Psych Medications

1. Olanzapine
Drug Class: Atypical (Second-Generation) Antipsychotic

MOA: Blocks dopamine and serotonin receptors in the brain. Helps manage mental health conditions:
schizophrenia, acute manic episodes, acute agitation.

Dosage: PO: 5-20 mg/day

Side Effects: feeling sleepy in the day

Weight gain, increased appetite
feeling dizzy
constipation

Adverse Effects: twitching or jerking movements in your face, tongue or other parts of your body
shuffling slowly when you walk, trembling or drooling
swelling, pain and redness in one leg

Nursing Responsibilities:
 Do not give to pt with dementia-related psychosis and allergy to olanzapine
 assess weight & BMI
 monitor EKG, HR and pulse before increasing/changing dose
 monitor blood glucose
 Make sure pt swallowed the drug

NHS. (2021). Olanzapine. https://www.nhs.uk/medicines/olanzapine/#:~:text=Olanzapine%20helps%20to

%20manage%20symptoms,mania%20symptoms%20of%20bipolar%20disorder)

2. Quetiapine
Drug Class: antipsychotics, 2nd Generation, mood stabilizers

MOA: acts by serving as an antagonist of dopamine and serotonin. used for the management of bipolar disorder,
schizophrenia, and major depressive disorder.

Dosage: 25mg/tab

Side Effects: headache

Fast heartbeat
Feeling sleepy during the day
Dizziness

Adverse Effects: NEUROLEPTIC MALIGNANT SYNDROME

Nursing Responsibilities:
 not be given to elderly patients with dementia-related psychosis; may ↑ risk of death
 Monitor BP & mental status (mood, orientation, behavior) before and periodically during therapy.
 Assess weight and BMI initially and throughout therapy.
 Observe patient carefully when administering to ensure medication is swallowed
 Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia,
seizures, diaphoresis, hypertension or hypotension, pallor, tiredness). Notify health care professional
immediately if these symptoms occur.
 NHS. (2022). Quetiapine. https://www.nhs.uk/medicines/quetiapine/side-effects-of-quetiapine/

3. Clozapine
Drug Class: atypical antipsychotic

MOA: binds to dopamine receptors in the CNS. Management of severely ill schizophrenics who are unresponsive
to standard antipsychotic drugs. Reduce current suicidal behavior in schizophrenic patients

Dosage: 25 mg/tab

Side Effects: weight gain

Fast heartbeat
drowsiness
Dizziness

Adverse Effects: NEUROLEPTIC MALIGNANT SYNDROME

Hypersalivation
Tachycardia
Hypotension
Sedation
delirium

Nursing Responsibilities:
 Monitor patient's BP, mental status & WBC
 Monitor for seizures & elderly patients for dehydration
 Assess weight and BMI initially
 educate pt to avoid smoking, alcohol and CNS depressants
 notify MD if unexplained palpitations, tachypnea, chest pain, sore throat, flu-like symptoms


4. Risperidone
Drug Class: atypical Antipsychotic – second-generation

MOA: decreases dopaminergic and serotonergic pathway activity in the brain, therefore decreasing symptoms of
psychoses, bipolar mania, or autism.

Dosage: 2 mg/tab

Side Effects: feeling sleepy in the day or difficulty falling asleep at night.
difficulty moving, stiff muscles with movements which are difficult to control, a slow shuffling
walk, shakes and drooling – this is known as dyskinesia.
headaches
weight gain

Adverse Effects: NEUROLEPTIC MALIGNANT SYNDROME

Aggressive behavior
Agitation
Anxiety
difficulty concentrating

Nursing Responsibilities:
  Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia,
seizures, diaphoresis, hypertension or hypotension, pallor, tiredness)
 Assess for suicidal tendencies, especially during early therapy
 Monitor BP, onset of extrapyramidal side effects and weight gain
 Not for use in pregnancy
 Stress importance of medication compliance

NHS. (2021). Risperidone. https://www.nhs.uk/medicines/risperidone/

5. Haloperidol 5mg + Diphenhydramine 50mg (Cocktail)

Drug Class: antipsychotics, 2nd Generation, mood stabilizers

MOA: acts by serving as an antagonist of dopamine and serotonin. used for the management of bipolar disorder,
schizophrenia, and major depressive disorder.

Dosage: 25mg/tab

Side Effects: headache

Fast heartbeat
Feeling sleepy during the day
Dizziness

Adverse Effects: NEUROLEPTIC MALIGNANT SYNDROME

Nursing Responsibilities:
 not be given to elderly patients with dementia-related psychosis; may ↑ risk of death
 Monitor BP & mental status (mood, orientation, behavior) before and periodically during therapy.

6. Haloperidol
Drug Class: Antipsychotics, First Generation

Moa: works by helping to restore the balance of certain natural substances in the brain (neurotransmitters). Helps
pt to think more clearly, feel less nervous, prevent suicide, reduces aggression, decreases negative thoughts and
hallucinations.

Dosage: 5mg/IM

Side Effects: Involuntary muscle contractions

Muscle stiffness
Repetitive, involuntary movements
Drowsiness
Weight gain

Adverse Effects: Itching, Blood dyscrasia, tardive dyskinesia, Respiratory depression., blurred vision

Nursing Responsibilities:
 Assess mental status (orientation, mood, behavior) prior to and periodically during therapy.
 Assess positive (hallucination, delusions) and negative (social isolation) symptoms of schizophrenia.
 Assess weight and BMI initially and throughout therapy.
 Monitor BP (sitting, standing, lying) and pulse prior to and frequently
 Monitor intake and output ratios
 RxList. (2021). Haloperidol. https://www.rxlist.com/haloperidol/generic-
drug.htm#what_are_side_effects_associated_with_using_haloperidol

7. Biperiden
Drug Class: Antipsychotics, First Generation

MOA: works by helping to restore the balance of certain natural substances in the brain (neurotransmitters).

Dosage:

Side Effects:

Adverse Effects:

Nursing Responsibilities:

8. Akitenon
Drug Class: Antiparkinson Agents, Anticholinergics

MOA: blocks the central cholinergic receptors and also block dopamine reuptake and storage in central sites thus
increasing dopaminergic activity; treat the stiffness, tremors, spasms, and poor muscle control of Parkinson's
disease.

Dosage: 2mg (1-3 times a day)

Side Effects: dry mouth/nose/throat

drowsiness
nausea/vomiting
urinary retention

Adverse Effects: anxiety

confusion
unusual tiredness
hyperventilation
mood changes

Nursing Responsibilities:
 Assess patient's gait and motor function
 Assess blood pressure
 Assess dizziness and drowsiness that might affect gait, balance, and other functional activities
 Monitor confusion, hallucinations, depression, and other psychologic problems
 Instruct patient to report other bothersome side effects, including severe or prolonged headache, vision
problems, decreased sweating, urinary problems

David’s Drug Guide for Rehabilitation Professionals. Biperiden.

https://fadavispt.mhmedical.com/content.aspx?bookid=1873&sectionid=139003188

9. Benztropine
Drug Class: Antiparkinson Agents, Anticholinergics
 MOA: blocks the activity of the muscarinic receptors mainly in the striatum; treat symptoms of Parkinson's
disease or involuntary movements due to the side effects of certain psychiatric drugs; helps decrease muscle
stiffness, sweating, and the production of saliva

Dosage: 1-2 mg IM/IV 1-2 mg orally

Side Effects: Blurred vision

dry mouth
Constipation
urinary retention

Adverse Effects: anxiety, nervousness, headache, confusion, arrhythmias

Nursing Responsibilities:
 Monitor patient response to therapy (improvement in signs and symptoms of Parkinson’s disease)
 Monitor for adverse effects (e.g. CNS changes, urinary retention, GI depression, increased sweating and
flushing, etc).
 Monitor patient compliance to drug therapy.
 Have patient void before taking the drugs to decrease risk of urinary retention.
 Evaluate disease progress and signs and symptoms periodically for reference of disease progress and drug
response.
 Educate client on drug therapy to promote understanding and compliance.
RNpedia. Antiparkinsonism Drugs Nursing Considerations & Management.
https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-notes/antiparkinsonism-drugs/

10. Cogentin
Drug Class: Anticholinergics

MOA: blocks chemicals that are thought to cause muscle spasms and tremors; used for Parkinson's disease and
movement problems (extrapyramidal symptoms, or EPS) caused by antipsychotic medications

Dosage:

Side Effects: Fast heartbeat

Slowed gut movement
Dry mouth
Nausea and vomiting
Constipation

Adverse Effects: Blurry vision

Confusion
Memory problems
Fever
Discomfort while urinating

Nursing Responsibilities:
 Monitor patient response to therapy (improvement in signs and symptoms of Parkinson’s disease)
 Monitor for adverse effects (e.g. CNS changes, urinary retention, GI depression, increased sweating and
flushing, etc).
  Monitor patient compliance to drug therapy.
 Have patient void before taking the drugs to decrease risk of urinary retention.
 Evaluate disease progress and signs and symptoms periodically for reference of disease progress and drug
response.
 Educate client on drug therapy to promote understanding and compliance.

GoodRx. Cogentin. https://www.goodrx.com/benztropine/what-is

11. Dantrolene
Drug Class: skeletal muscle relaxants

MOA: inhibit abnormal calcium release from sarcoplasmic reticulum, leading to muscle relaxation;

Dosage: 25 mg

Side Effects: Drowsiness, dizziness, weakness, tiredness, nausea, and diarrhea

Adverse Effects: confusion, muscle weakness, tachycardia,

Nursing Responsibilities:
 Assess patient's spasticity, ROM, functional ability, and posture
 Assess dizziness or drowsiness that might affect gait, balance
 Assess blood pressure
 Provide additional spasm and pain relief like rest periods
 Implement aggressive therapeutic exercises