Antipsychotic Rx

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Antipsychotic Rx
2013-01-28 23:15:11

Mental health
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  1. Haldol/haloperidol
    • Uses: Schizophrenia, psychotic disorders, schizoaffective disorders, impulsive or 
    • aggressive behavior in adolescents and adults, bipolar disorders to calm 
    • aggressive behavior.
    • Action: reduces release of dopamine. 
    • Side effects: Extrapyramidal effects (Parkinson’s like tremor, dystonia-muscle tightening in neck and shoulder, akathisia-restlessness, pacing or fidgeting, shuffling gait), anticholinergic effects, weight gain (slows down the metabolization of carbohydrates and fats), sedation, orthostatic hypotension, lowers the seizure threshold, tardive dyskinesia (rolling of tongue), malignant neuroleptic syndrome (first symptom = very high fever 105-107, hold Rx, notify MD), photosensitivity, breast enlargement in men and women. 
    • Nursing implications: 
    • For postural hypotension, take BP lying and standing and record differences, teach client to get up slowly from lying to sitting to standing.
    • Monitor weight for changes a reason patients will not want to take the medication.
  2. Why give Artane/Trihexyphenidyl, Cogentin/Benztropine to a pt with psychosis?
    are used to treat the extrapyramidal symptoms that are caused by typical antipsychotic medications and are often prescribed with the medication.
  3. Clozaril/clozapine
    Atypical antipsychotic
    • Lower potency.
    • Uses: Schizophrenia, psychotic disorders, schizoaffective disorders.
    • Side effects: agranulocytosis-lowering of white blood cells (once this occurs, must d/c), weight gain and Type-2 diabetes, may increase triglycerides and cholesterol.  
    • Nursing measures: Sometimes works when no other medication will work.
    • Needs monitoring for type-2 diabetes and metabolic syndrome as well as WBC count.
  4. Risperdal/Risperidone
    • Very expensive, but fewer side effects than other antipsychotics. 
    • Side effects: same as above, but less severe. 
    • Nursing implications: 
    • Avoid activities requiring mental alertness until adjusted to medication.
    • Alcohol use is contraindicated because medication is sedating.
    • Diabetic patients should monitor for signs and symptoms of hyperglycemia.
  5. Zyprexa/olanzapine
    • Medium potency
    • Atypical antipsychotic
    • Side effects: Moderate sedation, weight gain, type-II diabetes.
    • Nursing implications:
    • Rapidly calms agitation. 
    • Produces the most weight gain of the atypical antipsychotics.
    • Patient is at risk for type-2 diabetes.
    • Don't break the pills into halves. The medication oxidizes and looses the active ingredient. 
    • If the nurse gets the medication on the skin, can cause a rash.
  6. Abilify/Aripiprazole
    • High to moderate potency
    • 1st line Rx for many psychotic disorders.
    • Nursing implications:
    • Do not suddenly stop the medication.
    • Do not drink alcohol with medication.
  7. Saphris/asenapine
    • Available only as sublingual.
    • Can cause EPS like typical antipsychotics.
    • Side effects:  weight gain, oral numbness, sedating.

    • Nursing measures:
    • Can cause oral numbing.  Keep from getting bit if place under the tongue.