14.1 The Impact of Nutrition on Pulmonary Wellness Across the Lifespan

Antipsychotics are powerful medications that help manage psychotic disorders like schizophrenia. They work by blocking dopamine receptors in the brain, reducing symptoms like hallucinations and delusions. These drugs come in two main types: first-generation and second-generation.

Nurses play a crucial role in administering antipsychotics and monitoring patients. They assess mental status, watch for side effects, and educate patients on proper use. Understanding these medications is key for providing effective care and supporting patients' recovery.

Antipsychotic Medications

Key features of antipsychotic medications

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• Treat psychotic disorders including schizophrenia and bipolar disorder by reducing symptoms such as hallucinations, delusions, and disordered thinking
• Act on dopamine receptors in the brain, specifically as antagonists at D2 receptors, which reduces dopaminergic neurotransmission in the mesolimbic pathway associated with psychotic symptoms
• Classified into two main categories: first-generation (typical) antipsychotics (haloperidol, chlorpromazine) and second-generation (atypical) antipsychotics (risperidone, olanzapine)
• Some antipsychotics have additional mechanisms of action, including antagonism at serotonin 5-HT2A receptors, histamine H1 receptors, and muscarinic acetylcholine receptors, which can contribute to their therapeutic effects and side effect profiles
• Antipsychotics primarily work through receptor antagonism, particularly on neurotransmitters like dopamine and serotonin

First vs second-generation antipsychotics

• First-generation antipsychotics (FGAs) like haloperidol and chlorpromazine primarily act on D2 receptors and are effective in treating positive symptoms of schizophrenia such as hallucinations and delusions
  • FGAs have a higher risk of extrapyramidal side effects (EPS) including Parkinsonism, dystonia, akathisia, and tardive dyskinesia due to their strong D2 receptor antagonism
• Second-generation antipsychotics (SGAs) like risperidone, olanzapine, quetiapine, and aripiprazole act on multiple receptors (D2, 5-HT2A, H1, muscarinic) and are effective in treating both positive and negative symptoms of schizophrenia
  • SGAs have a lower risk of EPS compared to FGAs but a higher risk of metabolic side effects such as weight gain, dyslipidemia, hyperglycemia, and diabetes mellitus due to their effects on multiple receptor types
• Both FGAs and SGAs exhibit antidopaminergic effects, which are crucial for their therapeutic action

Symptom Management and Monitoring

• Antipsychotics are effective in managing positive symptoms (e.g., hallucinations, delusions) and negative symptoms (e.g., social withdrawal, lack of motivation) of schizophrenia
• Regular therapeutic drug monitoring is essential to ensure optimal dosing and minimize side effects
• Patients should be monitored for the development of metabolic syndrome, a cluster of conditions including increased blood pressure, high blood sugar, excess body fat, and abnormal cholesterol levels

Nursing considerations for antipsychotics

• Assess the patient's mental status and behavior before administering antipsychotics to establish a baseline and monitor for changes
• Monitor vital signs, especially blood pressure and heart rate, as antipsychotics can cause orthostatic hypotension and tachycardia
• Administer the medication as prescribed, ensuring the correct dose, route, and frequency to optimize therapeutic effects and minimize side effects
• Observe for side effects, including EPS (muscle rigidity, tremor, restlessness), metabolic changes (weight gain, increased appetite, fatigue), and anticholinergic effects (dry mouth, constipation, urinary retention)
• Assess the patient's response to the medication, looking for improvement in psychotic symptoms and the ability to perform daily activities and engage in therapy
• Collaborate with the healthcare team to adjust the medication regimen as needed based on the patient's response and side effects, ensuring optimal treatment outcomes

Patient education for antipsychotic use

• Explain the purpose and expected benefits of the antipsychotic medication, emphasizing the importance of consistent use for symptom management and improved quality of life
• Discuss potential side effects and how to manage them, including the importance of regular monitoring (blood glucose, lipids, weight), strategies to minimize weight gain (healthy diet, regular exercise), and reporting any new or worsening side effects to the healthcare team
• Emphasize the importance of adherence to the prescribed regimen, taking the medication consistently even when feeling better, and not stopping the medication without consulting the prescriber to prevent relapse and maintain treatment efficacy
• Encourage open communication with the healthcare team, discussing concerns, questions, or challenges related to the medication, and attending regular follow-up appointments to ensure optimal treatment and monitoring
• Provide resources for additional support, such as mental health support groups and educational materials on the disorder and its treatment, to empower patients and promote self-management and recovery