Monitoring antipsychotics

Atypical antipsychotics Monitor for increased appetite with weight gain (primarily in patients with initial low or normal body mass index) monitor closely if rapid or significant weight gain... 

Antipsychotics are also used for mood stabilisation in acute mania or BPAD prophylaxis (e.g. aripiprazole, olanzapine, risperidone, quetiapine). They require the usual antipsychotic monitoring. Some offer IM options and none need drug levels, which can help when people are acutely uncooperative or chaotic. 

Weight, BMI PRN Needed for antipsychotic monitoring - do as soon as possible... 

Dosages in older adults are usually in the lower range. Because older adults are more susceptible to cardiovascular and neuromuscular reactions to the antipsychotic drugs the nurse must dosely monitor them. It is important to increase the dosages gradually. 

Describe the components of a monitoring plan to assess the effectiveness and safety of antipsychotic medications. 

TABLE 34-10. Monitoring Protocol for Patients on Second-Generation (Atypical) Antipsychotics... 

Rechallenge with the lowest effective dose of SGA may be considered only for patients in need of reinstitution of antipsychotics following observation for at least 2 weeks without antipsychotics. There must be careful monitoring and slow-dose titration. 

If the white blood cell (WBC) count is less than 3,000/mm3 or the absolute neutrophil count (ANC) is less than 1,000/mm3, the antipsychotic should be discontinued, and the WBC count monitored closely until it returns to normal. 

Cocaine and other CNS stimulants Monitor cardiac function Lorazepam 2-4 mg IM every 30 minutes to 6 hours as needed for agitation Haloperidol 2-5 mg (or other antipsychotic agent) every 30 minutes to 6 hours as needed for psychotic behavior B2 B3... 

Raggi MA. 2002. Therapeutic drug monitoring chemical-clinical correlations of atypical antipsychotic drugs. Curr Med Chem 9(14) 1397-1349. 

Atypical antipsychotics may be helpful in managing the delusions and agitated behavior that can accompany dementia. These medications, include risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and olanzapine (Zyprexa). All antipsychotics, typical and atypical, appear to increase the risk of death in patients with dementia and psychosis. This appears as a warning in the package inserts of the newer drugs. A prudent approach is to discuss this risk with the caregiver, use the lowest effective dose, and monitor for effectiveness. 

Carbamazepine is more widely used for treating chronically agitated dementia patients. Its onset of action is delayed by several days to a couple of weeks therefore, other tranquilizing medications such as antipsychotics may need to be used when first starting carbamazepine. Carbamazepine doses have problematic side effects that require blood monitoring, and it also interacts with many medications. 

Bromocriptine (Parl el) [Antiparkinsonian Agent/Dopamine Receptor Agonist] Uses Parkin on Dz, hyperprolactinemia, acromegaly, pituitary tumors Action Direct-acting on the striatal dopamine receptors X prolactin secretion Dose Initial, 1.25 mg PO bid titrate to effect, w/ food Caution [B, ] Contra Severe ischemic heart Dz or PVD Disp Tabs, caps SE X BP, Raynaud phenomenon (vasospastic disorder resulting in discoloration of the fmgers/toes), dizziness, N, hallucinations Interactions T Effects W/ erythromycin, fluvoxamine, nefazodone, sympathomimetics, antihypertensives X effects W/ phenothiazines, antipsychotics EMS Monitor BP may cause intolerance to EtOH OD May cause NA, severe hypotension give IV fluids symptomatic and supportive... 

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