AntiPsychotic Medication

Question 1

Biological Action

Answer 1

Decreases dopamine

Question 2

Typical Antipsychotics characteristics

Answer 2

Older medications
less expensive
more long term experience with effects/side effects
more serious side effects (liability)

Question 3

Atypical Antipsychotics characteristics

Answer 3

newer medications
more expensive
less long term experience with effects and side effects
less serious side effects (liability)

Question 4

List of typical antipsychotics

Answer 4

Thorazine
Prolixin
Mellaril
Haldol

Question 5

List of atypical antipsychotics

Answer 5

Clozaril
Seroquel
Zyprexa
Risperdal
Geodon
Abilify
Invega

Question 6

Prolixin

Answer 6

comes in long acting IM preparation

prolixin decanoate

Question 7

Haldol

Answer 7

comes in short acting IM preparation and long term acting IM preparation (haldol decanoate)

Question 8

Clozaril–side effect

Answer 8

low liability for most side effects
Side effects: 
*reduces seizure threshold
*hypersalivation
*agranulosytosis

Question 9

Clozaril–lab values

Answer 9

Critical lab ranges

• less than 3,000 mm WBC
• less than 1,500 mm granulocyte count

Patients must submit blood counts usually every 1-2 weeks

therefore patients must be compliant, have transportation, and adequate finances to maintain blood count orders

Question 10

Clozaril–patient teaching

Answer 10

Teach the need for compliance with blood count orders
Signs and symptoms of infection
*fever
*malaise
*sore throat

Question 11

Clozaril–nursing actions to be taken with patient presenting symptoms of infection

Answer 11

order stat CBC
stop medication if results indicate low WBC or granulocytes
notify physician

Question 12

Zyprexa

Answer 12

comes in short acting IM preparation

Question 13

Risperdal

Answer 13

comes in long acting IM preparation

risperdal consta

Question 14

Side effect categories of typical and atypical antipsychotics

Answer 14

1. general side effects
2. extra pyramidal side effects (EPS)
3. Tardive dyskinesia (TD)
4. Neuroleptic malignant syndrome (NMS)

Question 15

General side effects

Answer 15

the same as antidepressants

Question 16

Extra pyramidal side effects

Answer 16

5 sub categories:

1. Dystonia–painful muscle contractions usually from the neck up
2. Pseudoparkinsons–drooling, stiffness, lack of arm swing when walking, shuffling forward bent gait, pin rolling, tremor
3. Akinesia–muscle stiffness and weakness
4. Akathisia–continual uncontrollable physical restlessness (common cause of suicide)
5. Oculogyric Crisis–uncontrollable rolling of the eyes back into the head

All EPS side effects are treated with Cogentin, Artane, Benadryl and symmetrel.
Often given IM or IV when symptoms are severe

nurse’s responsibility to stop medication and notify the physician

Question 17

Symmetrel

Answer 17

Drug of choice for pseudoparkinsons

Question 18

Tardive dyskinesia

Answer 18

bizarre facial and tongue movements
stiff neck
odd movements of the arms and legs
difficulty swallowing

TD can be irreversible

No treatment other than to decrease dose or change medication to another with less liability such as Clozaril

Nurse’s responsibility to stop medication and notify physician

Question 19

Neuroleptic malignant syndrome signs and symptoms

Answer 19

potentially fatal complication

Signs and symptoms:

• severe muscle rigidity–may apply to respiratory muscles causing hypoventilation
• elevated temperature–often up to 107 degrees
• Tachycardia
• tachypnea
• fluctuations in blood pressure
• Diaphoresis
• rapid deterioration of mental status
• coma and death

Escalates quickly requiring quick response by nurse

Patients presenting with s/s of NMS must have ALL antipsychotic meds dicontinued, call attending physician, and careful monitoring by nurse

Blood pressure and temperature should be monitored every 15 minutes until medical support is given to patient

Question 20

Patients with signs/symptoms of NMS are transfered to med surg units to recieve:

Answer 20

• muscle relaxants
• respiratory support including mechanical ventiliation if necessary
• cooling for elevated temperatures
• IV fluids
• administration of Parodel (Bromocriptine) medication that increases dopamine and dantrium (Dantrolene) which causes relaxation of skeletal muscles and also decreases body temperature

**Remember that the biological theory for etiology of Schizophrenia is increased Dopamine.
All antipsychotic medications decrease dopamine.
When dopamine lowers, some patients will experience various expressions of stiffness (EPS, TD, and NMS).
When dopamine is severely lowered as in NMS, the use of Parlodel to increase dopamine should correct this lowered biological level.