antipsychotic

• Antipsychotic Drugs is formerly known as neuroleptics.
• Antipsychotic Drugs work by blocking receptors of dopamine.
• primary medical treatment for schizophrenia
• also used in psychotic episodes of acute mania, psychotic depression, and drug-induced psychosis.
• used to treat the symptoms of psychosis, such as the delusions and hallucinations seen in schizophrenia, schizoaffective disorder, and the manic phase of bipolar disorder.
• dopamine receptors 2, 3, 4 have been associated with mental illness.
• the conventional, or first-generation, antipsychotic drugs are potent antagonists of D2, D3, and D4.
• first generation not only are effective in treating target symptoms but also produces many extrapyramidal side effects because of the blocking of the D2 receptors.
• atypical or second-generation antipsychotic drugs are relatively weak blockers of D2, which may account for the lower incidence of extrapyramidal side effects.
• second generation antipsychotics inhibit the reuptake of serotonin, as do some of the antidepressants, increasing their effectiveness in treating the depressive aspects of schizophrenia.
• the third generation, or dopamine system stabilizers, of antipsychotics, are thought to stabilize dopamine output
• third generation, or dopamine system stabilizers preserve or enhance dopaminergic transmission when it is too low and reduce it when it is too high.
• cariprazine (Vraylar) and brexpiprazole (Rexulti) are newer third-generation antipsychotics.

  • the most common side effects are (S) sedation, weight (G) gain, (A) akathisia, (H) headache, (A) anxiety, and (N) nausea.
• extrapyramidal symptoms (EPSs), serious neurologic symptoms, are the major side effects of antipsychotic drugs. they include acute (D) dystonia, pseudo (P) parkinsonism, and (A) akathisia.
• blockade of D2 receptors in the midbrain region of the brain stem is responsible for the development of EPSs.
• acute dystonia includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties.
• (acute dystonia) spasms or stiffness in muscle groups can produce:

  • torticollis i.e., twisted head and neck
• (acute dystonia) spasms or stiffness in muscle groups can produce:

  • opisthotonos i.e., tightness in the entire body with the head back and an arched neck
• spasms or stiffness in muscle groups can produce:

  • oculogyric crisis i.e., eyes rolled back in a locked position
• acute dystonia

  • immediate treatment with anticholinergic drugs, such as intramuscular benztropine mesylate (Cogentin) or intramuscular or intravenous diphenhydramine (Benadryl), usually brings rapid relief.
• acute dystonia

  • immediate treatment with anticholinergic drugs, such as intramuscular benztropine mesylate (Cogentin) or intramuscular or intravenous diphenhydramine (Benadryl), usually brings rapid relief.
• drug-induced parkinsonism, or pseudo-parkinsonism symptoms resemble those of Parkinson disease:

  • (s, s) stiff, stooped posture
• drug-induced parkinsonism, or pseudo-parkinsonism symptoms resemble those of Parkinson disease:

  • (M) mask like face
• drug-induced parkinsonism, or pseudo-parkinsonism symptoms resemble those of Parkinson disease:

  • decreased arm (S) swing
• drug-induced parkinsonism, or pseudo-parkinsonism symptoms resemble those of Parkinson disease:

  • (s, f) shuffling, festinating gait i.e., with small steps
• drug-induced parkinsonism, or pseudo-parkinsonism symptoms resemble those of Parkinson disease:

  • (C) cogwheel rigidity i.e., ratchet-like movements of joints
• drug-induced parkinsonism, or pseudo-parkinsonism symptoms resemble those of Parkinson disease:

  • (D) drooling
• drug-induced parkinsonism, or pseudo-parkinsonism symptoms resemble those of Parkinson disease:

  • (T) tremor
• drug-induced parkinsonism, or pseudo-parkinsonism symptoms resemble those of Parkinson disease:

  • (B) bradycardia
• drug-induced parkinsonism, or pseudo-parkinsonism symptoms resemble those of Parkinson disease:

  • (p, r) coarse pill rolling movements of the thumb and fingers while at rest
• parkinsonism is treated by:

  • adding an oral anticholinergic agent (e.g., amantadine), which is a dopamine agonist that increases transmission of dopamine blocked by the antipsychotic drug.
• akathisia is reported by the client as an intense need to move about.
• neuroleptic malignant syndrome is a potentially fatal idiosyncratic reaction to an antipsychotic (or neuroleptic) drug.
• the major symptoms of NMS

  • rigidity (R)
• the major symptoms of NMS

  • high fever (F)
• the major symptoms of NMS

  • (A) autonomic instability e.g., unstable blood pressure, diaphoresis, and pallor
• the major symptoms of NMS

  • (D) delirium
• the major symptoms of NMS

  • (E, C, P) elevated levels of enzymes, particularly creatine phosphokinase.
• NMS often occurs in the first 2 weeks of therapy
• NMS treatment includes institution of supportive medical care to treat dehydration and hyperthermia until the client’s physical condition stabilizes.