CHLORPROMAZINE, HALOPERIDOL and RISPERIDONE

CHLORPROMAZINE

• It was the first antipsychotic medication to be found.
• It is a conventional but powerful medication.

Mechanism of Action

It modifies dopamine's impact on the central nervous system. The mesolimbic dopaminergic system's postsynaptic dopamine D2 receptors are blocked, which is how it works.

Indication

• Psychosis.
• Tourette's disorder
• Mania.
• Nausea and vomit.
• Behavioral issues in kids.

Dose

• Adult
  • 10–25 mg once or twice daily, adjusted based on response, and 75–300 mg divided over the course of the day. 1g maximum per day.
• Child
  • 1 to 5 years: 0.5 to 1 mg/kg 6-12 years; 4-6 hourly; third to half of an adult dose
• IM/IV
  • Long IM 1–5 years: 0.5 mg/kg–6–8 hrly, with a daily maximum of 40 mg.
• 6-12 years
  • 0.5 mg/kg every 6–8 hours. 75mg maximum per day.

Contraindication

Parkin's disease, myasthenia gravis, severe heart and liver illness, narrow angle glaucoma, and bone marrow depression

Side Effect

Extrapyramidal response, tachycardia, arrhythmias, agranulocytosis, leukopenia, dry mouth, constipation, urine retention, mydriasis, dry eye, blurred vision, photosensitivity, hyperpigmentation, tardive dyskinesia, galactorrhea, weight gain, amenorrhea, gynecomastia, impotence,

Nursing Consideration

• The medication should be administered at the designated time.
• Patients should occasionally drink water because the medication may induce dry mouth and urinary retention.
• Patients should be advised against operating machinery if they feel sleepy.
• The patient might put on weight; in such case, provide pharmacological instruction.
• It is advised that nurses periodically take the vital signs.
• Inform the doctor and the pharmacists if a patient has allergies.

HALOPERIDOL

Mechanism of Action

• Dopaminergic neurotransmission is decreased in the CNS by haloperidol.
• It lessens the stress that comes with psychosis.
• It has marginally anticholinergic, ganglionic, and alpha adrenergic blocking effects.

Indication

• Therapy for psycosis
• Tourette syndrome
• Severe issues with child behavior.

Dose

• Adult
  • Maximum daily dose: 30 mg at 1.5-5 mg bid or tid.
• IV/IM
  • 2–10 mg at first, followed by 4–8 mg every hour for a maximum of 18 mg
• Children
  • Two doses of 25–50 micrograms/kg per day. 10 mg maximum daily

Contraindication

Hypersensitivity, severe hepatic or cardiac disease, bone marrow depression, parkinsonism, narrow-angle glaucoma, coma, and CNS depression

Side Effect

Sedation, extrapyramidal reaction, neuroleptic malignant syndrome, confusion during seizures, hypotension, tachycardia, dyspepsia, dry mouth, constipation, blurred vision, dry eye galactorrhea, and gynecomastia are some of the side effects that may occur.

Nursing Consideration

• According to the doctors' concerns, patients must obtain medication.
• There should be no exceptions to the dose.
• Patients should be advised against operating machinery if they are feeling drowsy.
• Provide drug education because the medication may induce galactorrhoea and dry eyes.
• It is advised that nurses periodically take the vital signs. It might result in hypotension.
• Inform the doctor if a patient has an allergy.

RISPERIDONE

Mechanism of Action

• It works by very effectively blocking serotonin 5TH2 and dopamine D2 receptors in the CNS and peripheral areas.

Indication

• Bipolar mood disorders, schizophrenia, and organic psychosis
• Signs of serious depression that are psychotic.

Dose

• Adult
  • First day 2mg in a single or two divided doses, second day: 4mg in a single or two divided doses, third day: 6mg in a single or two divided doses. Usually 4 to 8 mg per day, up to 16 mg per day.
• Elderly with hepatic or renal impairment
  • 500 microgram twice a day at first, then 1-2 mg every day.

Contraindication

• Infant, young children, and nursing mothers

Side Effect

• Extrapyramidal syndrome, tachycardia, extended QT intervals, agitation, anxiety, dyspepsia, constipation, orthostatic hypotension, and nausea

Nursing Consideration

• For the treatment of people with dementia-related psychosis, the medication is not licensed.
• It is advised that nurses note the sensitivity.
• Patients should be advised against operating machinery if they feel sleepy.
• When being used as an antipsychotic, the medication's dose should never be missed.
• It is advised that nurses periodically take the vital signs. It might result in hypotension.
• Breast milk excretion during lactation is possible; not recommended