Chapter 17 - Drugs for Psychoses

Question 1

Chlorpromazine Class: Phenothiazine

Answer 1

Action:
Prevent dopamine and serotonin from occupying their receptor sites in certain
regions of the brain. It is a conventional antipsychotic;

Uses:
Provide symptomatic relief of the positive symptoms of schizophrenia and to control
the manic symptoms of schizoaffective disorder.

Contraindications:
Children under 6 months old, allergy , circulatory collapse, liver damage, cerebral
arteriosclerosis, coronary disease, coma

Adverse Effects:
Strong blockade of alpha-adrenergic receptors and weak blockade of cholinergic receptors explain some of the drug’s adverse effects. Common adverse effects are dizziness, drowsiness, and orthostatic hypotension. Extrapyramidal side effects occur more commonly in elderly, female, and pediatric patients who are dehydrated. Neuroleptic malignant syndrome may occur.

Patient Teaching:

• Orthostatic hypotension may occur
• Avoid hazardous activities

Pregnancy Category:C

Question 2

Haloperidol Class: Antipsychotic

Answer 2

Action:
The mechanism of action is believed to be the same as that of the phenothiazines,
that is, by blocking of the dopamine type 2 receptor.

Uses:
Acute and chronic psychotic disorders; It is also used to treat patients with Tourette’s syndrome and children with severe behavior problems such as
unprovoked aggressiveness. When administered via IM or subcutaneous injection, it lasts approximately 3 weeks, which makes it beneficial for patients who are not likely to compliantly take medications independently.

Contraindications:
Allergy, coma, Parkinson’s disease

Adverse Effects:
Less sedation and hypotension than chlorpromazine, but the incidence of EPSs is
high. Elderly patients often experience worse adverse effects.

Patient Teaching:
EPS:

Pregnancy Category: C

Question 3

Risperidone Class: Antipsychotic

Answer 3

Action:
It is a serotonin (5-HT) receptor antagonist

Uses:
Treatment and prevention of schizophrenia relapse and expression of bipolar mania
symptoms, and to treat the symptoms of irritability in autistic children. This classification treats both the positive and negative symptoms of schizophrenia. It is
sometimes used in combination with other drugs. It can be administered via IM and be longlasting.

Contraindications:
Allergy and breastfeeding

Adverse Effects:
EPSs (involuntary shaking of the head, neck, and arms), hyperactivity, fatigue,
nausea, dizziness, visual disturbances, fever, and orthostatic hypotension.
Risperidone may cause weight gain and hyperglycemia, thus worsening glucose control in diabetic patients. Elderly patients experience worse adverse effects.

Patient Teaching:

• Heat stroke may occur
• Use contraception
• Notify PCP of suicidal thoughts/behaviors
• • works with both positive and negative symptoms
• • # 1 drug of choice, less likely for EPS

Pregnancy Category:C