13.03 Antipsychotics

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Overview

  1. Work on dopamine receptors to reduce psychotic symptoms

Nursing Points

General

  1. Typical antipsychotics for the positive symptoms of schizophrenia
  2. Atypical antipsychotics for the negative symptoms of schizophrenia

Assessment

  1. Caution with other CNS meds (i.e. barbiturates, benzodiazepines)
  2. Monitor for extrapyramidal side effects (EPS)
    1. Dystonia (sustained, repetitive muscle contractions, looks like tremors)
    2. Parkinsonism
    3. Akathisia (restless, constant movement)
    4. Tardive dyskinesia (lip-smacking, lip-puckering, excessive eye blinking, lip pursing, tongue movements)
  3. Adverse Effects
    1. Photosensitivity
    2. Agranulocytosis → decreased WBC → Risk for Infection / Sepsis
    3. Orthostatic hypotension
      1. Change positions slowly
      2. Fall precautions
    4. Possible Liver issues
      1. RUQ pain
      2. Jaundice
      3. Fever
      4. Malaise
    5. Neuroleptic Malignant Syndrome – adverse reaction to antipsychotic drugs
  4. Nursing Considerations
    1. Medication compliance
      1. Patients may hide pills in mouth – alternative option is liquid form
        1. Absorbed faster
        2. Protect from light
        3. Dilute with fruit juice if needed
    2. May turn urine pink or brown, educate patient to expect this so they are not alarmed
    3. Takes 1-6 weeks to be fully therapeutic
    4. Taper down when discontinuing, do not abruptly stop
  5. Neuroleptic Malignant Syndrome (NMS)
    1. Symptoms
      1. Fever
      2. AMS
      3. Muscle Rigidity
      4. Autonomic Dysfunction
    2. Nursing interventions
      1. Assess Patient
        1. Full set VS
        2. LOC
      2. Notify MD
        1. Most likely will D/C med
      3. Initiate seizure precautions
      4. Assess electrolyte levels; correct PRN
      5. IVF may be ordered
      6. Watch temp closely
        1. Cooling blanket
        2. Antipyretics

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