Antipsychotics

Drugs – Traditional (affects basal ganglia more than atypical)

 Phenothiazines (Thorazine, Prolixin, Mellaril, Stelazine); Navane, Haldol, Loxitane, Moban

 EPS: extrapyramidal side effects need to be monitored the most.
o Pseudo parkinsonism: mask like appearance, shuffling gait and stooped posture.
o Dystonia: you can see muscle sticking out, difficult time turning head one way, jaw tight
and thick tongue. Full body dystonia is possible – torticollis. Give Cogentin or Benadryl!
o Akathisia: only one of the eps symptoms that causes nervous and jittery. Inability to sit
still or remain motionless.
o Anticholinergic side effects – dry mouth, urinary retention, constipation, and blurred
vision.
o Tardive Dyskinesia: long-term slowed movements. Tardive means it is irreversible.
Bizarre facial and tongue movements, stiff neck, difficulty swallowing. Long term
antipsychotic treatment are at increased risk. Benadryl and Cogentin will not take away
tardive dyskinesia but will temp take away the symptoms.
o NMS – neuroleptic malignant syndrome.
 Severe muscle rigidity, hyperpyrexia, tachycardia, tachypnea, fluctuations in BP,
diaphoresis.
 Rapid mental detoriation or coma
 Rare and potentially fatal if not caught early enough.
 Nursing implementations: stop neuroleptic medication immediately, monitor
vitals, etc.
o Photosensitivity: Haldol!
o Akinesia: inability to initiate movement.
o Oculogyric crisis
o AIMS scale to evaluate EPS symptoms. Administer AIMS scale before giving dose of
antipsychotic. Do it again before 2nd dose. Should do it every time you administer an
antipsychotic ideally.
 Patient teaching
o Adhering to medication regimen
o Managing side effects: thirst, constipation, sedation.
o If you catch side effects within 24 hours, you can probably reverse them but when they
go on for long term, tardive effects become irreversible.
Drugs – Atypical

 Clozaril, Risperdal, Zyprexa, Seroquel, Geodon, Invega

 Stimulates hypothalamus.
 Fewer EPS, weight gain from stimulated hypothalamus, agranulocytosis (Clozaril – white blood
cells wiped out), increased prolactin, increased cholesterol, and triglycerides.
 Patient teaching
o Adhere to medication regimen.
o Reducing sugar and caloric intake
o Geodon – taking with food increases the effectiveness of the medication by increasing
absorption. Can cause heart problems – do not give to anyone with heart complications.
o Clozaril – weekly WBC monitoring, discontinue medication and seek care at first sign of
infection.
o Gynecomastia:
o Give any of the antipsychotics with Lithium before it starts working because it does
not have the caloric requirement that Geodon does.

Mood Stabilizing Agents

 Lithium, anticonvulsant medications carbamazepine (Tegretol), valproic acid (Depakote),

lamotrigine (Lamictal), gabapentin (Neurontin).
 Action: lithium enhances the reuptake of norepinephrine and serotonin in the brain, lowering
levels in the body and resulting in decreased hyperactivity. Action of anticonvulsants, verapamil,
and olanzapine in the treatment of bipolar disorder is not fully understood.
 Lithium
o S/S: nausea, diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, fatigue, weight
gain, acne. These may mirror toxic symptoms, but toxic ones may be more severe –
important to talk to client about the difference.
o Patient teaching: taking with food, having monthly blood levels drawn 12 hours after
last dose (maintain therapeutic levels between 0.5 – 1.5 mEq/L).
o Drink two to three liters of water a day to prevent kidney damage/failure because of
how lithium is excreted.
o Toxicity: vomiting, severe diarrhea, severe confusion, coma, ataxia, kidney failure,
tinnitus, persistent nausea and vomiting, coarse hand tremors.
 Monitor for side effects of anticonvulsants: nausea and vomiting, drowsiness, dizziness, blood
dyscrasias, prolonged bleeding time; weight gain; liver dysfunction (with valproic acid), risk of
severe rash (with lamotrigine), decreased efficacy with oral contraceptives (with topiramate).
 Side effects of Olanzapine (Zyprexa)
o Somneolence, dizziness, asthenia
Stimulant Drugs

 Methylphenidate (Ritalin, COncerta), Pemoline (Cylert), Dextroamphetamine (Adderall,

Dexedrine), Lisdexamfetamine Dimesylate (Vyvanse)
 S/S: Anorexia, weight loss, nausea, irritability, tics, heart palpitations.
 Patient teaching: avoid caffeine, sugar, chocolate. Can cause a decrease in appetite. Give before
4 PM for children, monitor around meal times. Give before/with/after breakfast?
 Some amphetamines are contraindicated in adults because of abuse.

Central Alpha-Agonists

 An alternative to CNS stimulants

 Clonidine *Catapres), and Guanfacine (Tenex)
 BP meds – lowers blood pressure. Learn more about this.
 S/S: dry mouth, hypotension, rebound hypertension, weight gain, nausea, drowsiness,
nervousness, agitation, headache, dizziness, fatigue, dry eyes.

Non-stimulant Atomoxetine (Strattera)

 Can cause liver failure. Affects liver – make sure you monitor it closely when giving to adults.
 S/S: decreased appetite, dizziness, nausea/vomiting, dry mouth, problems with urination,
decreased sleep, problems with liver function. Blood levels are important.

Antiparkinsonian Agents

 Cogentin/Benadryl
 Treatment of all forms of parkinsonism and for the relief of drug-induced extrapyramidal
reactions.
 Action: work to restore the natural balance of acetylcholine and dopamine in the CNS.
 Interactions
o Anticholinergic effects and potentially fatal paralytic ileus with other drugs that possess
these properties.
o Concurrent use with haloperidol or phenothiazine may result in decreased effect of the
antipsychotic and increased incidence of anticholinergic side effects.
o Additive CNS effects with CNS depressants.
o Paralytic ileus: things don’t move in colon anymore due to too many medications.
o Decreases probability that the person will have EPS reaction.
 S/S: anticholinergic effects, nausea, GI upset, sedation, dizziness

Do not give Haldol long term with Lithium .

Haldol – photosensitivity.

Blood draws - Lithium or antipsychotics.

PRN Anxiety symptoms : Buspirone