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13.03 Antipsychotics

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Overview

  1. Work on dopamine receptors to reduce psychotic symptoms

Nursing Points

General

  1. Typical antipsychotics for the positive symptoms of schizophrenia
  2. Atypical antipsychotics for the negative symptoms of schizophrenia

Assessment

  1. Caution with other CNS meds (i.e. barbiturates, benzodiazepines)
  2. Monitor for extrapyramidal side effects (EPS)
    1. Dystonia (sustained, repetitive muscle contractions, looks like tremors)
    2. Parkinsonism
    3. Akathisia (restless, constant movement)
    4. Tardive dyskinesia (lip-smacking, lip-puckering, excessive eye blinking, lip pursing, tongue movements)
  3. Adverse Effects
    1. Photosensitivity
    2. Agranulocytosis → decreased WBC → Risk for Infection / Sepsis
    3. Orthostatic hypotension
      1. Change positions slowly
      2. Fall precautions
    4. Possible Liver issues
      1. RUQ pain
      2. Jaundice
      3. Fever
      4. Malaise
    5. Neuroleptic Malignant Syndrome – adverse reaction to antipsychotic drugs
  4. Nursing Considerations
    1. Medication compliance
      1. Patients may hide pills in mouth – alternative option is liquid form
        1. Absorbed faster
        2. Protect from light
        3. Dilute with fruit juice if needed
    2. May turn urine pink or brown, educate patient to expect this so they are not alarmed
    3. Takes 1-6 weeks to be fully therapeutic
    4. Taper down when discontinuing, do not abruptly stop
  5. Neuroleptic Malignant Syndrome (NMS)
    1. Symptoms
      1. Fever
      2. AMS
      3. Muscle Rigidity
      4. Autonomic Dysfunction
    2. Nursing interventions
      1. Assess Patient
        1. Full set VS
        2. LOC
      2. Notify MD
        1. Most likely will D/C med
      3. Initiate seizure precautions
      4. Assess electrolyte levels; correct PRN
      5. IVF may be ordered
      6. Watch temp closely
        1. Cooling blanket
        2. Antipyretics

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  • Question 1 of 5

A client is brought into the emergency room by a family member. The client states she is being followed by people who are trying to kill her. The nurse reviews the client’s medications and notes that the client is likely to have schizophrenia based on which medication?

  • Question 2 of 5

A 29-year-old client is being seen for a diagnosis of schizophrenia. The physician has ordered an atypical antipsychotic medication for disease management. Which best describes how this type of medication works?

  • Question 3 of 5

The nurse is caring for a client with dystonia. What is the priority nursing intervention for this client?

  • Question 4 of 5

Which of the following medications would be classified as an antipsychotic medication?

  • Question 5 of 5

A client is diagnosed with neuroleptic malignant syndrome. Which of the following events has the client likely experienced?

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