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Typical/ First Generation/ Novel Antipsychotics *(Side Effects, Adverse Reactions, Special Precautions & Nursing Responsibilities)
I.
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.
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
b.
Risk factors: i. ii. iii. First week of treatment Younger than 40 years old Males
ii.
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.
a. Symptoms: restlessness anxiety b. Management o o Decreasing dosage of antipsychotic medication Changing of antipsychotic medication agitation rigid posture & gait
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
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
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
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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