Antipsychotic/neuroleptic Drugs - Central and Peripheral Nervous System II Drugs

What is the drug class of Haloperidol?

Typical antipsychotic.

What is the mechanism of action for Haloperidol?

It blocks central type 2 dopamine receptors in the brain and depresses the reticular activating system (RAS). It also has minimal anticholinergic, antihistaminic, and alpha-adrenergic blocking activity.

What is the main indication for using Haloperidol?

Treatment of patients with schizophrenia.

What are the severe and potentially fatal adverse effects associated with Haloperidol?

Prolonged QTc interval, neuroleptic malignant syndrome (NMS), and extrapyramidal symptoms (EPS) (which include pseudoparkinsonism, dystonia, akathisia, and tardive dyskinesia).

What are the common, less severe side effects of Haloperidol?

Drowsiness, insomnia, vertigo, orthostatic hypotension, photophobia, blurred vision, dry mouth, nausea, vomiting, anorexia, urinary retention, and photosensitivity.

What key patient education should be provided to someone taking Haloperidol?

Instruct the patient not to abruptly stop or skip doses, as doing so can trigger EPS movement disorders.

What are the major drug interactions to avoid when taking Haloperidol?

Combining it with alcohol or CNS depressants increases CNS depression. Combining with anticholinergics increases anticholinergic side effects. Combining with lithium can be a contraindication.

What are the important nursing considerations for Haloperidol administration?

It is erratically absorbed from the GI tract. Nurses must monitor cardiac arrhythmias on an EKG because of the risk for a prolonged QTc interval. It is contraindicated in older adults with dementia, severe CNS depression, and active alcohol use disorder.

What is the drug class of Clozapine?

Atypical antipsychotic.

What is the mechanism of action for Clozapine?

It blocks both dopamine and serotonin receptors, depresses the RAS, and provides anticholinergic, antihistaminic, and alpha-adrenergic blocking effects.

What are the indications for using Clozapine?

It is used for the management of severely ill patients with schizophrenia who are unresponsive to standard drugs, and it reduces the risk of recurrent suicidal behavior in schizophrenia or schizoaffective disorder.

What specific, high-risk adverse effects are associated with Clozapine?

Bone marrow suppression (neutropenia), weight gain, and the development of diabetes mellitus.

What are the other side effects of Clozapine?

Drowsiness, sedation, seizures, dizziness, syncope, headache, tachycardia, nausea, vomiting, fever, orthostatic hypotension, myocarditis, and cardiomyopathy.

What should patients be educated about when starting Clozapine?

They should be educated on the risks of weight gain and the symptoms of diabetes.

What are the drug interactions for Clozapine?

Alcohol and CNS depressants increase the risk of CNS depression, and anticholinergic medications increase anticholinergic effects.

What are the baseline labs and assessments required before starting a patient on Clozapine?

Assess for contraindications (severe CNS depression, glaucoma, diabetes, bone marrow suppression). Important baseline labs include a complete blood count (CBC), liver and renal function tests, blood glucose, thyroid function tests, and an ECG.

What is the drug class of Risperidone?

Atypical antipsychotic.

What is the mechanism of action for Risperidone?

It blocks both dopamine and serotonin receptors and depresses the RAS.

What are the indications for Risperidone?

Schizophrenia, as well as hyperactivity, combative behavior, or severe behavioral problems in children.

What are the main side effects and adverse effects of Risperidone?

It heavily emphasizes weight gain and the development of diabetes mellitus. It also carries risks for sedation, EPS, anticholinergic effects, and cardiovascular arrhythmias.

What is the essential patient education for Risperidone?

Educate the patient on proper adherence to prevent EPS, and teach them to monitor for signs of weight gain and diabetes.

What are the major drug interactions with Risperidone?

CNS depressants, alcohol, and anticholinergic drugs.

What should a nurse monitor for a patient on Risperidone?

Monitor patient weight and blood glucose levels regularly. Assess for movement disorders and cardiovascular changes.

What is the drug class of Lithium?

Drugs for Bipolar Disorders / Mood Stabilizer.

What is the mechanism of action for Lithium?

It alters sodium transport in nerve and muscle cells. It inhibits the release of norepinephrine and dopamine (but not serotonin), slightly increases their intraneuronal stores, and decreases the intraneuronal content of second messengers.

What is the primary indication for Lithium?

Treatment of manic episodes and maintenance treatment of bipolar disorder.

What are the long-term adverse effects of Lithium use?

Weight gain, renal toxicity, goiter, and hypothyroidism.

What are the signs of Lithium toxicity at a serum level of 1.5 mEq/L?

Lethargy, slurred speech, muscle weakness, fine tremor, polyuria, nausea, vomiting, and diarrhea.

What are the signs of Lithium toxicity at serum levels between 1.5 and 2.0 mEq/L?

Ataxia, clonic movements, hyperreflexia, seizures, hypotension, and ECG changes (bradycardia, Brugada’s syndrome).

What occurs at a Lithium serum level >2.5 mEq/L?

Complex multiorgan toxicity and a significant risk of death.

Why must patients on Lithium strictly monitor their sodium intake?

Because salt follows the drug in the body, so monitoring sodium intake is required to avoid accidental lithium toxicity.

What herbal supplement should be avoided when taking Lithium and why?

The herbal laxative psyllium, because it blocks lithium absorption.

What drugs interact with Lithium?

Haloperidol, neuromuscular-blocking agents, carbamazepine, thiazide diuretics, urine-alkalinizing drugs, indomethacin, some NSAIDs, and psyllium.

What is the safe therapeutic serum level for Lithium?

0.8–1.2 mEq/L.

What nursing actions are required if Lithium toxicity occurs (e.g., levels of 2.3 mEq/L with vomiting/diarrhea/confusion)?

Immediately stop the medication, place the patient on a cardiac monitor, and notify the provider.

What are the contraindications for Lithium?

Severe renal/cardiac disease, dehydration, and sodium depletion.

What is the drug class of Methylphenidate?

CNS Stimulant.

What is the mechanism of action for Methylphenidate?

It is a mild cortical stimulant (similar to amphetamines) that acts by blocking the reuptake of norepinephrine and dopamine and increasing the release of catecholamines from presynaptic neurons.

What are the primary indications for Methylphenidate?

ADHD, narcolepsy, and various sleep disorders.

What are the side effects and adverse effects of Methylphenidate?

Nervousness, insomnia, dry mouth, increased pulse rate and blood pressure, loss of appetite, nausea, growth impairment, priapism, abdominal pain, and skin rashes.

What should patients be advised to avoid while taking Methylphenidate?

They must strictly avoid excessive caffeine and over-the-counter cold medications, as these can dangerously increase stimulant effects.

What is a dangerous drug interaction associated with Methylphenidate?

Combining it with MAOIs or TCAs drastically increases the risk of toxicity and adverse effects. It also interacts with phenytoin, caffeine, and OTC cold meds.

What are the nursing considerations and contraindications for Methylphenidate?

It is contraindicated in patients with marked anxiety, agitation, glaucoma, cardiac disease, or a history of seizures and drug dependence. Nurses should actively assess the patient's baseline body weight and growth (especially in children) and monitor cardiac status (pulse, auscultation, blood pressure).