Schizophrenia Q 15
A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client?
A. Take the medication 1 hour before a meal.
B. Decrease the dosage if signs of illness decrease.
C. Apply sunscreen before being exposed to the sun.
D. Increase the dosage up to 50 mg twice per day if signs of illness don’t decrease.
Correct Answer: C. Apply a sunscreen before being exposed to the sun.
Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse should instruct the client to apply a sunscreen before exposure to the sun. Photosensitivity is an adverse effect of many drugs, characteristically producing skin lesions in the areas exposed to light, which includes the face, “V” area of the neck, extensor surfaces of forearms, and dorsa of hands with sparing of submental and retroauricular areas. Two major mechanisms mediating drug induced photosensitivity reactions are phototoxic and photoallergic responses.
Option A: The nurse also should teach the client to take haloperidol with meals — not 1 hour before. Haloperidol is used widely in different countries. It is available in various forms; the oral route is the most common. For the oral administration, it is available as a tablet form and oral concentrate form.
Option B: The nurse should instruct the client not to decrease the dosage unless the physician orders it. Haloperidol is a first-generation (typical antipsychotic) which exerts its antipsychotic action by blocking dopamine D2 receptors in the brain. When 72% of dopamine receptors are blocked, this drug achieves its maximal effect. Haloperidol is not selective for the D2 receptor. It also has noradrenergic, cholinergic, and histaminergic blocking action. The blocking of these receptors is associated with various side effects.
Option D: Toxicities are the exaggerated symptoms of known pharmacologic effects and known adverse reactions. The most prominent toxicities of haloperidol are 1) severe extrapyramidal symptoms, hypotension, sedation. The patient may appear comatose with severe respiratory depression or shock from hypotension. The extrapyramidal symptoms are muscular weakness or rigidity, a generalized or localized tremor that may be characterized by the akinetic or agitation types of movements, respectively. Haloperidol overdose is also associated with ECG changes known as torsade de pointes, which may cause arrhythmia or cardiac arrest.