13.2 Antipsychotics
3 min read•june 18, 2024
Antipsychotics are powerful medications that help manage psychotic disorders like . They work by blocking receptors in the brain, reducing symptoms like hallucinations and delusions. These drugs come in two main types: first-generation and second-generation.
Nurses play a crucial role in administering antipsychotics and monitoring patients. They assess mental status, watch for side effects, and educate patients on proper use. Understanding these medications is key for providing effective care and supporting patients' recovery.
Antipsychotic Medications
Key features of antipsychotic medications
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- Treat psychotic disorders including schizophrenia and by reducing symptoms such as hallucinations, delusions, and disordered thinking
- Act on dopamine receptors in the brain, specifically as antagonists at D2 receptors, which reduces dopaminergic neurotransmission in the associated with psychotic symptoms
- Classified into two main categories: first-generation (typical) antipsychotics (, ) and second-generation (atypical) antipsychotics (, )
- Some antipsychotics have additional mechanisms of action, including antagonism at 5-HT2A receptors, histamine H1 receptors, and muscarinic acetylcholine receptors, which can contribute to their therapeutic effects and side effect profiles
- Antipsychotics primarily work through , particularly on like dopamine and serotonin
First vs second-generation antipsychotics
- (FGAs) like haloperidol and chlorpromazine primarily act on D2 receptors and are effective in treating of schizophrenia such as hallucinations and delusions
- FGAs have a higher risk of extrapyramidal side effects (EPS) including , , , and due to their strong antagonism
- (SGAs) like , olanzapine, , and act on multiple receptors (D2, 5-HT2A, H1, muscarinic) and are effective in treating both positive and of schizophrenia
- SGAs have a lower risk of EPS compared to FGAs but a higher risk of metabolic side effects such as weight gain, dyslipidemia, , and diabetes mellitus due to their effects on multiple receptor types
- Both FGAs and SGAs exhibit , which are crucial for their therapeutic action
Symptom Management and Monitoring
- Antipsychotics are effective in managing positive symptoms (e.g., hallucinations, delusions) and negative symptoms (e.g., social withdrawal, lack of motivation) of schizophrenia
- Regular is essential to ensure optimal dosing and minimize side effects
- Patients should be monitored for the development of , a cluster of conditions including increased blood pressure, high blood sugar, excess body fat, and abnormal cholesterol levels
Nursing considerations for antipsychotics
- Assess the patient's mental status and behavior before administering antipsychotics to establish a baseline and monitor for changes
- Monitor vital signs, especially blood pressure and heart rate, as antipsychotics can cause and tachycardia
- Administer the medication as prescribed, ensuring the correct dose, route, and frequency to optimize therapeutic effects and minimize side effects
- Observe for side effects, including EPS (muscle rigidity, tremor, restlessness), metabolic changes (weight gain, increased appetite, fatigue), and anticholinergic effects (dry mouth, constipation, urinary retention)
- Assess the patient's response to the medication, looking for improvement in psychotic symptoms and the ability to perform daily activities and engage in therapy
- Collaborate with the healthcare team to adjust the medication regimen as needed based on the patient's response and side effects, ensuring optimal treatment outcomes
Patient education for antipsychotic use
- Explain the purpose and expected benefits of the medication, emphasizing the importance of consistent use for symptom management and improved quality of life
- Discuss potential side effects and how to manage them, including the importance of regular monitoring (blood glucose, lipids, weight), strategies to minimize weight gain (healthy diet, regular exercise), and reporting any new or worsening side effects to the healthcare team
- Emphasize the importance of adherence to the prescribed regimen, taking the medication consistently even when feeling better, and not stopping the medication without consulting the prescriber to prevent relapse and maintain treatment efficacy
- Encourage open communication with the healthcare team, discussing concerns, questions, or challenges related to the medication, and attending regular follow-up appointments to ensure optimal treatment and monitoring
- Provide resources for additional support, such as mental health support groups and educational materials on the disorder and its treatment, to empower patients and promote self-management and recovery
Key Terms to Review (88)
5-HT2A Receptor: The 5-HT2A receptor is a type of serotonin receptor that is widely expressed in the central nervous system and involved in various physiological and behavioral processes. It plays a crucial role in the mechanism of action of antipsychotic medications.
Abilify: Abilify (aripiprazole) is an atypical antipsychotic medication used to treat schizophrenia, bipolar disorder, and major depressive disorder. It works by balancing dopamine and serotonin levels in the brain.
ACE inhibitor: ACE inhibitors are medications that prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. They are commonly used to treat hypertension and heart failure.
Akathisia: Akathisia is a movement disorder characterized by an inner feeling of restlessness and an urgent need to move. It is often a side effect of antipsychotic and other psychopharmacologic drugs.
Akathisia: Akathisia is a movement disorder characterized by a subjective feeling of inner restlessness and an irresistible need to move. It is a common adverse effect associated with the use of antipsychotic medications, particularly in the context of treating mental health conditions.
American Academy of Child and Adolescent Psychiatry: The American Academy of Child and Adolescent Psychiatry (AACAP) is a professional medical organization dedicated to promoting the healthy development of children, adolescents, and families through advocacy, education, and research in child and adolescent psychiatry. AACAP provides resources and guidelines for the diagnosis and treatment of psychiatric disorders in young populations.
Anti-inflammatory: Anti-inflammatory drugs are medications used to reduce inflammation, which can help alleviate pain and swelling. They play a significant role in managing symptoms in various psychiatric conditions.
Antidopaminergic Effects: Antidopaminergic effects refer to the ability of certain drugs, particularly antipsychotics, to block or antagonize the action of the neurotransmitter dopamine in the brain. This reduction in dopamine signaling is a key mechanism of action for many antipsychotic medications used in the treatment of various psychiatric disorders.
Antipsychotic: Antipsychotics are medications used to manage and treat symptoms of psychosis, such as delusions, hallucinations, and disorganized thinking. They are primarily used in conditions like schizophrenia and bipolar disorder.
Aripiprazole: Aripiprazole is an atypical antipsychotic used primarily to treat schizophrenia and bipolar disorder. It works by modulating the activity of dopamine and serotonin in the brain.
Asociality: Asociality is a lack of motivation to engage in social interactions or a preference for solitary activities. It is commonly observed as a negative symptom in patients with schizophrenia.
Atypical antipsychotics: Atypical antipsychotics, also known as second-generation antipsychotics, are medications used to treat psychiatric conditions such as schizophrenia and bipolar disorder. They are preferred over typical antipsychotics due to fewer extrapyramidal side effects.
Atypical Antipsychotics: Atypical antipsychotics, also known as second-generation antipsychotics, are a class of medications primarily used to treat schizophrenia and other psychotic disorders. They differ from typical or first-generation antipsychotics in their pharmacological profile and reduced risk of certain side effects, such as extrapyramidal symptoms.
Avolition: Avolition is the decrease in the motivation to initiate and perform self-directed purposeful activities. It is commonly seen in individuals with schizophrenia and other mental health disorders.
Beers Criteria: The Beers Criteria is a guideline for healthcare professionals to help improve the safety of prescribing medications for older adults, identifying potentially inappropriate medications (PIMs) that pose higher risks than benefits in this population.
Benzodiazepine sedative-hypnotic: Benzodiazepine sedative-hypnotics are a class of drugs primarily used to treat anxiety, insomnia, and other conditions by depressing the central nervous system. They enhance the effect of the neurotransmitter GABA, promoting relaxation and sleep.
Bipolar Disorder: Bipolar disorder is a mental health condition characterized by extreme mood swings between manic episodes of elevated energy, mood, and activity, and depressive episodes of low mood, energy, and motivation. This condition is closely linked to the use of antipsychotics and mood stabilizers in clinical practice.
Cariprazine: Cariprazine is an atypical antipsychotic used primarily to treat schizophrenia and bipolar disorder. It works by modulating dopamine and serotonin receptors in the brain.
Catatonia: Catatonia is a neuropsychiatric syndrome characterized by abnormal motor behavior and a lack of responsiveness to external stimuli. It can occur in various psychiatric and medical conditions, including schizophrenia and mood disorders.
Children and adolescents: Children and adolescents are individuals typically categorized from birth to 18 years old. In pharmacology, this group requires special considerations due to ongoing development and differing drug metabolism compared to adults.
Chlordiazepoxide: Chlordiazepoxide is a benzodiazepine used primarily for the treatment of anxiety disorders and alcohol withdrawal symptoms. It works by enhancing the activity of GABA, a neurotransmitter that inhibits brain activity.
Chlorpromazine: Chlorpromazine is an antipsychotic medication primarily used to manage schizophrenia and bipolar disorder. It is also effective as an antiemetic, particularly in preventing nausea and vomiting.
Chlorpropamide: Chlorpropamide is a first-generation sulfonylurea used to treat type 2 diabetes mellitus. It works by stimulating the release of insulin from the pancreas.
Clozapine: Clozapine is an atypical antipsychotic used primarily for treatment-resistant schizophrenia. It works by affecting various neurotransmitter receptors in the brain, particularly serotonin and dopamine receptors.
Clozaril: Clozaril, also known as clozapine, is an atypical antipsychotic medication primarily used to treat schizophrenia in patients who are unresponsive to other treatments. It is known for its effectiveness but requires regular blood monitoring due to potential serious side effects.
Colazal: Colazal (balsalazide) is a medication used to treat mild to moderate ulcerative colitis. It works by reducing inflammation in the colon.
D2 Receptor: The D2 receptor is a type of dopamine receptor that is widely expressed in the brain and plays a crucial role in various physiological and pathological processes. It is a G-protein coupled receptor that mediates the effects of the neurotransmitter dopamine, which is involved in motor control, cognition, reward, and emotional regulation.
Depot injections: Depot injections are long-acting, intramuscular injections of medication that slowly release the drug into the bloodstream over an extended period. They are commonly used in the management of chronic psychiatric conditions to ensure consistent medication adherence.
Dopamine: Dopamine is a neurotransmitter that plays a crucial role in the brain's reward and pleasure centers, as well as in the regulation of various physiological processes. It is involved in a wide range of functions, from motor control and cognition to emotional and behavioral responses, making it a key player in understanding and treating numerous nervous system disorders.
Dopamine agonist: Dopamine agonists are medications that mimic the effects of dopamine by stimulating dopamine receptors in the brain. They are primarily used to treat conditions like Parkinson’s disease and certain psychiatric disorders.
Dystonia: Dystonia is a movement disorder characterized by involuntary muscle contractions causing repetitive movements or abnormal postures. It can be a symptom of various neurological conditions, including Parkinson's Disease.
Dystonia: Dystonia is a neurological movement disorder characterized by involuntary muscle contractions that cause abnormal, repetitive movements and twisted, sustained postures. It is often associated with the use of antipsychotic medications.
Extrapyramidal symptoms: Extrapyramidal symptoms (EPS) are drug-induced movement disorders that include various involuntary muscle movements, typically caused by antipsychotic and antiemetic medications. Symptoms can range from mild tremors to severe motor dysfunction.
Extrapyramidal Symptoms: Extrapyramidal symptoms (EPS) are a set of movement disorders that can occur as side effects of certain medications, particularly antipsychotics and antiemetics. These symptoms involve the disruption of the normal functioning of the extrapyramidal system, which is responsible for controlling involuntary muscle movements and coordination.
First-generation antipsychotics: First-generation antipsychotics, also known as typical antipsychotics, are a class of drugs used primarily to manage psychosis, particularly in schizophrenia. They work mainly by blocking dopamine receptors in the brain.
Fluphenazine: Fluphenazine is a first-generation antipsychotic medication used primarily to treat symptoms of schizophrenia and other psychotic disorders. It works by blocking dopamine receptors in the brain, thereby reducing psychotic symptoms.
Geodon: Geodon, also known as ziprasidone, is an atypical antipsychotic medication used to treat schizophrenia and bipolar disorder. It works by affecting the levels of certain chemicals in the brain.
Haldol: Haldol (haloperidol) is a first-generation antipsychotic medication primarily used to treat schizophrenia and acute psychotic states. It works by blocking dopamine receptors in the brain.
Haloperidol: Haloperidol is a first-generation antipsychotic used primarily to treat schizophrenia and acute psychosis. It works by blocking dopamine receptors in the brain.
Histamine-1 receptor antagonist: Histamine-1 receptor antagonists are drugs that block the H1 receptors, preventing histamine from exerting its effects. They are primarily used to treat allergic reactions, but also have sedative properties useful in antipsychotic treatments.
Hyperglycemia: Hyperglycemia refers to an abnormally high level of glucose in the bloodstream. It is a key feature in the pathophysiology of various medical conditions, particularly diabetes mellitus, and can have significant implications for fluid and electrolyte balance, inflammatory processes, and overall health.
Invega: Invega is an atypical antipsychotic medication primarily used to treat schizophrenia and schizoaffective disorder. It works by altering the effects of neurotransmitters in the brain, particularly dopamine and serotonin.
Latuda: Latuda is an atypical antipsychotic medication primarily used to treat schizophrenia and bipolar depression. It functions by modulating neurotransmitters in the brain, particularly serotonin and dopamine.
Lurasidone: Lurasidone is an atypical antipsychotic medication primarily used to treat schizophrenia and bipolar depression. It works by modulating the effects of neurotransmitters in the brain, particularly serotonin and dopamine.
Mesolimbic Pathway: The mesolimbic pathway is a dopaminergic neural pathway that originates in the ventral tegmental area (VTA) of the midbrain and projects to the limbic system, particularly the nucleus accumbens. This pathway is a key component of the brain's reward and motivation circuitry, playing a crucial role in the experience of pleasure, reinforcement of behaviors, and the development of addiction.
Metabolic Syndrome: Metabolic syndrome is a cluster of interconnected medical conditions that increase the risk of developing cardiovascular disease and type 2 diabetes. It is characterized by a combination of abdominal obesity, high blood pressure, high blood sugar, high triglycerides, and low HDL cholesterol levels.
Modecate: Modecate is a long-acting injectable antipsychotic medication used primarily for the treatment of schizophrenia and other severe mental health disorders. It contains the active ingredient fluphenazine decanoate, which belongs to the phenothiazine class of drugs.
Negative Symptoms: Negative symptoms refer to the absence or reduction of normal functions or behaviors in individuals with certain mental health conditions, particularly schizophrenia. These symptoms are characterized by a decrease or lack of emotional expression, motivation, and social interaction, which can significantly impact a person's daily life and functioning.
Neuroleptic Malignant Syndrome: Neuroleptic Malignant Syndrome (NMS) is a rare but potentially life-threatening neurological disorder that can occur as an adverse reaction to antipsychotic medications, also known as neuroleptics. It is characterized by a constellation of symptoms including muscle rigidity, fever, altered mental status, and autonomic dysfunction.
Neurotransmitters: Neurotransmitters are chemical messengers that transmit signals between neurons and target cells in the nervous system. They are responsible for the communication and coordination of various physiological and psychological processes in the body, and their imbalance or dysfunction can contribute to the development of various neurological and psychiatric disorders.
Olanzapine: Olanzapine is an atypical antipsychotic medication primarily used to treat schizophrenia and bipolar disorder. It works by altering the activity of certain natural substances in the brain.
Orthostatic Hypotension: Orthostatic hypotension is a sudden drop in blood pressure that occurs when an individual stands up from a sitting or lying position. This condition can lead to dizziness, lightheadedness, and even fainting, and is particularly relevant in the context of various medical conditions and drug therapies.
Paliperidone: Paliperidone is an atypical antipsychotic medication used primarily to treat schizophrenia and schizoaffective disorder. It works by modulating neurotransmitters in the brain, particularly dopamine and serotonin.
Pantoprazole: Pantoprazole is a proton-pump inhibitor (PPI) used to reduce stomach acid production. It is commonly prescribed for conditions such as gastroesophageal reflux disease (GERD) and Zollinger-Ellison syndrome.
Parkinsonism: Parkinsonism refers to a group of motor disorders characterized by tremors, rigidity, bradykinesia (slowness of movement), and postural instability. It is a neurological condition primarily affecting the motor system and is often associated with the degeneration of dopaminergic neurons in the substantia nigra region of the brain.
Pediatric clients: Pediatric clients are children and adolescents who require medical care, including pharmacological treatments. Special considerations must be made for their unique physiological and developmental needs.
Pediatric dosage: Pediatric dosage is the specific amount of medication prescribed to children, taking into account their age, weight, and developmental stage. It ensures both efficacy and safety in treating various pediatric conditions.
Positive Symptoms: Positive symptoms in the context of antipsychotics refer to the presence of abnormal or exaggerated behaviors, perceptions, and thought patterns associated with psychotic disorders such as schizophrenia. These symptoms represent an addition or distortion of normal functioning, often manifesting as hallucinations, delusions, disorganized speech, and bizarre behavior.
Prolixin: Prolixin, also known as fluphenazine, is a typical antipsychotic medication primarily used to treat symptoms of schizophrenia. It works by blocking dopamine receptors in the brain.
Proton pump inhibitor: Proton pump inhibitors (PPIs) are a class of medications that reduce stomach acid production by blocking the enzyme in the stomach wall that produces acid. They are commonly used to treat conditions like gastroesophageal reflux disease (GERD), ulcers, and hyperacidity.
Pseudoparkinsonism: Pseudoparkinsonism is a drug-induced condition that mimics the symptoms of Parkinson's disease, including tremors, rigidity, and bradykinesia. It commonly occurs as a side effect of antipsychotic medications.
Psychosis: Psychosis is a mental disorder characterized by a disconnection from reality, often manifesting as delusions and hallucinations. It can be caused by various factors including mental health conditions, substance abuse, and certain medications.
Quetiapine: Quetiapine is an atypical antipsychotic medication primarily used to treat schizophrenia, bipolar disorder, and major depressive disorder. It works by altering the actions of certain natural substances in the brain.
Receptor Antagonism: Receptor antagonism is a pharmacological mechanism where a drug or molecule binds to a receptor and blocks or inhibits the normal function or activation of that receptor, preventing the receptor's endogenous ligand or agonist from eliciting its typical physiological response. This concept is particularly relevant in the context of antipsychotic medications.
Restoril: Restoril is the brand name for temazepam, a benzodiazepine used primarily as a short-term treatment for insomnia. It works by enhancing the effects of GABA, a neurotransmitter that induces sleep and relaxation.
Risperdal: Risperdal, also known as risperidone, is an atypical antipsychotic used to treat schizophrenia, bipolar disorder, and irritability associated with autistic disorder. It works by altering the effects of chemicals in the brain.
Risperidone: Risperidone is an atypical antipsychotic medication primarily used to treat schizophrenia, bipolar disorder, and irritability in autism. It works by altering the effects of chemicals in the brain.
Risperidone: Risperidone is an atypical antipsychotic medication primarily used to treat schizophrenia, bipolar disorder, and irritability associated with autism. It works by modulating the activity of certain neurotransmitters in the brain to alleviate the symptoms of these mental health conditions.
Ropinirole: Ropinirole is a dopamine agonist used primarily to treat symptoms of Parkinson's disease and restless legs syndrome. It works by stimulating dopamine receptors in the brain.
Schizophrenia: Schizophrenia is a severe and chronic mental disorder characterized by distortions in perception, thinking, emotions, language, sense of self, and behavior. It is a complex neurological condition that affects how a person thinks, feels, and behaves, often leading to a distorted perception of reality.
Schizophrenia in children: Schizophrenia in children is a severe mental disorder characterized by distorted thinking, hallucinations, and impaired functioning. It typically presents before the age of 13 and can significantly impact a child's development.
Second-generation antipsychotics: Second-generation antipsychotics (SGAs), also known as atypical antipsychotics, are medications used to treat psychiatric conditions such as schizophrenia and bipolar disorder. They are distinguished from first-generation antipsychotics by their reduced risk of extrapyramidal side effects.
Sedative: A sedative is a type of medication that depresses the central nervous system, leading to relaxation and reduced anxiety. They are often used to treat conditions like insomnia, anxiety, and agitation.
Selective serotonin receptor agonists: Selective serotonin receptor agonists are drugs that specifically target and activate serotonin receptors in the brain to alleviate migraine headaches. They primarily work by narrowing blood vessels and reducing inflammation.
Seroquel: Seroquel, also known as quetiapine, is an atypical antipsychotic medication used to treat conditions such as schizophrenia and bipolar disorder. It works by altering the actions of certain chemicals in the brain.
Serotonin: Serotonin is a neurotransmitter that plays a crucial role in regulating various physiological and psychological processes in the body. It is involved in the functioning of the nervous system, the regulation of mood, sleep, appetite, and other important bodily functions.
Sulfonylurea antidiabetic: Sulfonylurea antidiabetics are a class of medications used to manage type 2 diabetes by increasing insulin secretion from the pancreatic beta cells. They help lower blood glucose levels but carry a risk of hypoglycemia.
Tardive dyskinesia: Tardive dyskinesia is a neurological disorder characterized by involuntary, repetitive body movements. It is often caused by long-term use of antipsychotic medications.
Tardive Dyskinesia: Tardive dyskinesia is a neurological disorder characterized by involuntary, repetitive movements that typically develop as a side effect of long-term use of antipsychotic medications. It is a serious and potentially irreversible condition that can significantly impact a patient's quality of life.
Therapeutic Drug Monitoring: Therapeutic drug monitoring is the measurement of the concentration of a drug in a patient's blood to ensure that the drug is within the optimal therapeutic range. It is a crucial aspect of the nursing process and medication administration, particularly for drugs with a narrow therapeutic index or potential for toxicity, such as antipsychotics.
Thorazine: Thorazine, also known as chlorpromazine, is a first-generation antipsychotic medication primarily used to treat schizophrenia and other psychotic disorders. It works by blocking dopamine receptors in the brain to reduce symptoms such as delusions and hallucinations.
Typical Antipsychotics: Typical antipsychotics, also known as first-generation antipsychotics, are a class of medications primarily used to treat symptoms of psychosis, such as hallucinations, delusions, and disorganized thinking. These drugs work by blocking dopamine receptors in the brain, which helps to restore the balance of neurotransmitters and alleviate the positive symptoms of psychotic disorders.
Vraylar: Vraylar is an atypical antipsychotic medication primarily used to treat schizophrenia and bipolar disorder. It works by modulating the activity of certain neurotransmitters in the brain, particularly dopamine and serotonin.
Xerostomia: Xerostomia is the medical term for dry mouth resulting from reduced or absent saliva flow. It can be a side effect of various medications, including antipsychotics.
Zestril: Zestril is a brand name for lisinopril, an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure and heart failure. It works by relaxing blood vessels, making it easier for the heart to pump blood.
Ziprasidone: Ziprasidone is an atypical antipsychotic medication used to treat schizophrenia and bipolar disorder. It works by altering the effects of chemicals in the brain, namely dopamine and serotonin.
Zyprexa: Zyprexa is a brand name for the antipsychotic medication olanzapine. It is used to treat psychiatric conditions such as schizophrenia and bipolar disorder.
Zyrtec: Zyrtec is a brand name for cetirizine, an antihistamine used to relieve allergy symptoms such as runny nose, sneezing, and itching. It is commonly used to treat both seasonal allergies and chronic urticaria (hives).