Antipsychotic Survival Guide
This pharmacologic class has the highest risk of extrapyramidal symptoms (EPS).
Typical antipsychotics
A client taking a typical antipsychotic develops painful muscle spasms of the neck and jaw.
What EPS is occurring?
Acute dystonia
This combination medication is considered first-line therapy for improving the symptoms of Parkinson's disease.
Levodopa/Carbidopa
This pharmacologic class requires routine serum drug level monitoring to help prevent toxicity.
Hydantoins
The nurse is caring for four clients. Which client should the nurse assess first?
1. A client taking a typical antipsychotic who reports dry mouth.
2. A client taking an atypical antipsychotic who reports increased appetite.
3. A client taking a typical antipsychotic who develops a temperature of 103°F (39.4°C), muscle rigidity, and confusion.
4. A client taking an atypical antipsychotic who reports constipation.
The client with fever, muscle rigidity, and confusion (Neuroleptic Malignant Syndrome).
This pharmacologic class is associated with weight gain, hyperglycemia, and metabolic syndrome.
Atypical antipsychotics
A client taking a typical antipsychotic paces the room and says, "I just can't sit still."
What EPS is occurring?
Akathisia
A client reports that their Parkinson's medication works well for a while, but then their tremors and rigidity return before the next dose is due. What phenomenon is the client experiencing?
ON-OFF phenomenon
A client taking a hydantoin develops swollen, bleeding gums. What adverse effect is the client experiencing?
Gingival hyperplasia
The nurse is caring for four clients. Which client should the nurse assess first?
1. A client taking levodopa/carbidopa who reports nausea.
2. A client taking a COMT inhibitor who states the medication is helping reduce "OFF" periods.
3. A client taking levodopa/carbidopa who becomes dizzy every time they stand up.
4. A client taking levodopa/carbidopa whose symptoms suddenly return and who is unable to move.
The client whose symptoms suddenly return and is unable to move (ON-OFF phenomenon affecting mobility and safety).
Which pharmacologic class is more likely to cause metabolic syndrome?
Atypical antipsychotics
A client taking a typical antipsychotic develops a shuffling gait, rigidity, and a resting tremor.
What EPS is occurring?
Drug-induced Parkinsonism (Pseudoparkinsonism)
This pharmacologic class is often added to levodopa/carbidopa to help reduce "OFF" periods by prolonging the effects of levodopa.
COMT inhibitors
This pharmacologic class is commonly used to stop an active seizure or status epilepticus.
Benzodiazepines
The nurse is caring for four clients. Which client should the nurse assess first?
1. A client taking a hydantoin who reports swollen gums.
2. A client taking a benzodiazepine with a respiratory rate of 8 breaths/minute.
3. A client taking levetiracetam who reports feeling tired.
4. A client taking a hydantoin who reports mild nausea.
The client taking a benzodiazepine with a respiratory rate of 8 breaths/minute.
Name three extrapyramidal symptoms (EPS) associated with typical antipsychotics.
A client taking an antipsychotic develops repetitive lip smacking, tongue movements, and involuntary facial grimacing.
What condition is occurring?
Tardive dyskinesia
A client taking levodopa/carbidopa asks why they should avoid taking the medication with a high-protein meal. What is the best explanation?
High-protein foods can decrease the absorption/effectiveness of levodopa.
The nurse is teaching a client prescribed a hydantoin. Name two important teaching points.
The nurse is caring for four clients. Which client should the nurse assess first?
1. A client taking a typical antipsychotic who reports lip smacking and tongue movements.
2. A client taking a hydantoin who reports slurred speech, unsteady gait, and nystagmus.
3. A client taking levodopa/carbidopa who reports dark-colored urine.
4. A client taking an atypical antipsychotic who reports a 5-pound weight gain.
The client taking a hydantoin with slurred speech, unsteady gait, and nystagmus (possible toxicity).
A client taking an antipsychotic develops a temperature of 103°F (39.4°C), severe muscle rigidity, confusion, and diaphoresis.
A client taking an antipsychotic has a temperature of 103°F (39.4°C), severe muscle rigidity, confusion, diaphoresis, and tachycardia.
What life-threatening syndrome is occurring?
Neuroleptic malignant syndrome (NMS)
A client taking levodopa/carbidopa stands up quickly and becomes dizzy and lightheaded. What common adverse effect is the client experiencing?
Orthostatic hypotension
A client taking a hydantoin reports slurred speech, unsteady gait, and involuntary eye movements. What is the nurse's priority concern?
Hydantoin toxicity (phenytoin toxicity)
The nurse is caring for four clients. Which client should the nurse assess first?
1. A client taking an atypical antipsychotic who has gained 10 lb (4.5 kg) over the past month.
2. A client taking levodopa/carbidopa who reports nausea after taking the medication.
3. A client taking a hydantoin who reports swollen gums despite good oral hygiene.
4. A client taking a typical antipsychotic who develops a temperature of 103°F (39.4°C), severe muscle rigidity, diaphoresis, and confusion.
The client with Neuroleptic Malignant Syndrome.