Antipsychotics : Adverse Effects and Interactions
抗精神病药：不良效应与相互作用
The adverse effects associated with the antipsychotic drugs are related to their dopamine-blocking, anticholinergic, antihistamine, and alpha-adrenergic activities. The most common CNS effects are sedation, weakness, tremor, drowsiness, extrapyramidal side effects (EPS), pseudoparkinsonism, dystonia, akathisia, tardive dyskinesia, and potentially irreversible neuroleptic malignant syndrome. Anticholinergic effects include dry mouth, nasal congestion, flushing, constipation, urinary retention, impotence, glaucoma, blurred vision, and photophobia. Cardiovascular (CV) effects, which are probably related to the dopamine-blocking effects, include hypotension, orthostatic hypotension, cardiac arrhythmias, congestive heart failure, and pulmonary edema. Several of these agents (thioridazine, mesoridazine, ziprasidone) are associated with prolongation of the QTc interval, which could lead to serious or even fatal cardiac arrhythmias. Patients receiving these drugs should have a baseline and periodic electrocardiogram (ECG) during therapy. In late 2003, the FDA issued a requirement that all of the atypical antipsychotics include warnings that there is a risk for the development of diabetes mellitus when these drugs are used. Consequently, when patients are maintained on any of the atypical antipsychotics, they should be monitored regularly for the signs and symptoms of diabetes mellitus.
Respiratory effects such as laryngospasm, dyspnea, and bronchospasm may also occur. The phenothiazines (chlorpromazine, fluphenazine, prochlorperazine, promethazine, and thioridazine) often turn the urine pink to reddish-brown as a result of their excretion. Although this effect may cause great patient concern, it has no clinical significance. In addition, bone marrow suppression is a possibility with some antipsychotic agents.
Because the combination of antipsychotics with beta-blockers may lead to an increase in the effect of both drugs, this combination should be avoided if possible. Antipsychotic– alcohol combinations result in an increased risk of CNS depression, and antipsychotic–anticholinergic combinations lead to increased anticholinergic effects, so dose adjustments are necessary. Patients who take either of these combinations should be monitored closely for adverse effects, and supportive measures should be provided. Patients should not take thioridazine or ziprasidone with any other drug that is associated with prolongation of the QTc interval.
★Vocabulary for Today ★
pseudoparkinsonism – n. 假性帕金森氏症
dystonia – n. 张力失常
akathisia – n. 静坐不能
tardive dyskinesia – n. 迟发性运动障碍
phenothiazine – n. 酚噻嗪
chlorpromazine – n. 氯丙嗪
fluphenazine – n. 氟非那嗪
prochlorperazine – n. 丙氯拉嗪
promethazine – n. 异丙嗪
thioridazine – n. 硫利达嗪
1. The client diagnosed with late- stage Alzheimer’s disease is agitated and having delusions. Which medication should the nurse anticipate the HCP prescribing?
A. Donepezil.
B. Haloperidol.
C. Fluoxetine.
D. Amitriptyline. 2. Which information should the nurse discuss with the client diagnosed with schizophrenia who is prescribed an atypical antipsychotic medication? Select all that apply.
A. Drink decaffeinated coffee and tea.
B. Decrease the dietary intake of salt.
C. Eat six small, high-protein meals a day.
D. Report muscle spasms and rigidity.
E. Monitor glucose levels and lipid levels.
1. B. Haloperidol.
Delusions and agitation respond to antipsychotic medications. Haloperidol (Haldol), an antipsychotic medication, has been used and has proved to be effective in treating these symptoms, so the nurse should anticipate this prescription. 2. A, D, E
(A) Caffeine-containing substances will negate the effects of antipsychotic medication; therefore, the client should drink caffeine-free beverages such as decaffeinated coffee and tea and caffeine-free colas. (D) Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD), exhibited by muscle spasms and rigidity. (E) Atypical antipsychotics may increase the client’s risk of developing diabetes and high cholesterol; therefore, the client’s weight, glucose levels, and lipid levels should be monitored regularly.
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