CLASSIFICATION & DRUG
MECHANISM OF ACTION
EXAMPLES
Acetylcholinesterase Inhibitors
examples:Donepezil (Aricept)
Galantamine (Razadyne, Reminyl)
Rivastigmine (Exelon)
N-Methyl-d-aspartate (NMDA)
Receptor Antagonists examples:
Memantine (Namenda) combination
NMDA receptor antagonist &
acetylcholinesterase inhibitors
Memantine hydrochloride extended-
release & donepezil hydrochloride
(Namzaric)
Conventional Antipsychotics
Phenothiazines: examples:
Chlorpromazine (Thorazine)
Fluphenazine
Perphenazine
Prochlorperazine (Compazine)
Thioridazine
Trifluoperazine
Nonphenothiazines: examples:
Haloperidol (Haldol)
Loxapine (Loxitane)
Pimozide (Orap)
Thiothixene (Navene)
NURSING IMPLICATIONS
Acetylcholinesterase inhibitors
reduce acetylcholine breakdown,
whereas NMDA receptor antagonists
limit the effects of glutamate. Both
drugs have a modest effect in slowing
an individual’s rate of cognitive
decline in Alzheimer disease.
May also be used for:
 Vascular dementia
 Parkinson-related dementia.
 Combination agent (Namzaric)
used only after patients have been
stabilized on memantine &
donepezil
Both phenothiazines &
nonphenothiazines block D2
dopamine receptors in the brain,
increasing synaptic levels of
dopamine & leading to a decrease in
symptoms of psychosis (including
delusions & hallucinations).
May also be used for:
 Schizophrenia & other psychotic
disorders
 Tourette syndrome.
 Explain the importance of taking medication
as directed; teach about discontinuation & decline
in function.
 Provide patient education regarding dizziness,
headache, gastrointestinal (GI) upset, & fatigue.
 Promote adequate fluid intake.
 Monitor patient’s pulse rate.
 Use with caution in patients with respiratory
conditions (e.g., asthma, COPD).
 Avoid the use of tricyclics & anticholinergic
drugs because of their antagonistic effects.
 Monitor for anticholinergic symptoms, such as
dry mouth, orthostatic hypotension, constipation,
urinary retention, sedation, & sexual dysfunction.
 Teach patient strategies to address
anticholinergic effects (e.g., rising slowly,
increasing fluid intake, & increasing fiber intake).
 Monitor for extrapyramidal symptoms (EPS),
such as acute dystonia, akathisia, parkinsonism, &
tardive dyskinesia (TD).
 Monitor for signs of hyperprolactemia
(menstrual irregularities, decreased libido,
gynecomastia, & osteoporosis). Adjunctive
therapies, counseling, or changing to a different
agent may improve some aspects of sexual
dysfunction.
 Monitor for autonomic instability associated
with neuroleptic malignant syndrome.
 Teach patients importance of adhering to
medication regimen & not to abruptly discontinue
medication.
 Teach patients importance of wearing
sunscreen.
Atypical Antipsychotics
examples:
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Clozapine (Clozaril)
Asenapine (Saphris)
Paliperidone (Invega)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Third-generation
Antipsychotics
examples: Aripiprazole (Abilify)
Brexpiprazole (Rexulti)
Anxiolytics
Nonbenzodiazepines
examples:
Buspirone (BuSpar)
Selective Serotonin Reuptake
Inhibitors (SSRIs) examples:
Sertraline (Zoloft), Fluoxetine
(Prozac)
Block D2 & serotonin receptors; treat
both positive & negative symptoms of
schizophrenia & psychotic disorders,
exert mood-stabilizing effect.
May also be used for:
 Schizophrenia & other psychotic
disorders
 Bipolar disorder.
Partial agonists of D2 receptors, also
block serotonin receptors.
Probably inhibits serotonin reuptake
& activates dopamine receptors in the
 These agents may increase confusion.
brain, leading to a decrease in
 Abrupt discontinuation may lead to rebound
symptoms of anxiety.
Inhibits reuptake of serotonin in the
central nervous system, leading to a
decrease in symptoms of depression
& anxiety.
May also be used for:
 Depression
 Anxiety
 Obsessive-compulsive disorder
 Posttraumatic stress disorder
 Social anxiety disorder.
 Monitor for adverse effects, such as alterations
in glucose metabolism, hyperlipidemia,
cardiovascular & cerebrovascular alterations &
blood abnormalities.
 Teach importance of healthy diet & exercise.
 Monitor for EPS & neuroleptic malignant
syndrome.
 Although generally well tolerated, patients
should still be monitored for EPS, neuroleptic
malignant syndrome (NMS), & medical effects
associated with atypical antipsychotics.
 Akathisia & restlessness may be more
pronounced with this medication.
 Teaching should address healthy diet &
exercise, importance of adherence, & recognizing
& reporting adverse effects.
 Monitor for dependency, drowsiness,
hypotension, tolerance, dizziness, & GI upset.
anxiety.
 Monitor for suicide risk.
 Monitor for serotonin syndrome.
 Abrupt discontinuation may cause serotonin
withdrawal.
 Provide patient education regarding dizziness,
insomnia, somnolence, GI upset, nausea or
diarrhea, & avoiding over-the-counter (OTC)
preparations that may increase risk of serotonin
syndrome.