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Antipsychotic Medications - Coggle Diagram
Antipsychotic Medications
First Generation
Haloperidol (high) & Chlorpromazine (low)
Education
Minimize anticholergic effects
sugarless gum
high fiber diet
2-3 L fluid daily
Void before taking med
Slowly change positions
Monitor for weight gain
Take meds at bedtime for sedation
Increase anti-seizure meds
Avoid exposure to sunlight
Takes 2 weeks for improvement
Controls positive symptoms
Block dopamine receptors
Potency
Low
Low EPS, High Sedation, High Anticholinergic
Medium
Moderate EPS, High sedation, Low anticholinergic
High
High EPS, Low sedation, Low anticholinergic
Adverse Effects
Agranulocytosis: WBC < 3.0
Anticholinergic
EPS
Acute dystonia
EMERGENCY: spasm of tongue, face, and back
Pseudoparkinsonism
Slow movement, rigidity, drooling
Akathisia
inability to sit still
Tardive dyskinesia
lip smacking, involuntary tongue movement
Neuroendocrine effects
Neuroleptic Malignant syndrome
high fever, sweating, abnormal BP, tachycardia, decreased LOC
Hypotension
Sedation
Seizures
Severe dyrhythmias
Sexual dysfunction
Skin effects
Liver impairment
Nursing Interventions
Fall Precautions due to peudoparkinsonism
If TD occurs, lower dose or discontinue for second gen
Treat NMS
cooling blanket, antipyretic
increase fluids
dantrolene to relax muscles
Obtain EKG and liver panel prior to starting meds
Treat EPS with antiparkinson agent (BENZTROPINE), beta blocker, benzos
Perform AIMS scale for EPS
Contraindications
Liver disease
Parkinsons
Hypotension
Dementia
Second Generation
Risperidone, Clozapine, & Olanzapine
Education
Minimize weight gain
Low calorie diet
Regular exercise
Report agitation, sedation, or insomnia
Labs for Agranulocytosis
Report infection immediately
Control positive, affective and negative symptoms
Block serotonin
Medication Effects
Decreased suicidal behavior
Improved memory
Fewer EPS and anticholinergic symptoms
Adverse Effects
Clozapine
Agranulocytosis
anticholinergic symptom
Metabolic syndrome
Metabolic Syndrome
New diabetes, Hyperglycemia
Increased lipids
Risk of hypertension and CV disorders
Weight gain
Hypotension
Anticholinergic
Agitation, Sedation, Insomnia
Mild EPS: Tremors
Elevated prolactin
man boobs, abnormal period
Sexual dysfunction
Contraindications
Pregnacy
Dementia
Cardiovascualr disease
Seizures
Diabetes
Third Generation
Aripirazole
Medication Education
Decreased EPS and anticholinergics
Low risk of weight gain
Adverse Effects
Sedation
Headache
Anxiety
Insomnia
Antidepressants
Paroxetine
Nursing Interventions
Assess for suicidal ideation
Education
Taper dose to avoid withdrawal
Combined treatment for depression and psychosis
Mood Stablizer
Lithium, Lorazepam, Valproate
Education
Watch for sedative effects
Treatment of Anxiety