- Body system
- Mental health
- Name stem
- -apine, -idone, -azine
- Drug cards
- 3 in this guide
Drugs in this class
- HaloperidolHaldol, Haldol Decanoate
- RisperidoneRisperdal, Risperdal Consta, Perseris, Uzedy, Rykindo
- ClozapineClozaril, Versacloz
Other examples: Olanzapine, Quetiapine, Aripiprazole, Ziprasidone, Chlorpromazine, Fluphenazine, Lurasidone.
How antipsychotics work
Block dopamine D2 receptors; second-generation drugs also block serotonin 5-HT2A receptors.
Uses
- Schizophrenia
- Bipolar mania
- Treatment-resistant depression (add-on)
- Acute agitation and delirium
Adverse effects
- Extrapyramidal symptoms: acute dystonia, akathisia, parkinsonism
- Tardive dyskinesia
- Metabolic syndrome: weight gain, hyperglycemia, dyslipidemia
- Orthostatic hypotension and sedation
- QT prolongation
- Neuroleptic malignant syndrome
- Agranulocytosis (clozapine)
Nursing considerations
- Neuroleptic malignant syndrome: high fever, severe muscle rigidity, altered mental status and unstable vital signs. Stop the drug and notify the provider immediately.
- Screen for tardive dyskinesia (AIMS) and monitor weight, glucose and lipids.
- Treat acute dystonia promptly with benztropine or diphenhydramine as ordered.
Patient teaching
- Rise slowly and avoid overheating.
- Report fever, stiffness or unusual movements.
- Healthy diet and activity help limit weight gain.
Antipsychotics NCLEX practice questions
Answer each question to see the rationale.
3 questions. Choose an answer to see the rationale.
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A patient on haloperidol has a temperature of 104°F (40°C), rigid muscles and confusion. What does the nurse suspect?
Show answer
Answer D: Neuroleptic malignant syndrome Hyperthermia, lead-pipe rigidity, altered mental status and autonomic instability are the hallmarks of neuroleptic malignant syndrome.
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Which monitoring is most important for a patient starting olanzapine?
Show answer
Answer B: Weight, blood glucose and lipids Second-generation antipsychotics, especially olanzapine and clozapine, cause weight gain and metabolic syndrome.
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A patient on clozapine reports a sore throat and fever. What is the priority?
Show answer
Answer B: Notify the provider and check the absolute neutrophil count Clozapine can cause severe neutropenia; signs of infection require an urgent ANC.
Frequently asked questions
What are antipsychotics?
Antipsychotics treat schizophrenia, bipolar disorder and agitation. First-generation drugs cause more movement disorders; second-generation drugs cause more metabolic effects. Neuroleptic malignant syndrome is the emergency to recognize.
How do antipsychotics work?
Block dopamine D2 receptors; second-generation drugs also block serotonin 5-HT2A receptors.
What are examples of antipsychotics?
Haloperidol, Risperidone, Clozapine, Olanzapine, Quetiapine, Aripiprazole, Ziprasidone and Chlorpromazine.
What are the nursing considerations for antipsychotics?
Neuroleptic malignant syndrome: high fever, severe muscle rigidity, altered mental status and unstable vital signs. Stop the drug and notify the provider immediately. Screen for tardive dyskinesia (AIMS) and monitor weight, glucose and lipids.