Psychiatric Drugs and Medications Q 43
Ansherina who is receiving a traditional antipsychotic agent complains that she is gaining weight. The nurse would:
A. Be aware that this is probably delusional thinking because these agents cause weight loss.
B. Encourage the client to follow a healthy diet and use diet soda to help stabilize her weight.
C. Discuss a switch to a high-potency agent so the weight gain will not be a problem.
D. Establish a contract with the client to carefully follow her high-calorie diet.
Correct Answer: B. Encourage the client to follow a healthy diet and use diet soda to help stabilize her weight.
These agents have a known side effect of weight gain. Managing dietary intake can assist in the management of the potentially distressing effect. Olanzapine has been associated most frequently with weight gain, increased appetite, and somnolence. Quetiapine is the least likely to cause extrapyramidal side effects. The most common side effects of quetiapine are somnolence, orthostatic hypotension, and dizziness. Ziprasidone has almost no weight gain but can cause prolongation of QTc.
Option A: First-generation antipsychotics are indicated in the treatment of delusional disorder as well as paranoia associated with personality disorders. Newer medications — called atypical antipsychotic drugs — appear to be more effective in treating the symptoms of delusional disorder. These medications work by blocking dopamine and serotonin receptors in the brain. Serotonin is another neurotransmitter believed to be involved in delusional disorder.
Option C: Second-generation antipsychotics carry the FDA boxed warning of increased incidence of stroke in elderly patients with dementia. The recommendation is to avoid the use of second-generation antipsychotics along with other drugs that prolong the QTc interval.
Option D: Wherever possible use drugs with a lower risk of weight gain. Monitor weight and Body Mass Index (BMI) during antipsychotic treatment. More regular measurements are needed in the first few months of treatment as this is when the risk of weight gain is highest.