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„ Drugs used to treat mania and psychosis ‹ May alter electrical activity of neurons ‹ Overexcitement of neurons in some part of brain and may be component of bipolar disorder ‹ Alteration in electrical activity explains some of the untoward and toxic effects of lithium lithium represents a potential threat to all body functions that are regulated by electrical activity ‹ Lithium has the lowest therapeutic index ‹ Therapeutic index— the ratio of lethal ‹ Blood level that can cause death is not far removed from effective level of drug which is true for lithium (Therapeutic window) ‹ Sodium and potassium play strong role in maintaining fluid balance and distribution of fluids in body compartments „ Lithium— prototypical antimanic drug „ Effective in 90% of clients with pure manic episodes and protect against future depressive episodes „ Most effective in reducing symptoms of: ‹ Distractibility; difficulty concentrating ‹ Many conditions can move patient from ‹ What is therapeutic for one patient may „ Advanced signs of toxicity 1.5-2.0 mEq/L „ Drink 6-8 glasses H2O daily (1500-3000ml) „ Do not restrict sodium—4-5 Gms daily „ Avoid excessive use of caffeine and colas „ Driving and heavy machinery with caution „ Avoid activities that cause sodium depletion „ Lithium levels should be drawn 8-12 hours ‹ Block dopamine (DA) receptors in basal ‹ DA regulates & inhibits prolactin release receptors, acetylcholine and nor-epinephrine (NE) ‹ Results in antiparasympathetic effects ‹ Reduce violent and aggressive behavior Acute Dystonic Reactions„ Occur early in TX„ Involuntary ms.—posture, gait, ocular movements„ Oculogyric crisis: eyes roll upward„ Torticollis: contracted cervical ms. produce neck „ Laryngeal-pharyngeal dystonias: assoc. w/gagging,cyanosis, resp. distress & asphyxia ‹ Life-threatening—immediate intervention ‹ All dystonic conditions respond to IM ‹ Subjective & objective restlessness ‹ Anticholinergic agents—Artane & Cogentin ‹ Benzodiazepines (BZDs)—Ativan, Valium, ‹ Lack spontaneity in movement or speech ‹ May continue when drug is discontinued ‹ Abnormal involuntary movements of face,  Lip smacking, teeth grinding, tongue rolling or protrusion, tics &diaphragmatic movements which may impair breathing „ Hypotension & orthostatic hypotension „ Cardinal symptoms„ Mental changes„ Rigidity (Lead pipe)„ Hyperthermia (up to 108F)„ Diaphoresis„ Tachypnea„ Autonomic Dysfunction Hypotension, tachycardia, sweating, salivation, ‹ Agitation, hyperreflexia, impaired breathing, „ Treat both positive and negative signs and „ Improved quality of life r/t improved social Clozapine (Clozaril) side effects cont.
‹ Seizures 3% incidence related to dosage „ Dosages of 6mg/day are associated with „ Dosages of 10mg/day are associated with „ Other side effects similar but milder than „ trihexphenidyl (Artane) abuse potential due mg. IM (Note well: This protocol is different than what is stated in Varcarolis) „ Patients with schizophrenia who have existing cardiac disease should have a thorough cardiac work-up periodically. Drug of choice of major antipsychotics is haloperidol (Haldol) because of its low anticholinergic properties. Preferred treatment is with atypical antipsychotics.
„ Patient taking traditional neuroleptics need „ Atypical Antipsychotics:„ Disadvantages: ‹ All but ziprasidone (Geodon) and aripiprazole ‹ Result in poor self-esteem and noncompliance „ For patients who tend to cheek their meds many of the major antipsychotics and atypical antipsychotics are available in liquid form. A drug of choice is olanzepine (Zyprexa Zydis). A new injectable form of resperadone (Resperdal) is Resperadone Consta.

Source: http://www.ccri.edu/nursing/pdfs/2040antipsych-fk.pdf