1.

Side effects and nursing implications of the following stabilizing agents:

1.3 Antipsychotics
OLANZAPINE
(Zyprexa)
Side effects
CNS: Somnolence, dizziness, nervousness, headache, akathisia, personality disorders,
tardive dyskinesia, neuroleptic malignant syndrome
CV: Orthostatic hypotension, peripheral edema, tachycardia
GI: Constipation, abdominal pain
Respiratory: Cough, pharyngitis
Other: Fever, weight gain, joint pain
ASSESSMENT
History: Allergy to olanzapine, myeloproliferative disorders, severe CNS depression,
comatose states, history of seizure disorders, lactation; CV or cerebrovascular disease,
dehydration, Alzheimer's disease, prostate enlargement, narrow-angle glaucoma, history of
paralytic ileus or breast cancer, elderly or debilitated patients, pregnancy
Physical: T, weight; reflexes, orientation, intraocular pressure, ophthalmologic exam; P, BP,
orthostatic BP, ECG; R, adventitious sounds; bowel sounds, normal output, liver evaluation;
prostate palpation, normal urine output; CBC, urinalysis, liver and renal function tests

INTERVENTIONS
Do not dispense more than 1-wk supply at a time.
Peel back foil on blister pack of disintegrating tablets; do not push through foil; use dry hands
to remove tablet and place in mouth.
Monitor for the many possible drugdrug interactions before beginning therapy.
Monitor elderly patients for dehydration and institute remedial measures promptly; sedation
and decreased sensation of thirst related to CNS effects of drug can lead to dehydration.
Encourage patient to void before taking the drug to help decrease anticholinergic effects of
urinary retention.
Monitor for elevations of temperature and differentiate between infection and neuroleptic
malignant syndrome.
Monitor for orthostatic hypotension and provide appropriate safety measures as needed.

TEACHING POINTS
Take this drug exactly as prescribed; do not change dose without consulting your health care
provider.
Peel back foil on blister pack of disintegrating tablets; do not push through foil; use dry hands
to remove tablet, place entire tablet in mouth.
These side effects may occur: drowsiness, dizziness, sedation, seizures (avoid driving,
operating machinery, or performing tasks that require concentration); dizziness, faintness on
arising (change positions slowly, use caution); increased salivation (if bothersome, contact your
nurse or physician); constipation (consult with your nurse of physician for appropriate relief
measures); fast heart rate (rest and take your time if this occurs).
This drug cannot be taken during pregnancy. If you think you are pregnant or wish to become
pregnant, contact your nurse or physician.
Report lethargy, weakness, fever, sore throat, malaise, mouth ulcers, and flulike symptoms.

ARIRIPIPRAZOLE
(Abilify)
Side effects
CNS: headache, anxiety, insomnia, lightheadedness, somnolence, tremor, asthenia, tardive
dyskinesia, blurred vision, seizures (potentially life-threatening), akathisia
CV: orthostatic hypotension
Dermatologic: rash
GI: nausea, vomiting, constipation, diarrhea, abdominal pain, esophageal dysmotility
Respiratory: rhinitis, cough
Other: fever, neuroleptic malignant syndrome, increased suicide risk
NURSING IMPLICATIONS
Assessment & Drug Effects
Monitor diabetics for loss of glycemic control.
Monitor cardiovascular status. Assess for and report orthostatic hypotension. Take BP
supine then in sitting position. Report systolic drop of >1520 mm Hg. Patients at
increased risk are those who are dehydrated, hypovolemic, or receiving concurrent
antihypertensive therapy.
Monitor body temperature in situations likely to elevate core temperature (e.g., exercising
strenuously, exposure to extreme heat, receiving drugs with anticholinergic activity, or
being subject to dehydration).
Monitor for and report signs of tardive dyskinesia.
Monitor for and immediately report S&S of neuroleptic malignant syndrome (NMS) that
include: hyperpyrexia, muscle rigidity, altered mental status, irregular pulse or blood
pressure, tachycardia, diaphoresis, and cardiac dysrhythmia. Withhold drug if NMS is
suspected.
Lab tests: Monitor periodically Hct & Hgb. Monitor periodically blood glucose. Monitor
for elevated CPK and myoglobinuria if NMS is suspected.

Patient & Family Education
Carefully monitor blood glucose levels if diabetic.
Do not drive or engage in other potentially hazardous activities until reaction to drug is
known.
Avoid situations where you are likely to become overheated or dehydrated.
Notify physician if you become pregnant or intend to become pregnant while taking this
drug.
Do not breast feed while taking this drug.

CHLORPROMAZINE
(Thorazine)
Side effects
CNS: Drowsiness, insomnia, vertigo, headache, weakness, tremors, ataxia, slurring,
cerebral edema, seizures, exacerbation of psychotic symptoms, extrapyramidal
syndromes, neuroleptic malignant syndrome
GI: Dry mouth, salivation, nausea, vomiting, anorexia, constipation, paralytic ileus,
incontinence
CV: Hypotension, otrhostatic hypotension, hypertension, tachycardia, bradycardia,
cardiac arrest, CHF, cardiomegaly, refractory arrhythmias, pulmonary edema
Respiratory: Bronchospasm, laryngospasm, dyspnea, suppression of cough reflex and
potential aspiration
Hematologic: Eosinophilia, leukopenia, leukocytosis, anemia, aplastic anemia, hemolytic
anemia, thrombocytopenic or nonthrombocytopenic purpura, pancytopenia, elevated
serum cholesterol
GU: Urinary retention, polyuria, incontinence, priapism, ejaculation inhibition, male
impotence, urine discolored pink to red-brown
EENT: Nasal congestion, glaucoma, photophobia, blurred vision, miosis, mydriasis,
deposits in the cornea and lens, pigmentary retinopathy
Hypersensitivity: Jaundice, urticaria, angioneurotic edema, laryngeal edema,
photosensitivity, eczema, asthma, anaphylactoid reactions, exfoliative dermatitis, contact
dermatitis
Endocrine: Lactation, breast engorgement in females, galactorrhea, syndrome of
inappropriate ADH secretion, amenorrhea, menstrual irregularities, gynecomastia,
changes in libido, hyperglycemia, inhibition of ovulation, infertility, pseudopregnancy,
reduced urinary levels of gonadotropins, estrogens and progestins
Other: Fever, heat stroke, pallor, flushed facies, sweating, photosensitivity
Assessment & Drug Effects
Establish baseline BP (in standing and recumbent positions), and pulse, before initiating
treatment.
Monitor BP frequently. Hypotensive reactions, dizziness, and sedation are common
during early therapy, particularly in patients on high doses and in the older adult
receiving parenteral doses. Patients usually develop tolerance to these adverse effects;
however, lower doses or longer intervals between doses may be required.
Lab tests: Periodic CBC with differential, liver function tests, urinalysis, and blood
glucose.
Monitor cardiac status with baseline ECG in patients with preexisting cardiovascular
disease.
Be alert for signs of neuroleptic malignant syndrome (see Appendix G). Report
immediately.
Observe and record smoking since it increases metabolism of phenothiazines, resulting in
shortened half-life and more rapid clearance of drug. Higher dosage in smokers may be
required. Advise patient to stop or at least reduce smoking, if possible.
Monitor I&O ratio and pattern: Urinary retention due to mental depression and
compromised renal function may occur. If serum creatinine becomes elevated, therapy
should be discontinued.
Monitor for antiemetic effect of chlorpromazine, which may obscure signs of overdosage
of other drugs or other causes of nausea and vomiting.
Be alert to complaints of diminished visual acuity, reduced night vision, photophobia,
and a perceived brownish discoloration of objects. Patient may be more comfortable with
dark glasses.
Monitor diabetics or prediabetics on long-term, high-dose therapy for reduced glucose
tolerance and loss of diabetes control.
Ocular examinations, and EEG (in patients >50 y) are recommended before and
periodically during prolonged therapy.
Patient & Family Education
Take medication as prescribed and keep appointments for follow-up evaluation of dosage
regimen. Improvement may not be experienced until 7 or 8 wk into therapy.
Do not alter dosing regimen, and do not give the drug to another person.
May cause pink to red-brown discoloration of urine.
Wear protective clothing and sunscreen lotion with SPF above 12 when outdoors, even
on dark days. Photosensitivity associated with chlorpromazine therapy is a phototoxic
reaction. Severity of response depends on amount of exposure and drug dose. Exposed
skin areas have appearance of an exaggerated sunburn. If reaction occurs, report to
physician.
Practice meticulous oral hygiene. Oral candidiasis occurs frequently in patients receiving
phenothiazines.
Report extrapyramidal symptoms that occur most often in patients on high dosage, the
pediatric patient with severe dehydration and acute infection, the older adult, and women.
Avoid driving a car or undertaking activities requiring precision and mental alertness
until drug response is known.
Do not abruptly stop this drug. Abrupt withdrawal of drug or deliberate dose skipping,
especially after prolonged therapy with large doses, can cause onset of extrapyramidal
symptoms (see Appendix F) and severe GI disturbances. When drug is to be
discontinued, dosage must be tapered off gradually over a period of several weeks.
Do not breast feed while taking this drug.