Nursing diagnosis

Nursing diagnosis

  • Risk for other-directed violence
  • Risk for injury
  • Risk for activity intolerance
  • Noncompliance

Drug Classification

Drug trade/ Generic names

Actions

Side effects

Nursing implication

First-Generation (Conventional or typical)

Thorazine (Chlorpromazine)

Mellaril (thioridazine)

Loxitane (loxipine)

Moban (Molindone)

Trilafon (Perphenazine

Trifluoperazine

Navane (Thiorthixene)

Prolixin (Fluphenazine)

Haldol (Haloperidol)

Orap (Pimozide)

Strong antagonist to Dopamine receptors, blocking the action of dopamine.  Antagonist to muscarinic receptors for acetylcholine, adrenergic receptors for norepinephrine and histamine receptors.

Extrapyramidal symptoms (EPS) such as acute dystonia, akathisia, dyskinesia, tardive dyskinesia, and pseudoparkinsonism.  In women, amenorrhea, and in men, gynecomastia. Anticholinergic side effects, low seizure threshold, tachycardia, hypotension, and ejaculatory dysfunction.

Perform AIMS test with conventional antipsychotics.  Monitor for signs of dry mouth, sedation, blurred vision, and dry mouth.  Monitor vital signs

Second-Generation

(Atypical)

Clozaril (Clozapine)

Zyprexa (Olanzapine)

Invega (Paliperidone)

Seroquel (Quetiapine)

Risperdal (Risperidone)

Geodon (Ziprasidone)

Dopamine and serotonin antagonists (blockers).  Thought to decrease psychosis.

Weight gain, insulin resistance, metabolic syndrome, sexual dysfunction.

Clozaril – 1st atypical antipsychotic to be used. Frequent monitoring of WBCs every 1-2 weeks due to bone marrow suppression and agranulocytosis.

Risperdal – high risk for EPS.  Monitor weight.

Issues in Antipsychotic Maintenance Therapy

  • Clozapine (Clozaril) and Agranulocytosis risk
    • Medications such as clozaril have risks of agranulocytosis (blood disorder in which the patient’s absolute neutrophil count (ANC) drops to extremely low levels) causing neutropenia
  • Extrapyramidal side effects
    • Pseudoparkinsonism, Akinesia (Impairment in voluntary movement), Akathisia (continuous restlessness), Dystonia (Involuntary muscle spasms), Oculogyric crisis (uncontrolled rolling back of the eyes), and Tardive dyskinesia (unusual facial and tongue movements, stiff neck, and difficulty swallowing)
  • Hormonal side effects
    • In men: Decreased libido, gynecomastia, retrograde ejaculation,
    • In women: Amenorrhea galactorrhea