Typical Antipsychotics - 1st Generation

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Typical Antipsychotics - 1st Generation (targets positive symptoms: delusions, catatonia, bizarre behavior, hallucinations) Drug UsesActions/ Contraindicatio ns Side EffectsTherapeutic Effects

haloperidol acute psychosisAction:

blocks dopamine receptors in brain don't give if pt

has: parkinson’s,

seizures, severe mental depression akathisia (restlessness) dystonia (uncontrollable muscle contraction- results in twisting of body)

Assess for:

EPS, TD, parkinsonism uncontrollable temper outburst stereotypic behavior (banging head on wall) NMS - assess temp.alopecia urinary retention amenorrhea breast engorgement galactorrhea priapism gynecomastia seizures hyperthermia

Assess for:

laryngospasm / bronchospasm hyperglycemia, hypoglycemia, hyponatremia sedation, decreased agitation, decreased combativeness, decreased psychomotor activity, decreased hallucinations, decreased delusions, decreased psychotic behavior (Haldol) chronic useful for schizophrenia outpatients in long-acting form mental retardation with hyperkinesia tourettes in children autism spectrum disorder targets positive symptoms conversion disorder Thiothixene (Navane) acute psychosisorthostatic hypotension NMS = Neuroleptic Malignant Syndrome : escalates rapidly - usually starts w/ fever - life threatening hyperpyrexia, severe HTN, diaphoresis, (103 °, 116 bpm, 34 Resp, 100/50 BP) stop immediately; bring to ER benztropine (Cogentin) anticonvulsant for EPS usually taken with 1st gen. antipsychotics, also treats symptoms of Parkinson’s disease.If antipsychotics are abruptly stopped, can get acute psychosis. If taking antipsychotics watch glucose & TSH Atypical Antipsychotics - 2nd Generation Not typically used...too expensive 3 / 4

(Targets positive and negative symptoms (-pine, -done) DrugUses Actions/ Contraindicatio ns Side Effects Therapeutic Effects Clozapine (Clozaril) schizophrenia, used in pts who respond poorly to other antipsychotics

Actions:

dopamine & serotonin receptor blocker also blocks glutamate, anticholinergic, alpha adrenergic blocker dizziness, decreased alertness, agranulocytosis - rare

Notify Dr if:

increased HR, lethargy, weakness, flu-like symptoms do weekly blood test for safe dosing for 6 mos do WBC count with neutrophils weekly.Watch for sore throat because of infections.targets positive & negative symptoms don't give to pt with agranulocytosis EPS, TD, dystonia, akathisia seizures hyperglycemia weight gain monitor for hyperglycemia- potentially dangerous side effect of agranulocytosis don’t give to older pt with dementia orthostatic hypotension increased death in older adults with dementia- related psychosis Olanzapine (Zyprexa) derivative of clozapine weight gainwatch glucose; great for anorexia short acting anti- psychotic if used with metformin, can counterbalance weight changes.give to anorexia nervosa ptsdrug is sedating, administer at bedtime Aripiprazole schizophrenia, lowers dopamineakathisia [restlessness] (Abilify) bipolar disorder, depression, anxiety Asenapine (Saphris) Iloperidone (Fanapt) D2, D3, 5-HT2a receptors orthostatic hypotension - goes away with time Lurasidone (Latuda) major depression, D2, 5HT2a receptors avoid grapefruit and grapefruit juice

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