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Nursing Mental Health Drugs: Antipsychotics Cheat Sheet (DRAFT) by

First and Second Gen Antipsychotics. Based on AC testable material for MH class.

This is a draft cheat sheet. It is a work in progress and is not finished yet.

First Generation (Conve­nti­onal) Antips­ych­otics

Mode of Action
block dopamine receptors.
Drugs
Chlorp­rom­azine, Halope­ridol, Fluphe­nazine, Loxapine, Thiori­dazine
Side effects
Antich­oli­nergic, sedation, ED, gyneco­mastia, galact­orrhea. substa­ntial weight gain
Adverse Effect: Extrap­yra­midal Symptoms (EPS)
Caused by block of dopamine. Must monitor for involu­ntary movements.
1) Acute Dystonia
S/S: facial grimacing, involu­ntary eye movement upward, muscle spasms of face, neck, tongue and back (trunk will arch forward), laryngeal spasms
2) Pseudo­par­kin­sonism
S/S: stooped posture, shuffling gait, rigidity, bradyk­inesia, tremors at rest, pill rolling motion.
3) Akathisia
S/S: restless, trouble standing still, paces the floor, feet in constant motion, rocking back and forth.
4) Tardive Dyskinesia
S/S: protru­sio­n/r­olling of the tongue, suckin­g/s­macking of the lips, chewing motion, facial dyskin­esia, involu­ntary movements of body/e­xtr­emi­ties.
If positive for EPS stop medication or add benzat­ropine (Cogentin)

Most effective on Positive symptoms of schizo­phrenia that include delusions (fix/false beliefs), halluc­ina­tions (visual/ auditory).
  

Second Generation (uncon­ven­tional) Antips­ych­otics

Mode of Action
Blocks dopamine and serotonin
Clozapine
Consid­era­tions: Relatively free of EPS, convul­sions are possible.
 
Fatal side effect: suppress bone marrow and induces agranu­loc­ytosis (lack of WBC). Routine labs weekly for 6 months.
Ripser­idone
Consid­era­tions: Highest risk of EPS, sedation & orthos­tatic hypote­nsion = fall risk. Weight gain, sedation, and sexual dysfun­ction may lead to non-ad­her­ence.
Olanzapine
SE: Sedation, weight gain, hyperg­lycemia (new onset type 2 DM) and higher risk of metabolic syndrome.
Zipras­idone
CI'D in patients with known hx of QT interval prolon­gation, recent acute MI, uncomp­romised heart failure. must be taken with food to enable absorption
Ariprazole
Dopamine modulator, can be agonist or antago­nist. no weight gain or sedation.
targets positive & negative symptoms of schizo­phr­enia.

often chosen as first line due to more favorable side effect profile less EPS but increased risk of metabolic syndrome (increased weight, hyperg­lyc­emia, and elevated trigly­cer­ides).

Ripser­idone & Olanzapine have injectable long term forms