📘 Important for Psychiatric Nursing, Mental Health Nursing, Pharmacology Exams
🔰 Definition:
Antipsychotic drugs (also known as neuroleptics or major tranquilizers) are medications used to treat psychotic disorders, such as schizophrenia, bipolar disorder (manic phase), delusional disorder, and psychotic depression. ✅ They reduce hallucinations, delusions, thought disturbances, agitation, and aggression.
💊🧠 Extrapyramidal Symptoms (EPS) and Nursing Management
📘 Important for Psychiatric Nursing, Pharmacology, Mental Health & Staff Nurse Exams
🔰 What are Extrapyramidal Symptoms (EPS)?
EPS are a group of drug-induced movement disorders caused by dopamine blockade in the brain due to typical (first-generation) antipsychotic drugs like haloperidol, chlorpromazine, etc.
✅ EPS affect motor control and are reversible if detected early.
🧪 Cause:
Blockade of dopamine D2 receptors in the nigrostriatal pathway by typical antipsychotics
🧭 Types of Extrapyramidal Symptoms (EPS):
🟥 1. Acute Dystonia
Onset: Within hours to days Symptoms:
Sudden, painful muscle contractions
Twisting of neck (torticollis)
Eye deviation (oculogyric crisis)
Facial grimacing
🟧 2. Parkinsonism (Pseudoparkinsonism)
Onset: 5–30 days Symptoms:
Tremors (resting)
Bradykinesia (slow movement)
Mask-like face
Rigidity
Shuffling gait
🟨 3. Akathisia
Onset: 5–60 days Symptoms:
Inner restlessness
Unable to sit still
Pacing, tapping feet
Anxiety, agitation
🟩 4. Tardive Dyskinesia
Onset: Months to years Symptoms:
Irreversible involuntary movements
Lip-smacking, chewing motion
Tongue protrusion
Facial grimacing
Choreoathetoid limb movements
⚠️ Risk Factors:
Use of high-potency typical antipsychotics (e.g., Haloperidol)
High doses
Long duration of therapy
Elderly and females
History of EPS
👩⚕️ Nursing Management of EPS:
🟩 1. Early Identification and Monitoring
🔹 Observe for muscle stiffness, tremors, restlessness, involuntary movements 🔹 Use tools like AIMS scale (Abnormal Involuntary Movement Scale) for tardive dyskinesia 🔹 Monitor onset timing after antipsychotic administration
🟨 2. Notify the Physician Promptly
🔹 Report symptoms for dose adjustment or medication change 🔹 Do not stop medication abruptly
🟧 3. Administer Antiparkinsonian Medications as Prescribed
🔹 For dystonia and Parkinsonism:
Trihexyphenidyl
Benztropine 🔹 For akathisia:
Propranolol
Lorazepam or Clonazepam
🟥 4. Emotional Support and Patient Education
🔹 Reassure the patient that symptoms are drug-related and manageable 🔹 Educate about importance of reporting early signs 🔹 Inform patient not to self-stop medication
🟦 5. Prevention and Long-term Care
🔹 Use lowest effective dose 🔹 Prefer atypical antipsychotics in high-risk patients 🔹 Monitor regularly for signs of tardive dyskinesia
📚 Golden One-Liners for Revision:
🟨 EPS = motor side effects due to antipsychotics
🟨 Dystonia = acute muscle spasms
🟨 Akathisia = restlessness
🟨 Tardive dyskinesia = late onset, often irreversible
🟨 Trihexyphenidyl and benztropine = drugs to manage EPS
🟨 Nurse must monitor, report, support, and educate
💊⚠️ Antipsychotic Specific Drugs and Their Special Cautions
📘 Important for Mental Health Nursing, Pharmacology & Psychiatric Nursing Exams
🔰 Overview:
While all antipsychotic drugs carry risk of side effects, certain specific drugs have unique cautions related to serious adverse effects like agranulocytosis, metabolic syndrome, EPS, NMS, and QT prolongation.
🧭 Cautions for Commonly Used Antipsychotic Drugs:
🟥 1. Clozapine(Atypical)
Used for: Treatment-resistant schizophrenia Cautions:
Agranulocytosis (life-threatening ↓ WBC count)
Seizure risk
Myocarditis
Severe constipation → paralytic ileus
Weight gain and metabolic syndrome
Nursing Actions:
Do regular WBC/ANC monitoring (weekly for 18 weeks, then monthly)
Educate patient to report fever, sore throat, or infection
Monitor bowel movement, ECG, and weight
🟧 2. Risperidone(Atypical)
Used for: Schizophrenia, bipolar disorder Cautions:
Risk of EPS at high doses
Hyperprolactinemia → breast enlargement, galactorrhea
May cause orthostatic hypotension
Nursing Actions:
Monitor for signs of EPS (tremors, rigidity)
Teach slow position change to avoid falls
Monitor prolactin-related side effects
🟨 3. Olanzapine(Atypical)
Used for: Schizophrenia, mania Cautions:
High risk of weight gain, diabetes, and dyslipidemia
Sedation
Avoid in obese, diabetic, or hypertensive patients
Nursing Actions:
Monitor BMI, blood sugar, lipid profile
Encourage diet control and physical activity
Administer at bedtime if sedation is a problem
🟩 4. Haloperidol(Typical, high-potency)
Used for: Acute psychosis, agitation Cautions:
High risk of EPS (dystonia, Parkinsonism, akathisia)
Neuroleptic Malignant Syndrome (NMS)
QT prolongation → cardiac risk
Nursing Actions:
Watch for sudden muscle rigidity, fever (NMS)
Monitor ECG for QT prolongation
Administer anticholinergic (e.g., trihexyphenidyl) if EPS occurs
🟦 5. Quetiapine(Atypical)
Used for: Schizophrenia, bipolar disorder Cautions:
Causes sedation, dizziness
Risk of metabolic syndrome
May cause cataracts on long-term use
Nursing Actions:
Give at bedtime to reduce sedation complaints
Monitor weight, blood sugar, and lipid profile
Encourage regular eye check-ups
🟪 6. Aripiprazole(Atypical, partial D2 agonist)
Used for: Schizophrenia, bipolar disorder, depression adjunct Cautions:
Less metabolic risk, but may cause akathisia
Insomnia, anxiety, and agitation in some patients
Nursing Actions:
Monitor for restlessness and inability to sit still
📘 Important for Psychiatric Nursing, Pharmacology, Mental Health & Staff Nurse Competitive Exams
🔰 Definition:
Antidepressants are psychotropic drugs used to relieve symptoms of depression and other related mood disorders by modulating neurotransmitters like serotonin (5-HT), norepinephrine (NE), and dopamine (DA) in the brain.
🔹 Antidepressants may take 2–4 weeks to show effect 🔹 Do not stop suddenly – taper required 🔹 Avoid alcohol and other CNS depressants 🔹 MAOI users must avoid tyramine-rich food
🟧 3. Monitor for Side Effects and Adverse Reactions
🔹 Watch for serotonin syndrome 🔹 Report agitation, tremor, confusion, fever 🔹 For TCAs: monitor ECG, especially in elderly
🟥 4. Ensure Medication Adherence
🔹 Supervise medication in suicidal patients 🔹 Encourage regular follow-up and support
🟦 5. Psychological Support
🔹 Provide counseling or refer to therapist 🔹 Involve family in treatment plan
📚 Golden One-Liners for Quick Revision:
🟨 SSRIs are first-line antidepressants (safe, well-tolerated)
🟨 TCAs are older, cause sedation & cardiac risks
🟨 MAOIs need diet restrictions (no cheese, wine)
🟨 Antidepressants take 2–4 weeks to show effect
🟨 Monitor for suicidal behavior in initial treatment
✅ Top 5 MCQs for Practice:
Q1. Which antidepressant class is safest in overdose?
🅰️ TCA ✅ 🅱️ SSRI 🅲️ MAOI 🅳️ SNRI Correct Answer: 🅱️ SSRI Rationale: SSRIs have minimal cardiotoxicity and are safer in overdose.
Q2. Patient on MAOIs must avoid:
🅰️ Rice 🅱️ Apple ✅ 🅲️ Cheese and wine 🅳️ Bananas only Correct Answer: 🅲️ Cheese and wine Rationale: Tyramine-rich foods can cause hypertensive crisis.
Q4. A nurse should closely monitor for serotonin syndrome when:
🅰️ TCA is given with sedative ✅ 🅱️ SSRI is combined with MAOI 🅲️ MAOI is stopped early 🅳️ SSRI is stopped suddenly Correct Answer: 🅱️ SSRI is combined with MAOI
📘 Important for Psychiatric Nursing, Pharmacology & Mental Health Nursing Exams
🔰 Definition:
Anti-manic drugs or mood stabilizers are medications used to control acute manic episodes, prevent mood swings, and maintain emotional stability in conditions like bipolar disorder and mania.
✅ They stabilize mood by modulating neurotransmitters like dopamine, glutamate, and GABA.
🧭 Classification of Anti-Manic Drugs:
🟩 1. Lithium (Classic Mood Stabilizer)
First-line drug for acute mania and bipolar maintenance
Narrow therapeutic index
🟨 2. Anticonvulsants (Used as Mood Stabilizers)
Examples:
Valproic acid / Divalproex sodium
Carbamazepine
Lamotrigine
Oxcarbazepine
🟧 3. Atypical Antipsychotics with Mood-Stabilizing Properties
Examples:
Olanzapine
Risperidone
Quetiapine
Aripiprazole
Used for acute mania and bipolar depression, especially in combination with lithium or valproate.
Q5. What lab test should be monitored for a patient on carbamazepine?
🅰️ BUN 🅱️ Blood sugar ✅ 🅲️ CBC 🅳️ Serum amylase Correct Answer: 🅲️ CBC Rationale: To detect agranulocytosis or aplastic anemia
💊😟 Anti-Anxiety Drugs (Anxiolytics)
📘 Important for Psychiatric Nursing, Mental Health Nursing, Pharmacology & Staff Nurse Exams
🔰 Definition:
Anti-anxiety drugs, also called anxiolytics, are medications used to reduce or control symptoms of anxiety, such as restlessness, fear, tension, panic, and sleep disturbances.
✅ They are mainly used in generalized anxiety disorder (GAD), panic disorder, phobias, and acute anxiety states.
🧭 Classification of Anti-Anxiety Drugs:
🟥 1. Benzodiazepines (BZDs)
🧪 Enhance GABA neurotransmission → calming effect 🎯 Used for acute anxiety, insomnia, panic attacks
Q4. A nurse should avoid giving benzodiazepines with:
🅰️ Food ✅ 🅱️ Alcohol 🅲️ Water 🅳️ Fruit juice Correct Answer: 🅱️ Alcohol
Q5. Common side effect of SSRIs in anxiety treatment is:
🅰️ Seizures 🅱️ Mania ✅ 🅲️ Increased anxiety in initial days 🅳️ Hypertension Correct Answer: 🅲️ Increased anxiety in initial days
💊🧠 Anti-Parkinsonism Drugs
📘 Important for Mental Health Nursing, Pharmacology, Neurology & Staff Nurse Exams
🔰 Definition:
Anti-Parkinsonism drugs are medications used to treat symptoms of Parkinson’s disease or Parkinsonism caused by antipsychotic drugs (drug-induced Parkinsonism or extrapyramidal symptoms – EPS).
✅ These drugs work by restoring the balance between dopamine and acetylcholine in the brain.