성장을 멈추지 마세요

체험은 만족하셨나요?

현재 45,766명이 마이메르시로 공부 중이에요

지식 자료를 소장하고 멋진 의료인으로 성장하세요

학습 자료 둘러보기 →
Antipsychotic Medications | 마이메르시 MyMerci
제안하기

뭔가 하고 싶은 말이 있는거야?

0 / 2000
컨텐츠 수정하기

컨텐츠 내용을 수정할 수 있습니다

수정하기
닫기

Antipsychotic Medications

NCLEX Review Guide: Psychiatric Medications - Antipsychotics

Antipsychotic Classifications

Typical (First-Generation) Antipsychotics

  • First-generation antipsychotics work primarily by blocking dopamine D2 receptors in the brain, which helps control psychotic symptoms but often leads to extrapyramidal side effects.
  • Common medications include haloperidol (Haldol), chlorpromazine (Thorazine), fluphenazine (Prolixin), and thioridazine (Mellaril).

Key Points

  • Higher incidence of extrapyramidal symptoms (EPS) compared to atypical antipsychotics
  • More likely to cause tardive dyskinesia with long-term use
  • Generally less expensive than atypical antipsychotics

Atypical (Second-Generation) Antipsychotics

  • Second-generation antipsychotics block both dopamine D2 receptors and serotonin 5-HT2A receptors, providing efficacy against positive and negative symptoms with reduced extrapyramidal effects.
  • Common medications include risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and clozapine (Clozaril).

Key Points

  • Lower risk of extrapyramidal symptoms than typical antipsychotics
  • Higher risk of metabolic side effects (weight gain, diabetes, hyperlipidemia)
  • Clozapine requires regular monitoring of white blood cell count due to risk of agranulocytosis

Comparison: Typical vs. Atypical Antipsychotics

Feature Typical (First-Generation) Atypical (Second-Generation)
Primary Mechanism D2 receptor blockade D2 and 5-HT2A receptor blockade
EPS Risk High Low to moderate
Tardive Dyskinesia Risk Higher Lower
Metabolic Effects Lower Higher (weight gain, diabetes)
Efficacy for Negative Symptoms Limited Better
Cost Generally less expensive Generally more expensive

Indications & Therapeutic Uses

Primary Indications

  • Antipsychotics are primarily indicated for the treatment of schizophrenia, schizoaffective disorder, and psychotic symptoms associated with other mental health conditions.
  • Some antipsychotics are approved for bipolar disorder (both manic and depressive phases), treatment-resistant depression, and Tourette's syndrome.

Key Points

  • Effective for positive symptoms (hallucinations, delusions, thought disorders)
  • Atypical antipsychotics may be more effective for negative symptoms (apathy, social withdrawal)
  • Some antipsychotics have FDA approval for adjunctive treatment of major depressive disorder

Off-Label Uses

  • Antipsychotics are sometimes used off-label for severe anxiety disorders, agitation in dementia, delirium, and severe behavioral problems in children and adolescents.
  • Low-dose quetiapine is sometimes prescribed off-label for insomnia, though this practice is controversial due to side effect risks.

Antipsychotics used in elderly patients with dementia-related psychosis increase risk of death. These medications have a black box warning for this population.

Side Effects & Adverse Reactions

Extrapyramidal Symptoms (EPS)

  • Acute dystonia: Involuntary muscle contractions, often affecting the neck, tongue, or eyes, typically occurring within hours to days of starting treatment or increasing dosage.
  • Akathisia: Subjective feeling of inner restlessness, manifesting as inability to sit still, pacing, or rocking, usually occurring within days to weeks of treatment.
  • Parkinsonism: Symptoms resembling Parkinson's disease including tremor, rigidity, bradykinesia, and masked facies, typically appearing within weeks to months.
  • Tardive dyskinesia: Late-onset involuntary movements, particularly of the face, mouth, and tongue, which may be irreversible and typically develops after months to years of treatment.

Key Points

  • EPS is more common with high-potency typical antipsychotics (e.g., haloperidol)
  • Anticholinergic medications (benztropine, trihexyphenidyl) can be used to treat acute EPS
  • Beta-blockers or benzodiazepines may help manage akathisia

Metabolic Side Effects

  • Atypical antipsychotics, particularly clozapine and olanzapine, can cause significant weight gain, hyperglycemia, and dyslipidemia, increasing cardiovascular risk.
  • Regular monitoring of weight, blood glucose, and lipid profiles is essential for patients on atypical antipsychotics, with baseline measurements obtained before initiating therapy.

Key Points

  • Risk of metabolic effects varies: clozapine/olanzapine (highest) > quetiapine/risperidone > ziprasidone/aripiprazole (lowest)
  • Patient education about diet, exercise, and monitoring is essential
  • Consider medication switch if severe metabolic effects occur

Other Significant Side Effects

  • Neuroleptic Malignant Syndrome (NMS): A rare but potentially fatal reaction characterized by hyperthermia, muscle rigidity, altered mental status, and autonomic instability requiring immediate discontinuation and supportive care.
  • QT prolongation: Several antipsychotics (especially ziprasidone, thioridazine) can prolong the QT interval, potentially leading to life-threatening arrhythmias.
  • Hyperprolactinemia: Elevated prolactin levels can cause galactorrhea, amenorrhea, gynecomastia, and sexual dysfunction, more common with typical antipsychotics and risperidone.
  • Anticholinergic effects: Dry mouth, constipation, urinary retention, blurred vision, and cognitive impairment, particularly with low-potency typical antipsychotics like chlorpromazine.

Neuroleptic Malignant Syndrome is a medical emergency requiring immediate discontinuation of the antipsychotic, intensive supportive care, and possibly dantrolene or bromocriptine.

Nursing Considerations

Assessment & Monitoring

  • Perform baseline assessments including vital signs, weight, waist circumference, fasting blood glucose, lipid panel, and ECG (for medications with QT prolongation risk) before initiating therapy.
  • Monitor for therapeutic effects and adverse reactions, with special attention to EPS, metabolic changes, and cardiac effects during follow-up visits.

AIMS Monitoring

Remember the Abnormal Involuntary Movement Scale (AIMS) for assessing tardive dyskinesia:

  • Facial and oral movements
  • Extremity movements
  • Trunk movements
  • Global judgments

Conduct AIMS assessment regularly for patients on long-term antipsychotic therapy.

Patient Education

  • Educate patients about the importance of medication adherence, expected therapeutic effects, potential side effects, and the typically delayed onset of full therapeutic benefit (2-6 weeks).
  • Instruct patients to report concerning symptoms immediately, particularly severe muscle stiffness, high fever, confusion, irregular heartbeat, or suicidal thoughts.

Key Points

  • Emphasize that abrupt discontinuation can cause withdrawal symptoms or psychotic relapse
  • Advise about lifestyle modifications to minimize metabolic effects
  • Educate about avoiding alcohol and other CNS depressants

Administration Considerations

  1. Verify medication order, including drug, dose, route, and timing.
  2. Assess patient's current mental status and vital signs before administration.
  3. For oral medications, ensure patient actually swallows the medication (check for "cheeking").
  4. For IM injections, follow proper injection technique and observe patient afterward.
  5. For long-acting injectable (LAI) antipsychotics, verify appropriate intervals between doses.
  6. Document administration and patient response.

For IM administration of olanzapine (Zyprexa), observe for at least 3 hours for signs of post-injection delirium/sedation syndrome, which can resemble an overdose.

Clinical Scenario: Managing Antipsychotic Side Effects

A 32-year-old patient with schizophrenia reports feeling "jittery" and unable to sit still after starting haloperidol 5 mg twice daily three days ago. On assessment, the patient appears restless, constantly shifting position, and pacing. Vital signs are within normal limits.

Nursing Considerations:

  • Recognize symptoms as akathisia, a common EPS side effect of haloperidol
  • Contact prescriber to report symptoms and discuss potential interventions (dose reduction, addition of beta-blocker, or switch to atypical antipsychotic)
  • Reassure patient that symptoms can be managed and are not unusual
  • Document assessment findings and interventions

Commonly Confused Points

Differentiating Types of EPS

EPS Type Timing Symptoms Management
Acute Dystonia Hours to days Muscle spasms, oculogyric crisis, torticollis IM/IV anticholinergics (benztropine)
Akathisia Days to weeks Restlessness, inability to sit still Beta-blockers, benzodiazepines, dose reduction
Parkinsonism Weeks to months Tremor, rigidity, bradykinesia Oral anticholinergics, dose reduction
Tardive Dyskinesia Months to years Orofacial movements, choreiform movements Prevention, switch to atypical, VMAT2 inhibitors

Key Points

  • Timing of onset helps differentiate between types of EPS
  • Tardive dyskinesia is the most concerning due to potential irreversibility
  • Early recognition and intervention is essential

Antipsychotics vs. Anxiolytics

Feature Antipsychotics Anxiolytics (Benzodiazepines)
Primary Indication Psychotic disorders, bipolar disorder Anxiety disorders, insomnia
Mechanism Dopamine/serotonin receptor blockade GABA enhancement
Onset of Action Full effect: 2-6 weeks Rapid: minutes to hours
Key Side Effects EPS, metabolic effects Sedation, dependence, respiratory depression
Abuse Potential Low High

Key Points

  • Antipsychotics are not first-line for anxiety disorders despite sedating effects
  • Benzodiazepines may worsen symptoms in psychotic disorders
  • Both may be used together during acute psychotic agitation

NMS vs. Serotonin Syndrome

Feature Neuroleptic Malignant Syndrome Serotonin Syndrome
Causative Agents Antipsychotics SSRIs, SNRIs, MAOIs, other serotonergic drugs
Onset Gradual (1-3 days) Rapid (hours)
Temperature Severe hyperthermia (>40°C) Mild to moderate fever
Muscle Findings Lead-pipe rigidity Hyperreflexia, clonus, tremor
Treatment Dantrolene, bromocriptine Cyproheptadine, benzodiazepines

Both NMS and Serotonin Syndrome are medical emergencies requiring immediate discontinuation of causative agents and supportive care. Mortality is higher with untreated NMS.

Study Tips

Memory Aids for Antipsychotics

Typical vs. Atypical Antipsychotics

Remember "DANCE" for what typical antipsychotics cause more than atypicals:

  • Dystonia
  • Akathisia
  • Neuroleptic malignant syndrome
  • Cognitive effects (anticholinergic)
  • Endocrine effects (prolactin elevation)

Atypical Antipsychotics and Metabolic Risk

Remember "COZQ" for metabolic risk from highest to lowest:

  • Clozapine (highest risk)
  • Olanzapine
  • Ziprasidone/risperidone/quetiapine (middle risk)
  • aripiprazole/lurasidone (lowest risk)

Monitoring for Clozapine

Remember "ABCS" for clozapine monitoring:

  • Agranulocytosis (WBC monitoring)
  • Blood pressure (orthostatic hypotension)
  • Cardiac effects (myocarditis)
  • Seizures (lower seizure threshold)

NCLEX Practice Strategies

  • Focus on patient safety, monitoring parameters, and nursing interventions rather than memorizing specific medications and doses.
  • Practice questions involving prioritization of care for patients experiencing antipsychotic side effects, especially those requiring immediate intervention (NMS, severe dystonia).

Key Points

  • Know the major side effect profiles and monitoring requirements for each class
  • Understand patient education priorities for antipsychotic therapy
  • Be familiar with emergency interventions for serious adverse effects

Quick Check Questions

1. Which antipsychotic requires regular WBC monitoring due to risk of agranulocytosis?

2. What is the most appropriate initial nursing intervention for a patient experiencing acute dystonic reaction?

3. Which metabolic parameters should be monitored in patients taking atypical antipsychotics?

4. What is the cardinal symptom of akathisia?

5. Which antipsychotic side effect is characterized by involuntary movements of the face and tongue that may be irreversible?

Common NCLEX Pitfalls

  • Confusing the timing and presentation of different types of EPS
  • Not recognizing the symptoms of NMS as a medical emergency
  • Overlooking the importance of metabolic monitoring with atypical antipsychotics
  • Misunderstanding the appropriate nursing interventions for antipsychotic side effects

Summary of Key Points

  • Antipsychotics are divided into two main classes: typical (first-generation) and atypical (second-generation), with different receptor profiles and side effect patterns.
  • Typical antipsychotics primarily block dopamine D2 receptors and are associated with higher rates of EPS, while atypical antipsychotics affect both dopamine and serotonin receptors and have higher metabolic risks.
  • Major side effects include extrapyramidal symptoms (acute dystonia, akathisia, parkinsonism, tardive dyskinesia), metabolic effects, neuroleptic malignant syndrome, and QT prolongation.
  • Nursing considerations include comprehensive assessment, careful monitoring, thorough patient education, and vigilance for adverse effects requiring intervention.
  • Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia but requires special monitoring due to risk of agranulocytosis.

Self-Assessment Checklist








Remember that antipsychotic medications are powerful tools that require careful nursing assessment, monitoring, and patient education. Your understanding of these medications and their effects can significantly impact patient safety and treatment outcomes. Stay vigilant for side effects and always prioritize patient education to promote medication adherence and therapeutic success.

다음 이론을 계속 학습하려면 로그인하세요.

로그인하고 계속 학습
컨텐츠를 그만볼래?

필기노트, 하이라이터, 메모는 잘 쓰고 있어?

내보내줘
어떤 폴더에 저장할래?

컨텐츠 노트에는 총 0개의 폴더가 있어!

폴더 만들기
컨텐츠 만들기
만들기
신고했어요.

운영진이 검토할게요!

해당 유저를 차단했어요.

마이페이지에서 차단한 회원을 관리할 수 있어요.