Syndrome


  Happen when there is blockade of dopamine (D2) receptors in the midbrain region of the brain stem (decreased dopamine)
• Extra Pyramidal Syndrome - mnemonic: APAT
• Extra Pyramidal Syndrome

  APAT

  • Acute dystonia
  • Pseudoparkinsonism
  • Akathisia
  • Tardive dyskinesia
• Acute Dystonia 


  Acute muscle rigidity and cramping
• Acute Dystonia

  • Torticollis - contracted position of the neck
  • Oculogyric crisis - contracted position of the eyes upward
  • Opisthothonus - arching of the back
  • Writer's clamp - fatigue spasms affecting the hands
  • Laryngospasm - life-threatening
• Acute Dystonia

  More likely to be seen in the 1st week of the treatment. First side effect
• Pseudoparkinsonism 


  Shuffling or festinating gait, mask-like facies, coarse pill-rolling movements
• Akathisia 


  Continuous restlessness, fidgeting, jittery feelings, and nervousness
• Akathisia 


  Inability to sit still or rest
• Tardive Dyskinesia


  Is the late adverse effect of Antipsychotics that usually presents as tongue protrusion, teeth grinding, and lip smacking
• Tardive Dyskinesia usually occurs after 6 months and is permanent/irreversible
• Prevention of Tardive Dyskinesia: Start with the lowest dose to prevent drug accumulation
• Medical Management of Tardive Dyskinesia: Valbenazine (Ingrezza)
• When missing an antipsychotic dose, take the dose ASAP if it is < 4 hrs and skip if it is > 4 hrs
• Long term Antipsychotics are administered IM once a month or as needed, indicated for non-compliant patients and they all end in Decanoate aka Depot Therapy
• When a schizophrenic patient experiences EPS/Tardive Dyskinesia, notify the physician and do not discontinue to prevent relapse, instead decrease the dose or switch to another generation
• Pharmacologic Management of EPS

  A - Akineton - Biperidine

  B - Benadryl - Diphenhydramine

  C - Cogentin - Benztropine
• Neuroleptic Malignant Syndrome


  Most fatal side effect of Schizophrenia characterized by Hyperthermia, Hypertension, and Muscle spasms
• To prevent NMS, the nurse must hydrate the patient
• Nursing action of NMS: Discontinue the medication
• Neuroleptic Malignant Syndrome

  "Withhold meds first before reporting to HCP"
• Medical Management of NMS: Baclofen (muscle relaxant), antipyretics
• Side Effects of Antipsychotics & Nursing Interventions

  Anticholinergic effects - DRY

  • Constipation - increase fluid and fiber
  • Dry mouth - ice chips, sugarless hard candy
  • orthostatic hypotension - change position gradually
  • agranulocytosis - monitor decrease WBC, report any signs of infection
  • photosensitivity - protect eyes and skin
• WOF

  Clozapine - agranulocytosis

  Quetiapine - weight gain

  Ziprasidone - torsades de pointes (QT prolongation)