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NURS 222 Chapter 26 Notes Chapter 26: Antipsychotics and Anxiolytics I. Antipsychotics- more commonly referred to as neuroleptics or psychotropics.

s. Neuroleptic- any drug that modifies psychotic behavior and exerts an antipsychotic effect. Psychosis Psychosis- losing contact with reality and is manifested in a variety of mental/psychiatric disorders and characterized by more than one symptom: delusions, hallucinations, catatonia, incoherence, and aggressive/violent behavior. Schizophrenia- the major category of psychosis in which many of the above symptoms are manifested. Symptoms usually develop in adolescence or early adulthood. Symptoms are divided into two groups: 1) Positive- exaggeration of normal function (agitation, incoherent speech, hallucination, delusion, and paranoia). 2) Negative- decrease or loss in function and motivation (social withdrawal, poor self-care; more chronic and persistent). Typical antipsychotics treat positive symptoms mainly. Atypical antipsychotics treat the negative symptoms. Antipsychotics are sometimes called dopamine agonists and block the dopamine receptors in the brain, so as to reduce the psychotic symptoms. EPS (ExtraPyramidal Symptoms)- effects such as tremors, masklike facies, rigidity, and shuffling gait develop when dopamine is blocked in the brain. Antipsychotic Agents There are two major categories of antipsychotics: (1) typical antipsychotics and (2) atypical antipsychotics. 1. Pharmacophysiologic Mechanisms of Action o Block the actions of dopamine and may be classified as dopaminergic antagonists. o Block the D2 receptors, which promotes presence of EPS. o Atypical antipsychotics have a weak affinity to D2 and strong affinity to D4 and block serotonin receptors; meaning fewer EPS. 2. Adverse Reactions o Extrapyramidal Syndrome- also known as pseudoparkinsonism includes stooped posture, shuffling gait, rigidity, bradykinesia, tremors while resting, pill-rolling motion of the hand. ~ More pronounced when taking high-potency typical antipsychotics. o Acute dystonia- facial grimacing, involuntary upward eye movement, muscle spasms of face, tongue, neck, and back, and laryngeal spasms; occurs in 5% clients within days of taking typical antipsychotics.

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o Akathisia- restlessness, trouble standing still, paces the floor, feet in constant motion, rocking back and forth (occurs in 20% of clients taking typical antipsychotic). o Tardive dyskinesia- protrusion and rolling of the tongue, sucking/smacking movements of the lips, chewing motion, facial dyskinesia, involuntary movements of the body and extremities (occurs with typical antipsychotic use for more than a year; STOP USE IF SEEN!!). o Neuroleptic Malignant Syndrome (NMS)- a rare but potentially fatal condition including muscle rigidity, sudden high fever, ,altered mental status, BP fluctuations, tachycardia, dysrhythmias, seizures, rhabdomyolysis, acute renal failure, respiratory failure, and coma. Phenothiazines o First subgroup of typical antipsychotics. o Divided into three subgroups based on side effects: a) Aliphatic phenothiazines- strong sedative effect, decreased BP, moderate EPS, and orthostatic hypotension. b) Piperazine phenothiazines- low sedative and strong antiemetic effect; little effect on BP, cause more EPS than others. c) Piperidine phenothiazines- strong sedative effect, cause fewer EPS, no antiemetic effect, lowmoderate effect on BP. o Given PO, IM, or IV; peak serum levels in 2-3 hours; highly PB; excretion slow, metabolized by liver; causes pinkish to red-brown urine color. o Full therapeutic effects may not be evident for 3-6 weeks. Nonphenothiazines o Second subgroup of typical antipsychotics. o Haloperidol is the main one and blocks dopamine receptors. o Side effects include drowsiness, some anticholinergic effects: dry mouth, increased heart rate, urinary retention, and constipation; EPS, dystonia, akathisia, tardive dyskinesia; blood dyscrasias with longtime usage such as agranulocytosis; pruritis and photosensitivity. Antipsychotic Dosage for Older Adults o Older adults require smaller doses (25-50%). Atypical (Serotonin/Dopamine Antagonists) Antipsychotics o Effective in treating both positive and negative symptoms of schizophrenia. o Not likely to cause EPS or tardive dyskinesia. o Weight gain is a common side effect. o Common drugs: a) Clozapine (Clozaril)- only indicated in for the treatment of severely ill schizophrenic clients who havent responded to traditional antipsychotic drugs. Adverse reactions include seizures and agranulocytosis.

Does not cause EPS, although tremors and occasional rigidity have been reported. Dizziness, sedation, tachycardia, orthostatic hypotension, and constipation are common side effects. b) Risperidone (Risperdal)- treats positive and negative symptoms of schizophrenia. Occurrence of EPS and tardive dyskinesia low. III. Anxiolytics Anxiolytics- antianxiety drugs primarily used to treat anxiety and insomnia. Major anxiolytic group is benzodiazepines; they enhance the action of GABA. There are two types of anxiety: (1) primary anxiety and (2) secondary anxietyrelated to selected drug use or medical/psychiatric disorders. 1. Nonpharmacologic Measures o Relaxation technique, psychotherapy, and support groups should be tried before anxiolytics are given. o Panic attack- dyspnea, choking sensation, chest pain, heart palpitations, dizziness, faintness, sweating, trembling/shaking, and fear of losing control. 2. Benzodiazepines o Most frequently prescribed is lorazepam (Ativan). o Lipid-soluble and readily absorbed from GI tract. o Highly PB; metabolized by liver and excreted in urine (lower dose for those with renal/hepatic diseases). o Side effects: sedation, dizziness, headaches, dry mouth, blurred vision, rare urinary incontinence, constipation. o Adverse reactions: leucopenia, fever, malaise, sore throat; tolerance and physical dependency. o Withdrawal symptoms if abruptly discontinued. o Avoid alcohol and other CNS depressants 3. Miscellaneous Anxiolytics o Buspirone hydrochloride (BuSpar) has fewer side effects of sedation and physical/psychologic dependency than benzodiazepines. o

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