S/E of Conventional Antipsychotics & related nsg int:

List S&S of anticholinergic toxicty:

• dry mucous membranes
• reduced or absent peristalsis
• mydriasis
• nonreactive pupils
• hot,dry, red skin
• hyperpyrexia w/out diaphoresis
• tachycardia
• agitation
• unstable vs
• worsening of psychotic symptoms
• delirium
• urinary tetention
• seizure
• repetitive motor movement

S/E of Conventional Antipsychotics & related nsg int:

TX in the event of anticholinergic toxicity:

• Potentially life-threatening medical emergency:
• consult prescriber immediately
• hold all meds
• implement emergency cooling meausres as ordered (cooling blanket, alcohol, or ice bath)
• implement urinary catheterization prn
• admin. benzodiazepines or other prn sedation as ordered
• physostigmine may be ordered

S/E of Conventional Antipsychotics & related nsg int:

S&S of pseudoparkinsonism:

• masklike facies
• stiff & stooped posture
• shuffling gait
• drooling
• tremor
• "pill-rolling" phenomenon

S/E of Conventional Antipsychotics & related nsg int:

TX in the event of pseudoparkinsonism: 

• admin. prn antiparkinsonian agent (e.g., trihexyphenidyl or benztropine)
• if tolerable, consult prescriber regarding med change
• provide towel or handkerchief to wipe excess saliva

S/E of Conventional Antipsychotics & related nsg int:

TX in the even of acute dystonic reactions (also opisthotonos, oculogyric crisis, laryngeal dystonia)

• admin. antiparkinsonian agent
• consider diphenhydramine hydrochloride (Benadryl) 25-50mg IM/IV
• relief usually occurs in 5-15 mins. 
• prevent further dystonias w/antiparkinsonian agent
• experience can be frightening, pt may fear choking
• accompany to quiet area; provide comfort/support
• assist pt to understand event & avert distortion or mistrust of medications
• monitor airway

S/E of Conventional Antipsychotics & related nsg int:

TX in the even of akathisia (motor inner-driven restlessness, i.e., tapping foot incessantly, rocking forward & backward in chair, shifting wt from side to side)

• consult prescriber re: possible med change. Give antiparkinsonian agent.
• tolerance to akathisia does not develop, but akathisia disappears when neuroleptic is d/c'd
• propranolol (Inderal), lorazepan (Ativan), or diazepam (Valium) may be used
• in severe cases, may cause great distress & contribute to suicidality

S/E of Conventional Antipsychotics & related nsg int:

TX in the event of TD:

• no known tx
• d/c'ing drug rarely relieves symptoms
• possibly 20% of pts taking these drugs for >2 yrs may develop TD
• encourage pt to be screened for TD q3months
• onset may merit reconsideration of meds
• changes in appearance may contribute to stigmatizing response
• teach pt actions to conceal involuntary mvmts (purposeful muscle contraction overrides involuntary tardive movements)

S/E of Conventional Antipsychotics & related nsg int:

TX in the event of hypotension & postural hypotension:

• check bp before giving agent
• systolic pressure of 80 mm Hg when standing is indication not to give current dose
• advist pt to arise slowly to prevent dizziness & hold onto railing/furniture while arising to reduce falls
• effect usually subsides when drug is stabilized in 1 - 2 weeks
• elastic bandages may prevent pooling
• if condition is dangerous, counsult MD re: med change, volume expanders, or pressure agents

S/E of Conventional Antipsychotics & related nsg int:

TX for tachycardia:

• always evaluate pts with existing cardiac problems before antipsychotic drugs are administered
• Haloperidol (Haldol) is usually the preferred drug because of its low ACh effects

S/E of Conventional Antipsychotics & related nsg int:

TX in the event of agranulocytosis:

Onset: 1st 12 weeks of therapy; occurs suddenly

potentially dangerous blood dyscrasia

• blood work usually done every wk for 6 mon., then every 2 mon.
• MD may order blood work to determine presence of leukopenia or agranulocytosis
• If positive test: drug is dc'd, reverse isolation may be initiated
• Mortality is high if the drug is not ceased & if tx is not initiated
• teach pt to observe for signs of infection

S/E of Conventional Antipsychotics & related nsg int:

Signs & symptoms of agranulocytosis:

symptoms include:

• sore throat
• fever
• malaise
• mouth sores

S/E of Conventional Antipsychotics & related nsg int:

TX for cholestatic jaundice (rare, reversible, usually benign if caught in time; prodromal s&s are fever, malaise, nausea, & abd pain; jaundice appears 1 wk later)

• consult MD re: possible med change
• bed rest & high-protein, high-carb diet if ordered
• LFTs should be performed q6months

S/E of Conventional Antipsychotics & related nsg int:

TX for Neuroleptic Malignant Syndrome (NMS): 

rare, potentially fatal, acute/medical emergency

• stop neuroleptic
• transfer STAT to medical unit
• Bromocriptine (Parlodel) can relieve muscle rigidity & reduce fever
• Dantrolene (Dantrium) may reduce muscle spasms
• Cool body to reduce fever (cooling blankets, alcohol, cool water or ice bath as ordered)
• Maintain hydration w/oral & IV fluids; correct electrolyte imbalance
• arrhythmias should be treated
• small doses of heparin may decrease possibility of pulmonary emboli
• early detection increases pt's chance of survival

S/E of Conventional Antipsychotics & related nsg int:

S&S of Neuroleptic Malignant Syndrom (NMS):

Severe extrapyramidal: severe muscle rigidity, oculogyric crisis, dysphasia, flexor-extensor posturing, cogwheeling

Hyperpyrexia: Temp over 103 F or 39 C

Autonomic dysfunction:hypertension, tachycardia, diaphoresis, incontinence

Delirium, stupor, coma

Onset: variable, progresses rapidly over 2-3 days

Risk Factors: Concomitant use of psychotropics, older age, female, presence of a mood disorder, and rapid dose titration (increase)