Antipsychotic Medications

What are the primary uses of antipsychotic medications?

mainly used to treat schizophrenia spectrum disorders, but can also be used to treat acute aggression and the manic phase of BPD

What are the advantages of first-generation antipsychotics?

Very effective at reducing positive symptoms, relieves anxiety and agitation, and are inexpensive.

What are some disadvantages of first-generation antipsychotics?

High risk for adverse events, extrapyramidal symptoms (EPSs), and various side effects.

What are atypical antipsychotics?

Second-generation antipsychotics that stabilize dopamine and increase circulating serotonin.

What is the prototype of atypical antipsychotics?

Clozapine

What is the main risk associated with Clozapine?

Agranulocytosis, which can lead to severely low levels of WBCs.

What is Neuroleptic Malignant Syndrome (NMS)?

potentially fatal reaction to antipsychotic medications that occurs w/in the first week of tx or during dosage increases but can occur at any time during therapy; caused by dopamine blockade (usu conventional antipsychotics)

What are the major symptoms of Neuroleptic Malignant Syndrome (NMS)?

sudden high fever, encephalopathy, elevated CPK enzymes, and rigidity (muscle), BP instability, diaphoresis, tachycardia, decr LOC, and coma

What are extrapyramidal symptoms (EPS)?

Movement disorders caused by antipsychotic medications, including akathisia, acute dystonia, pseudoparkinsonism, and tardive dyskinesia.

What treatment is indicated for akathisia?

Reduction or change of antipsychotic, and treatment with antiparkinsonian agents, BBs, lorazepam or anticholinergics

What is acute dystonia?

Severe muscle spasms of the tongue, neck, face, and back; can cause oculogyric crisis

What are the symptoms of pseudoparkinsonism?

Tremors, rigidity, akinesia, mask-like faces, stooped posture, and shuffling gait, drooling, positive symptoms of schizophrenia

What is tardive dyskinesia (TD)?

Involuntary movements of the tongue, face, arms, legs, and trunk that develops over months-years and is permanent

What defines first-generation (conventional) antipsychotics?

Antipsychotics that are associated with a high risk of EPS and are less favored as first-line treatments.

How often are CBCs required for clients on Clozapine?

Weekly for the first 6 months, biweekly for the next 6 months, and monthly thereafter.

What are the advantages of second-generation antipsychotics?

Lower risk of EPS, may relieve both positive and negative symptoms, and can also help with cognitive symptoms.

What are the disadvantages of atypical antipsychotics?

High likelihood of metabolic syndrome, weight gain, and potential for increased blood sugar, cholesterol, and blood pressure.

What is the primary goal of treatment with antipsychotic medications?

To suppress acute episodes and maintain the highest possible level of functioning.

What should a nurse do if a patient experiences Neuroleptic Malignant Syndrome (NMS)?

Immediately stop the medication, monitor V/S, apply cooling blankets, admin antipyretics, incr fluid intake, admin dantrolene or bromocriptine (relax musc), admin meds for arrhythmias, transfer to ICU

What is akathisia?

intense inability to sit or stand still, often presenting with pacing and agitation.

What indicates the need to monitor for tardive dyskinesia?

Monitoring should occur after 12 months of medication therapy, then every 3 months.

Which antipsychotic medication is known for helping with mood stabilization?

Atypical antipsychotics, particularly second-generation ones.

What is the difference between reversible and irreversible EPS?

Reversible EPS (like akathisia, acute dystonia, and pseudoparkinsonism) can be managed, while tardive dyskinesia is irreversible.

What is the typical management strategy for pseudoparkinsonism?

Treatment with antiparkinsonian agents and possibly reducing or changing the antipsychotic.

What should be done in the case of acute dystonia?

Immediate treatment with benztropine or diphenhydramine IM or IV and monitoring airway until spasms subside.

What type of side effects are more common with first-generation antipsychotics?

Extrapyramidal symptoms and various adverse effects.

Why are second-generation antipsychotics often preferred over first-generation?

Due to significant advantages and lower-risk disadvantages, including lower occurrence of EPS.

What are the names of first generation antipsychotics?

Chlorpromazine, haloperidol, fluphenazine, perphenazine, loxapine, thiothixene

Name some atypical second generation antipsychotics.

clozapine, olanzapine, quetiapine, asenapine, risperidone, ziprasidone, paliperidone, lurasidone (all end in -pine or -done)

Name some atypical third generation antipsychotics.

aripiprazole, cariprazine, brexpiprazole

What are the advantages of atypical antipsychotics?

can help w/mood stabilization, relieve both positive and negative symptoms, may help w/cognitive symptoms, low risk causing EPSs, less anticholinergic side effects

What are the disadvantages of atypical antipsychotics?

high likelihood of metabolic syndrome, more expensive, shouldn’t use in elderly adults w/dementia, cautious in pts w/heart disease

What are the advantages of third gen antipsychotics?

very low risk of EPSs and metabolic syndrome

What are the side effects of metabolic syndrome?

weight gain, incr blood sugar, incr cholesterol, incr BP

What is first line tx for schizophrenia?

atypical antipsychotics, second gen

What are the symptoms of agranulocytosis?

fever, sore throat, fatigue

What are some examples of LAIs for maintenance therapy?

risperidone, paliperidone palmitate, olanzapine

What is a requirement before receiving a depot injection?

must be on a stable form of medication

What is the acronym of symptoms for Neuroleptic Malignant Syndrome?

F: fever
E: encephalopathy (altered LOC)
V: V/S instability (HTN, diaphoresis)
E: elevated CPK (creatinine phosphokinase)
R: rigidity of muscles (severe)

What is the method of action for first gen, conventional antipsychotics?

they bind very tightly to D2 (dopamine 2) receptors in the brain, the receptor responsible for positive symptoms of schizophrenia

Why are akathisia, acute dystonia, and pseudoparkinsonism referred to as early EPSs?

they generally occur at the beginning of antipsychotic tx from day 1-2mos; they can also occur during this time frame after increasing a pt’s dose

What needs to change after an acute case of dystonia?

reduce antipsychotic dosage or change the med

How long should a pt be monitored for acute dystonia after the first dose of an antipsychotic?

1-5 days

What is the acronym for the manifestations of pseudoparkinsonism?

T: tremors and pill-rolling mvmnts
R: rigidity
A: akinesia or bradykinesia
M: mask-like faces
P: posture stooped
S: shuffling gait

What is the tx for pseudoparkinsonism?

antiparkinsonian agent (benztropine), reduce or change antipsychotic, fall precautions

How long does pseudoparkinsonism take to manifest?

occurs w/in the first 30 days following start of antipsychotic med or incr in dosage

What are the txs for tardive dyskinesia?

no reliable tx once it develops; primary tx is to lower the dose or switch to an atypical antipsychotic

What are some visual symptoms of tardive dyskinesia?

involuntary mvmnts of body and extremities, chewing motion, sucking/smacking lip mvmnts, protrusion/rolling of tongue

What are some visual symptoms of acute dystonia?

facial grimacing, involuntary upward eye mvmnt, muscle spasms, laryngeal spasms

What are some visual symptoms of akathisia?

feet in constant motion, rocking back and forth