This document summarizes the side effects and nursing considerations for four antipsychotic medications - olanzapine, aripiprazole, chlorpromazine, and olanzapine. It lists common side effects such as drowsiness, dizziness, weight gain, hypotension, extrapyramidal symptoms, and tardive dyskinesia. Nurses should monitor patients for these side effects as well as signs of more severe reactions like neuroleptic malignant syndrome. Assessment includes monitoring vital signs, glucose levels, symptoms, and providing patient education about safety and side effect reporting.
This document summarizes the side effects and nursing considerations for four antipsychotic medications - olanzapine, aripiprazole, chlorpromazine, and olanzapine. It lists common side effects such as drowsiness, dizziness, weight gain, hypotension, extrapyramidal symptoms, and tardive dyskinesia. Nurses should monitor patients for these side effects as well as signs of more severe reactions like neuroleptic malignant syndrome. Assessment includes monitoring vital signs, glucose levels, symptoms, and providing patient education about safety and side effect reporting.
This document summarizes the side effects and nursing considerations for four antipsychotic medications - olanzapine, aripiprazole, chlorpromazine, and olanzapine. It lists common side effects such as drowsiness, dizziness, weight gain, hypotension, extrapyramidal symptoms, and tardive dyskinesia. Nurses should monitor patients for these side effects as well as signs of more severe reactions like neuroleptic malignant syndrome. Assessment includes monitoring vital signs, glucose levels, symptoms, and providing patient education about safety and side effect reporting.
Side effects and nursing implications of the following stabilizing agents:
1.3 Antipsychotics OLANZAPINE (Zyprexa) Side effects CNS: Somnolence, dizziness, nervousness, headache, akathisia, personality disorders, tardive dyskinesia, neuroleptic malignant syndrome CV: Orthostatic hypotension, peripheral edema, tachycardia GI: Constipation, abdominal pain Respiratory: Cough, pharyngitis Other: Fever, weight gain, joint pain ASSESSMENT History: Allergy to olanzapine, myeloproliferative disorders, severe CNS depression, comatose states, history of seizure disorders, lactation; CV or cerebrovascular disease, dehydration, Alzheimer's disease, prostate enlargement, narrow-angle glaucoma, history of paralytic ileus or breast cancer, elderly or debilitated patients, pregnancy Physical: T, weight; reflexes, orientation, intraocular pressure, ophthalmologic exam; P, BP, orthostatic BP, ECG; R, adventitious sounds; bowel sounds, normal output, liver evaluation; prostate palpation, normal urine output; CBC, urinalysis, liver and renal function tests
INTERVENTIONS Do not dispense more than 1-wk supply at a time. Peel back foil on blister pack of disintegrating tablets; do not push through foil; use dry hands to remove tablet and place in mouth. Monitor for the many possible drugdrug interactions before beginning therapy. Monitor elderly patients for dehydration and institute remedial measures promptly; sedation and decreased sensation of thirst related to CNS effects of drug can lead to dehydration. Encourage patient to void before taking the drug to help decrease anticholinergic effects of urinary retention. Monitor for elevations of temperature and differentiate between infection and neuroleptic malignant syndrome. Monitor for orthostatic hypotension and provide appropriate safety measures as needed.
TEACHING POINTS Take this drug exactly as prescribed; do not change dose without consulting your health care provider. Peel back foil on blister pack of disintegrating tablets; do not push through foil; use dry hands to remove tablet, place entire tablet in mouth. These side effects may occur: drowsiness, dizziness, sedation, seizures (avoid driving, operating machinery, or performing tasks that require concentration); dizziness, faintness on arising (change positions slowly, use caution); increased salivation (if bothersome, contact your nurse or physician); constipation (consult with your nurse of physician for appropriate relief measures); fast heart rate (rest and take your time if this occurs). This drug cannot be taken during pregnancy. If you think you are pregnant or wish to become pregnant, contact your nurse or physician. Report lethargy, weakness, fever, sore throat, malaise, mouth ulcers, and flulike symptoms.
ARIRIPIPRAZOLE (Abilify) Side effects CNS: headache, anxiety, insomnia, lightheadedness, somnolence, tremor, asthenia, tardive dyskinesia, blurred vision, seizures (potentially life-threatening), akathisia CV: orthostatic hypotension Dermatologic: rash GI: nausea, vomiting, constipation, diarrhea, abdominal pain, esophageal dysmotility Respiratory: rhinitis, cough Other: fever, neuroleptic malignant syndrome, increased suicide risk NURSING IMPLICATIONS Assessment & Drug Effects Monitor diabetics for loss of glycemic control. Monitor cardiovascular status. Assess for and report orthostatic hypotension. Take BP supine then in sitting position. Report systolic drop of >1520 mm Hg. Patients at increased risk are those who are dehydrated, hypovolemic, or receiving concurrent antihypertensive therapy. Monitor body temperature in situations likely to elevate core temperature (e.g., exercising strenuously, exposure to extreme heat, receiving drugs with anticholinergic activity, or being subject to dehydration). Monitor for and report signs of tardive dyskinesia. Monitor for and immediately report S&S of neuroleptic malignant syndrome (NMS) that include: hyperpyrexia, muscle rigidity, altered mental status, irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia. Withhold drug if NMS is suspected. Lab tests: Monitor periodically Hct & Hgb. Monitor periodically blood glucose. Monitor for elevated CPK and myoglobinuria if NMS is suspected.
Patient & Family Education Carefully monitor blood glucose levels if diabetic. Do not drive or engage in other potentially hazardous activities until reaction to drug is known. Avoid situations where you are likely to become overheated or dehydrated. Notify physician if you become pregnant or intend to become pregnant while taking this drug. Do not breast feed while taking this drug.
CHLORPROMAZINE (Thorazine) Side effects CNS: Drowsiness, insomnia, vertigo, headache, weakness, tremors, ataxia, slurring, cerebral edema, seizures, exacerbation of psychotic symptoms, extrapyramidal syndromes, neuroleptic malignant syndrome GI: Dry mouth, salivation, nausea, vomiting, anorexia, constipation, paralytic ileus, incontinence CV: Hypotension, otrhostatic hypotension, hypertension, tachycardia, bradycardia, cardiac arrest, CHF, cardiomegaly, refractory arrhythmias, pulmonary edema Respiratory: Bronchospasm, laryngospasm, dyspnea, suppression of cough reflex and potential aspiration Hematologic: Eosinophilia, leukopenia, leukocytosis, anemia, aplastic anemia, hemolytic anemia, thrombocytopenic or nonthrombocytopenic purpura, pancytopenia, elevated serum cholesterol GU: Urinary retention, polyuria, incontinence, priapism, ejaculation inhibition, male impotence, urine discolored pink to red-brown EENT: Nasal congestion, glaucoma, photophobia, blurred vision, miosis, mydriasis, deposits in the cornea and lens, pigmentary retinopathy Hypersensitivity: Jaundice, urticaria, angioneurotic edema, laryngeal edema, photosensitivity, eczema, asthma, anaphylactoid reactions, exfoliative dermatitis, contact dermatitis Endocrine: Lactation, breast engorgement in females, galactorrhea, syndrome of inappropriate ADH secretion, amenorrhea, menstrual irregularities, gynecomastia, changes in libido, hyperglycemia, inhibition of ovulation, infertility, pseudopregnancy, reduced urinary levels of gonadotropins, estrogens and progestins Other: Fever, heat stroke, pallor, flushed facies, sweating, photosensitivity Assessment & Drug Effects Establish baseline BP (in standing and recumbent positions), and pulse, before initiating treatment. Monitor BP frequently. Hypotensive reactions, dizziness, and sedation are common during early therapy, particularly in patients on high doses and in the older adult receiving parenteral doses. Patients usually develop tolerance to these adverse effects; however, lower doses or longer intervals between doses may be required. Lab tests: Periodic CBC with differential, liver function tests, urinalysis, and blood glucose. Monitor cardiac status with baseline ECG in patients with preexisting cardiovascular disease. Be alert for signs of neuroleptic malignant syndrome (see Appendix G). Report immediately. Observe and record smoking since it increases metabolism of phenothiazines, resulting in shortened half-life and more rapid clearance of drug. Higher dosage in smokers may be required. Advise patient to stop or at least reduce smoking, if possible. Monitor I&O ratio and pattern: Urinary retention due to mental depression and compromised renal function may occur. If serum creatinine becomes elevated, therapy should be discontinued. Monitor for antiemetic effect of chlorpromazine, which may obscure signs of overdosage of other drugs or other causes of nausea and vomiting. Be alert to complaints of diminished visual acuity, reduced night vision, photophobia, and a perceived brownish discoloration of objects. Patient may be more comfortable with dark glasses. Monitor diabetics or prediabetics on long-term, high-dose therapy for reduced glucose tolerance and loss of diabetes control. Ocular examinations, and EEG (in patients >50 y) are recommended before and periodically during prolonged therapy. Patient & Family Education Take medication as prescribed and keep appointments for follow-up evaluation of dosage regimen. Improvement may not be experienced until 7 or 8 wk into therapy. Do not alter dosing regimen, and do not give the drug to another person. May cause pink to red-brown discoloration of urine. Wear protective clothing and sunscreen lotion with SPF above 12 when outdoors, even on dark days. Photosensitivity associated with chlorpromazine therapy is a phototoxic reaction. Severity of response depends on amount of exposure and drug dose. Exposed skin areas have appearance of an exaggerated sunburn. If reaction occurs, report to physician. Practice meticulous oral hygiene. Oral candidiasis occurs frequently in patients receiving phenothiazines. Report extrapyramidal symptoms that occur most often in patients on high dosage, the pediatric patient with severe dehydration and acute infection, the older adult, and women. Avoid driving a car or undertaking activities requiring precision and mental alertness until drug response is known. Do not abruptly stop this drug. Abrupt withdrawal of drug or deliberate dose skipping, especially after prolonged therapy with large doses, can cause onset of extrapyramidal symptoms (see Appendix F) and severe GI disturbances. When drug is to be discontinued, dosage must be tapered off gradually over a period of several weeks. Do not breast feed while taking this drug.