Psych medication questions are mostly about safety: spotting dangerous side effects early and teaching clients what to avoid.
Antipsychotics
First-generation drugs like haloperidol cause more movement side effects. Second-generation drugs like olanzapine, quetiapine, and risperidone cause more weight gain and diabetes.
| Side effect | What it looks like | When | What to do |
|---|---|---|---|
| Acute dystonia | Sudden muscle spasms, twisted neck, eyes rolled up | Hours to days | Give benztropine or diphenhydramine as ordered. Watch the airway |
| Akathisia | Can't sit still, pacing, restless | Days to weeks | Report it. Often mistaken for anxiety |
| Pseudoparkinsonism | Tremor, shuffling walk, stiffness | Weeks | Report it. Anticholinergics may help |
| Tardive dyskinesia | Lip smacking, tongue thrusting, facial grimacing | Months to years | Report it. It may be permanent. Screen with the AIMS scale |
Neuroleptic malignant syndrome (NMS)
A rare emergency. Signs: high fever, rigid "lead pipe" muscles, confusion, and unstable vital signs, plus a high CK. Stop the antipsychotic, notify the provider right away, and cool the client. Dantrolene or bromocriptine may be ordered.
Clozapine
Can cause a dangerous drop in white blood cells (agranulocytosis). Absolute neutrophil count (ANC) is monitored regularly. Teach clients to report a sore throat or fever right away.
Lithium
- Therapeutic level: about 0.6 to 1.2 mEq/L. Above 1.5 is toxic.
- Early toxicity: nausea, vomiting, diarrhea, and a coarse tremor. Severe toxicity causes confusion and seizures.
- Keep salt and fluid intake consistent. Dehydration, NSAIDs, and some diuretics raise the level.
SSRIs and serotonin syndrome
- SSRIs take 2 to 6 weeks to work. Suicide risk can rise early in treatment, as energy returns before mood lifts.
- Serotonin syndrome: agitation, fever, sweating, fast heart rate, tremor, muscle twitching, and diarrhea. Usually from combining serotonin drugs. Stop the drug and report it.
MAOIs
Avoid foods high in tyramine: aged cheese, cured or smoked meats, tap beer, soy sauce, and sauerkraut. They can cause a hypertensive crisis, with a severe headache and stiff neck.
See the full drug guide for more.
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Quick answers
What are the signs of neuroleptic malignant syndrome?
High fever, rigid muscles, confusion, unstable vital signs, and a high CK. It is an emergency. Stop the antipsychotic and notify the provider right away.
What is a therapeutic lithium level?
About 0.6 to 1.2 mEq/L. Levels above 1.5 are toxic.
Evidence & Clinical Sources
- DailyMed FDA drug labels
- Vallerand & Sanoski, Davis's Drug Guide for Nurses, F.A. Davis
- Halter, Varcarolis' Foundations of Psychiatric-Mental Health Nursing, Elsevier
Reviewed against current guidelines and drug labels. Always follow your program, a current drug reference, and facility policy. Our sources policy
For learning only. Lab ranges and policies vary. Always follow your nursing program, a current drug reference, and your facility's policies.