Antipsychotics

Typical/ First Generation/ Novel Antipsychotics *(Side Effects, Adverse Reactions, Special Precautions & Nursing Responsibilities)

I.

Side Effects & Adverse Reactions

A. Extrapyramidal Symptoms (EPS) o Serious Neurologic symptoms which are the major side effects of antipsychotics. Due to the blockage of D2 receptors in the midbrain.

a. Manifestations: i. Acute Dystonia

ii. Pseudoparkinsonism iii. Akathisia

i.

Dystonia o Acute muscular rigidity and cramping, stiff or thick tongue with difficulty in swallowing and laryngospasm and respiratory difficulties.

a.

Symptoms:

Muscular rigidity and cramping Stiff or thick tongue with difficulty in swallowing

In severe cases: Laryngospasm Respiratory difficulty

b.

Risk factors: i. ii. iii. First week of treatment Younger than 40 years old Males

iv. Receiving high potency drugs: Haloperidol, Thiothixene

ii.

Pseudoparkinsonism o o Drug- induced parkinsonism Symptoms similar to Parkinsons disease

a. Symptoms stiff- stooped posture mask- like facies decreased am swing shuffling, festinating gait cogwheel rigidity iii. Akathisia o Reported by the client as an intense need to move about.

drooling tremor bradycardia

pill- rolling movement of fingers at rest

a. Symptoms: restlessness anxiety b. Management o o Decreasing dosage of antipsychotic medication Changing of antipsychotic medication agitation rigid posture & gait

o Adding oral anticholinergic medication (amantadine) to treatment o Administering a beta-blocker or benzodiazepine

B. Neuroleptic Malignant Syndrome (NMS) o Potentially fatal idiosyncratic reaction to an antipsychotic medication (neuroleptic).

a. Symptoms: rigidity high fever confusion & delirium elevated CPK levels changing LOC

 autonomic instability

i. unstable blood pressure ii. pallor iii. Diaphoresis

b. Risk factors: i. ii. First 2 weeks of treatment Dehydration

iii. Poor nutrition iv. Concurrent medical condition

c. Management & Treatment o o Immediate discontinuation of all antipsychotic medications Supportive treatment for dehydration and hyperthermia

Note: After NMS, the decision to treat the client with other antipsychotic drug requires full discussion between the client/folk and the physician to weigh the relative risks against the potential benefits of therapy.

C. Tardive Dyskinesia (TD) o o o o Syndrome of permanent involuntary movement. Pathophysiology remains unclear. No effective treatment for general use. Antipsychotic medication can mask beginning symptoms

a. Symptoms: Involuntary movement of: i. tongue ii. facial muscles iii. neck muscles iv. uper & lower extremities

v. truncal musculature

tongue thrusting & protruding lip smacking blinking grimacing

excessive unescessary facial movement b. Management o o After it has developed, TD is irreversible Decreasing or discontinuing antipsychotic medication can arrest progression

o o o o

Prevention is the best mode of action Keeping maintenance medications at lowest level possible dose Changing antipsychotic medications Periodic monitoring of patient

D. Anticholinergic Side Effects o o Often occur with the use of antipsychotics Taking anticholinergic medications for EPS may cause increased problems

a. Symptoms: orthostatic hypotension dry mouth constipation urinary hesitancy or retention

blurred vision dry eyes photophobia nasal congestion decreased memory

b. Management o o Supportive treatment for presenting symptoms Use of calorie- free beverages or hard candy to alleviate dry mouth Inclusion fruits and grains in the diet prevents constipation

E. Other side effects i. Elevated Prolactin levels a. Symptoms: breast enlargement & tenderness diminished libido erectile & orgasmic dysfnction menstrual irregularities increased risk for breast cancer contributes to weight gains

ii. Cardiovascular Irregularities a. Symptoms: postural hypotension palpitation tachycardia lengthened QT interval dysrhythmia

Client Teaching Inform the client and folk to watch out the possible side effects of the antipsychotic medication being taken and prompt referral to the physician/psychiatrist. Teach client and folks of managing or avoiding unpleasant side effects or adverse reactions and maintaining the medication regimen. Teach patient and folks to monitor patients sleepiness and drowsiness and to limit or avoid physical activities if level of consciousness is decreased. Teach the patient and folk that if medication is missed, he or she can take the missed dose if it is only 3-4 hours late. If the dose is more than 4 hours overdue or the next dose is due, the client may omit the forgotten dose. Encourage compliance to medication by utilizing charts or pillboxes which can be prefilled with accurate doses for the day of the week.

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