Antipsychotic Drugs

What is the main purpose of antipsychotic medications?

Treat psychotic symptoms such as hallucinations, delusions, and disorganized thinking

What are the major categories of antipsychotic adverse effects?

Anticholinergic, antiadrenergic, cardiac, extrapyramidal, endocrine, metabolic, sexual, and GI effects

Which antipsychotics are more likely to cause extrapyramidal symptoms (EPS)?

High-potency antipsychotics

What are the major anticholinergic effects of antipsychotics?

Dry mouth, constipation, decreased sweating, dilated pupils, urinary retention, and slowed bowel/bladder function

What should the nurse monitor for with anticholinergic effects?

Constipation, urinary retention, blurred vision, dry mouth, and difficulty tolerating heat

What is the major antiadrenergic adverse effect of antipsychotics?

Orthostatic hypotension

What teaching should be given for orthostatic hypotension?

Rise slowly from lying or sitting positions to prevent dizziness and falls

What are the 2 main groups of antipsychotics?

First-generation (typical) and second-generation (atypical)

What is the main neurotransmitter blocked by typical antipsychotics?

Dopamine (D2)

What is the main difference between high- and low-potency typical antipsychotics?

High potency → more EPS; low potency → more anticholinergic effects, sedation, and hypotension

What are the high-potency typical antipsychotics?

Haloperidol, fluphenazine, trifluoperazine

What are the main adverse effects of high-potency typical antipsychotics?

EPS: akathisia, dystonia, parkinsonism, tardive dyskinesia, and NMS.

What are the low-potency typical antipsychotics?

Chlorpromazine and thioridazine

What are the main adverse effects of low-potency typical antipsychotics?

Anticholinergic effects, sedation, orthostatic hypotension, and cardiac effects

What is the easiest way to remember high vs low potency?

HIGH potency = HIGH EPS. LOW potency = LOW EPS but more anticholinergic effects.

What are common second-generation (atypical) antipsychotics?

Risperidone, olanzapine, quetiapine, clozapine, ziprasidone, and aripiprazole.

What is the major adverse-effect concern with atypical antipsychotics?

Metabolic syndrome: weight gain, insulin resistance, high glucose, high cholesterol, and hypertension

What should be monitored with atypical antipsychotics?

Weight, glucose/A1C, lipids, and blood pressure

Which antipsychotic requires ANC monitoring?

Clozapine

Why does clozapine require ANC monitoring?

It can cause agranulocytosis/neutropenia, increasing infection risk

What should a patient taking clozapine report immediately?

Fever, sore throat, or other signs of infection.

Typical antipsychotics

1st gen

Atypical antipsychotics

2nd gen

Typical antipsychotics: main concern

EPS

Atypical antipsychotics: main concern

Metabolic effect

High-potency examples- 1st gen

Haloperidol, fluphenazine, trifluoperazine

Low-potency typicals- 1st gen

More anticholinergic effects, sedation, hypotension

Low-potency examples- 1st gen

Chlorpromazine, thioridazine

Common atypicals- 2nd gen

Risperidone, olanzapine, quetiapine, clozapine, ziprasidone, aripiprazole

Atypical: metabolic effects- 2nd gen

Weight gain, high glucose, high cholesterol

Monitor with atypicals- 2nd gen

Weight, glucose/A1C, lipids, BP

Clozapine: major concern- 2nd gen

Agranulocytosis

Clozapine: monitor

ANC

Clozapine: report

Fever or sore throat

Risperidone: major concern

High prolactin

Olanzapine: major concern

Metabolic effects

Ziprasidone: major concern

QT prolongation

Aripiprazole: major concern

Akathisia

1st gen high potency drugs cause more

EPS- Movement problems caused by dopamine blockade

What are some extrapyramidal symptoms with high potency agents (1st gen)?

akathisia (Restlessness; can't sit still), Akinesia and bradykinesia (slow motion), Dystonia (freezing), Drug-induced parkinsonism (bradykinesia, rigidity, tremors), Tardive dyskinesia

Acute dystonia: treatment

Benztropine or diphenhydramine

Drug-induced parkinsonism

Tremor, rigidity, slow movement

TD: common signs

Lip smacking, tongue movements, chewing

TD: medication examples

Valbenazine or deutetrabenazine

TD: avoid

Anticholinergics

NMS: biggest clues

High fever + severe rigidity

NMS: treatment

Dantrolene + bromocriptine

NMS

Potentially fatal emergency

Low-potency drugs cause more intense

anticholinergic effects (dry mouth, blurred vision) and antiadrenergic effects (orthostatic hypotension)

High-potency drugs cause

more EPSEs and prolactin elevation