Antipsychotics administration

IM antipsychotic administration (e.g., ziprasidone 10 to 20 mg, olanzapine 2.5 to 10 mg, or haloperidol 2 to 5 mg) can be used to calm agitated patients. However, this approach does not improve the extent of response, time to remission, or length of hospitalization. 

Switching from other antipsychotics - Nh e immediate discontinuation of the previous antipsychotic treatment may be acceptable for some patients with schizophrenia, gradual discontinuation may be more appropriate for others. In all cases, minimize the period of overlapping antipsychotic administration. 

Switching from other antipsychotics - The period of overlapping antipsychotic administration should be minimized. When switching patients with schizophrenia from depot antipsychotics, if medically appropriate, initiate quetiapine therapy in place of the next scheduled injection. Periodically reevaluate the need for continuing existing EPS medication. 

Tardive dyskinesia after long-term antipsychotic administration is thought to be due to... 

Long-acting, parenteral, antipsychotic administration remains an important option in various clinical situations. Presently, only neuroleptics are available in this formulation, but it is anticipated that depot formulations of novel antipsychotics (e.g., risperidone, olanzapine) may soon be approved. The advent of such agents should significantly improve the efficacy and safety of this strategy. 

However, conventional antipsychotics may be added to atypical antipsychotics to lead in the initiation of atypical antipsychotic administration for the treatment of positive symptoms, when the more rapid onset of action of the conventional antipsychotics is necessary the conventional antipsychotics then can be phased out while the atypical antipsychotics are phased in for maintenance in a less acute situation (Fig. 11 —59). Conventional antipsychotics may also be useful to periodically top up patients receiving atypical antipsychotic maintenance treatment who are experiencing bouts of aggressiveness, thereby also allowing for more rapid and more robust relief of symptoms than an additional dose of the maintenance atypical antipsychotic (Fig. 11-59). 

List the uses, general drug actions, general adverse reactions, contraindications, precautions, and interactions associated with the administration of the antipsychotic drugs. 

Educating the Patient and Family Noncompliance is a problem with some patients once they are discharged to the home setting. It is important for the nurse to accurately evaluate the patient s ability to assume responsibility for taking dragp at home. The administration of antipsychotic dru becomes a family responsibility if the outpatient appears to be unable to manage his or her own drug therapy. 

Cocaine or stimulant intoxication may require administration of a small dose of a short-acting benzodiazepine (e.g., lorazepam 1 to 2 mg) for agitation or severe anxiety. Antipsychotics (e.g., haloperidol 2 to 5 mg) should be used only if psychosis is present. If hyperthermia is present, initiate cooling measures. 

To date, clozapine remains the only drug with proven and superior efficacy in treatment-resistant patients, and it is currently the only drug approved for the treatment-resistant schizophrenic. Studies have shown a response of approximately 30% to 50% in these well-defined treatment-resistant patients. Clinical trials have consistently found clozapine to be superior to traditional antipsychotics for treatment-refractory patients, and it is efficacious even after nonresponse to other SGAs and in partially responsive patients. It is often rapidly effective even in those who have had a poor response to other medication for years. Recent studies have demonstrated that it has a beneficial effect for aggression and suicidality, which led to the Food and Drug Administration (FDA) approval for the treatment of suicidal behavior in people with psychosis.41... 

Pharmacotherapy is the cornerstone of acute and maintenance treatment of bipolar disorder. Mood-stabilizing drugs are the usual first-choice treatments and include lithium, divalproex, carbamazepine, and lamotrigine. Atypical antipsychotics other than clozapine are also approved for treatment of acute mania. Lithium, lamotrigine, olanzapine, and aripiprazole are approved for maintenance therapy. Drugs used with less research support and without Food and Drug Administration (FDA) approval include topiramate and oxcarbazepine. Benzodiazepines are used adjunctively for mania. 

Kubo, M. et al. (2005). Influence of itraconazole co-administration and CYP2D6 genotype on the pharmacokinetics of the new antipsychotic Aripriprazole. Drug Metab. Pharmacokinet.,... 

Introduced in clinical practice in the 1960s, lithium was the first mood stabilizer to be used in China. This was followed by carbamazepine and sodium valproate. For many years, these were the only treatment options available as mood stabilizers. Although lamotrigine was approved for maintenance treatment of bipolar I disorder in 2003 by FDA (Food and Drug Administration) in the USA, this indication has not yet been approved by the Chinese authorities. At present, only one atypical antipsychotic drug, risperidone, has been approved for treating acute mania (February 2005 by SFDA [State Food and Drug Administration]) in China (see Table 6.1). 

Roberts D., Vickers G. Atypical neuroleptics increase self-administration of cocaine an evaluation of a behavioral screen for antipsychotic activity. Psychopharmacology. 82 1135, 1984. 

Akathisia The motor restlessness often noted as a side effect of long-term administration of typical antipsychotic drugs. 

Other orthopramides have been shown to be resistant to in vivo hydrolysis. Thus, the gastrokinetic drug cisapride (4.80) was not hydrolyzed after oral administration to dogs and humans [51]. Similarly, sulpiride (4.81), an antidepressant and antipsychotic drug, did not undergo hydrolysis in humans and laboratory animals. These compounds are metabolized by other routes, and hydrolysis of the amide bond, when it occurs at all, is only a minor pathway. 

Some medication side effects also occur only after prolonged administration and, as such, are products of the adaptive response to the continued administration of the medication. For example, taking a so-called conventional or typical antipsychotic for a long period of time can cause involuntary movements called tardive dyskinesias. These dyskinesias are believed to occur after chronic administration of the antipsychotic has caused changes in the density and/or sensitivity of dopamine receptors in brain regions that coordinate movement. 

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