ANTIPSYCHOTICS

TYPICAL/CONVENTIONAL ANTIPSYCHOTICS

ATYPICAL ANTIPSYCHOTICS

CLASSIFICATION OF ANTIPSYCHOTICS

CHEMICAL CLASS

DAILY DOSAGE RANGE(MG)

AVAILABLE FORMS (MG)

Phenothiazines
Aliphatic Chlorpromazine 75 400 Tab:10,25,50,100,200 Oral conc:100/ml Inj : 25/ml

Piperidines Thioridazine (Mellaril) Perphenazine (Trilafon)

150 800 12 - 64

Tab: 10,15,25,50,100,150,200 Conc: 30/ml,100/ml Tab: 2,4,8,16 Conc: 16/5ml Inj: 5/ml

Piperazine Trifluoperazine

4 - 40

Tab: 1,2,5,10

CLASSIFICATION
CHEMICAL CLASS Butyrophenones Haloperidol 1 - 100 Tab : 0.5,1,2,5,10,20 Conc : 2/ml Inj : 50/ml Caps : 1,2,5,10,20 Conc : 5/ml DAILY DOSAGE RANGE(MG) AVAILABLE FORMS (MG)

Thioxanthenes Thiothixene 6 - 30

CHEMICAL CLASS

DAILY DOSAGE RANGE(MG)

AVAILABLE FORMS (MG)

Atypical antipsychotics
Clozapine (Clozaril) Risperidone (Risperdal) 300 900 1-6 Tab : 12.5,25,100 Tab : 0.25,0.5,1,2,3,4 Conc : 1/ml Powder for inj : 25,37.5,50 Tab : 2.5,5,7.5,10,15,20 Powder for inj : 10 Tab : 25,100,200,300 Tab : 5,10,15,20,30

Olanzapine (Zyprexa) Quetiapine (Seroquel) Aripiprazole

5 - 20 150 750 10 - 30

Ziprasidone

40 - 160

Caps : 20,40,60,80 Powder for inj : 20

SIDE EFFECTS AND NURSES ROLE

Dry mouth
Typical antipsychotics
Chlorpromazine Thioridazine Trifluoperazine Ziprasidone Fluphenazine Perphenazine Haloperidol Thiothixene

Atypical antipsychotics
Quetiapine Aripiprazole

Explain that this will subside after few weeks

Clear small items from pathway to pervent falls

Blurred vision
Typical antipsychotics Thioridazine Fluphenazine Haloperidol Typical antipsychotics

Constipation
Atypical antipsychotics

Atypical antipsychotics

Chlorpromazine Thioridazine

Clozapine Aripiprazole

Haloperidol

Ziprasidone

Urinary retention
Instruct client to report any difficulty in urination. Monitor intake and output.

Urinary retention
Typical antipsychotics Triflupromazine Thioridazine Fluphenazine Perphenazine Haloperidol Atypical antipsychotics

Concentrates may be mixed with juice or other liquid just before adminisration

Administer tablets or capsules with food.

Nausea
Typical antipsychotics Chlorpromazine Thioridazine Trifluoperazine Atypical antipsychotics Risperidone Ziprasidone

Avoid driving or operating dangerous machines while experiencing sedation

Sedation
Typical antipsychotics
Chlorpromazine
Triflupromazine

Atypical antipsychotics
Risperidone
Aripiprazole

Thioridazine
Trifluoperazine Perphenazine Fluphenazine

Instruct client to rise slowly from a lying or sitting position

Typical antipsychotics
Orthostatic hypotension
Trifluoperazine Perphenazine

Photosensitivity
Chlorpromazine Fluphenazine Thiothixine

Atypical antipsychotics
Clozapine

Decreased libido Galactorrhoea and Gynecomastia Amenorrhoea Sexual dysfunction

Hormonal effects

Nursing intervention
Provide explanation of the effects and reassurance of reversibility. Discuss with physician possibility of ordering alternate medication.

Weight gain
Typical antipsychotics
Triflupromazine Thioridazine

Atypical antipsychotics
Clozapine Olanzapine

Ziprasidone
Quetiapine

Extrapyramidal symptoms (EPS) Tardive dyskinesia Teach client and family members to observe for EPS and report immediately. Neuroleptic malignant syndrome (NMS) Teach client and family members to observe for NMS and report immediately. Discontinue neuroleptic medication immediately. Monitor vital signs,degree of muscle rigidity,intake and output and level of consciousness.

Extrapyramidal symptoms (EPS)

Typical antipsychotics
Chlorpromazine
Thioridazine Trifluoperazine Fluphenazine

Atypical antipsychotics
Olanzapine
Risperidone

Perphenazine
Haloperidol

Thiothixene

Routine ECG should be taken before initiation and periodically during therapy.
Monitor vital signs every shift. Observe for symptoms of dizziness, palpitations , syncope or weakness.

Agranulocytosis Teach client to observe and report immediately for symptoms of sore throat, fever, malaise. A complete blood count should be monitored weekly for first 6 months and every other week thereafter.

QT interval prolongation

Agranulocyto Hypersalivat Diabetes sis ion

Hyperliped emia

Clozapine Ziprasidone

Clozapine Chlorpromazi ne

Clozapine Risperidone

Clozapine Olanzapine

Clozapine Olanzapine Quetiapine

Traditional Neuroleptics: Adverse Effects

Class/agent Sedation ACH EPS Orthostasis

chlorpromazine thioridazine

+++

++ to +++

+ to ++

+++

fluphenazine
haloperidol trifluoperazine

+ to ++

0 to +

+++

perphenazine
thiothixene

0 = none or not significant; + = mild; ++ = moderate; +++ = marked ACH = anticholinergic effects; EPS = extrapyramidal effects

Atypical Neuroleptics: Adverse Effects

Agent clozapine Sedation +++ +++ ACH 0-+ EPS Orthostasis +++

risperidone
Olanzapine Quetiapine

0-+
+ +

0-+
+ +

0 - ++ (a)
0 0

+
+ +

0 = none or not significantly different from placebo; + = mild; ++ = moderate; +++ = marked. ACH = anticholinergic effects; EPS = extrapyramidal effects a Dose-related EPS above 6 mg/day

 Tripathi KD. Essenials of Medical Pharmacology. 6th ed. Jaypee; p. 424 - 433. Wilson BA,Shannon MT,Stang CL. Nurses Drug Guide.3rd ed. Stamford; p. 303,358,673. Townsend MC. Psychiatric Mental Health Nursing. 5th ed. Jaypee; p. 304 306. available at http://www.mentalhealth.com/drug /p30-c01.html assessed on 11/4/12 available at http://www.britannica.com / EBchecked/topic/ 455623/ phenothiazine assessed on 13/4/12

Bibliography

Bibliography
available at http://www.patient.co.uk/medicine / Perphenazine.htm assessed on 13/4/12 available at http://en.wikipedia.org/wiki/ Butyrophenone assessed on 15/4/12 available at http://www.ncbi.nlm.nih.gov/pmc / articles/PMC2327229/ assessed on 16/4/12 available at http://www.reintegration.com / professional/total/ effects.asp assessed on 16/4/12