Antipsychotic Drugs

Antipsychotic drugs formerly known as neuroleptics are used to treat symptoms of psychosis,
such as delusions and hallucinations seen in schizophrenia, schizoaffective disorder and manic
phase of bipolar disorder. It works by blocking the receptors of the neurotransmitter dopamine.

Types of Antipsychotic durgs

Typical/Conventional antipsychotic drugs are potent antagonist (blockers) of D2, D3, D4. Treats
positive (+) symptoms of schizophrenia produces many extrapyramidal side effects because of
the blocking of the D2 receptors.

 Chlorpromazine (Thorazine)
 Fluphenazine (Prolixin)
 Thioridazine (Mellaril)
 Haloperidol (Haldol)
 Loxapine (Loxitane)

Atypical antipsychotic drugs are relatively weak blockers of D2, which may account for the
lower incidence of extrapyramidal side effects. It inhibit the reuptake of serotonin, as do some
of the antidepressants, increasing their effectiveness in treating the depressive aspects of
schizophrenia. Treats positive and negative symptoms of schizophrenia and decrease WBC
(agranulocytosis)

 Clozapine ( Clozaril)
 Risperidone (Risperdal)
 Olanzapine (Zyprexa)

Side Effects

Extrapyramidal Symptoms are serious neurologic symptoms, are the major side effects of
antipsychotic drugs. They include acute dystonia, pseudo parkinsonism, akathisia, neuroleptic
malignant syndrome and tardive dyskinesia. Blockade of D2 receptors in the midbrain region of
the brain stem is responsible for the development of EPS.

-increase acetylcholine decrease levels of dopamine

1. Acute dystonia- acute muscular rigidity and cramping, stiff tongue with difficulty
swallowing and in severe cases, laryngospasm and respiratory difficulties.
 Treatment: Intramuscular Benztropine mesylate (Cogentin) or Benadryl usually brings
rapid relief .
2. Pseudo parkinsonism – stiff, stooped posture; masklike faces, decreased arm swing,
shuffling gait, cogwheel rigidity, drooling, coarse pill rolling movements of thumb and
fingers while at rest.
Treatment: changing to an antipsychotic medication that has lower incidence of EPS or
by adding oral anticholinergic agent Amantadine which is a dopamine agonist that
increases the transmission of dopamine blocked by the antipsychotic drug
3. Akathisia- restless or anxious and agitated often with a rigid posture or gait and lack of
spontaneous gestures.
Treatment: change in antipsychotic medication or by additional oral gent such as beta
blocker, anticholinergic or benzidiazepine.
4. Neuroleptic Malignant Syndrome- potentially fatal idiosyncratic reaction to an
antipsychotic drug. Symptoms are high fever, autonomic instability such as high blood
pleasure diaphoresis and pallor and elevated levels of enzymes.
Treatment: discontinue medications and the institution supportive medical care to treat
dehydration and hyperthermia until the client’s physical condition stabilizes
5. Tardive dyskinesia- syndrome of permanent involuntary movements and irreversible
caused by long term used of antipsychotic medications. Manifested by lip smacking,
protruding, grimacing and other excessive unnecessary facial movements.
Treatment: Ingrezza , Austedo and Teva are the first drugs to treat TD

Anticholinergic Side Effects often occur with the use of antipsychotic drug and includes dry
mouth, constipation, urinary retention, blurred near vision, nasal congestion, decreased
memory.

Treatment: calorie free beverages or hard candy for dry mouth, stool softeners and
adequate fluid intake and inclusion of vrains and fruit in the diet

Other Side Effects

Antipsychotic drugs may increase blood prolactin levels that may cause breast enlargement and
tenderness in men and women, diminished libido, erectile dysfunction and menstrual
irregularities and increased risk for breast cancer and can also contribute to weight gain