Question about Antipsychotic Sideffects

allnurses Guide · Oct 25, 2012

My professor said urinary retention (which I can agree - risk of infection).
But I think it's sedation because of what goes along with it ie. cns depression, bradycardia, depressed breathing.

Well, not just infection, but you would also have to look at what happens with electrolytes, BUN and creatinine.

I would have picked sedation as it would occur more quickly.

That and because I don't tend to like things messing with my patient's breathing, if you know what I mean.

I would also wonder about drug elimination, too.

lovingtheunloved, ASN, RN · Oct 26, 2012

I'm gonna go with sedation. For the previously mentioned reasons, plus, if they're sedated, they're going to fall. Hard. And hurt things like brains and bones. At least with urinary retention, you can stick a foley in pretty easily. You have to wait for sedation to wear off.

Esme12, ASN, BSN, RN · Oct 26, 2012

Did your CI tell you why she thought urinary retention was of greater importance?

Anticholinergic side effects can be divided into 2 types of side effects, peripheral and central. "We" need to be attuned to the possibility of these side effects in order to effectively treat patients. The potential medical complications of the anticholinergic side effects are appreciable, and in susceptible patients, particularly older patients or patients with a preexisting condition like asthma, these side effects can be debilitating.

Because of the interaction of the parasympathetic nervous system.......initially, Peripheral side effects may not all appear serious, this is misleading because these side effects can lead to a plethora of medical complications. Complications can range from ulceration of the gums and respiratory problems to hyperthermia and myocardial infarction

Peripheral Side Effects

Peripheral side effects are more physical than central side effects and therefore might be easier to diagnose. Typical symptoms include dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate, and decreased sweating.

Central Side Effects

Impairment in cognitive function has long been recognized as central to the abnormalities in schizophrenia.⁶ This preexisting impairment can be exacerbated by the presence of central side effects caused by anticholinergic properties of antipsychotic agents. Central side effects are cerebral and include impaired concentration, confusion, attention deficit, and memory impairment

Managing Anticholinergic Side Effects

trudiegrl · Oct 26, 2012

She asked us which of the following list of anticholinergic side effects: constipation, dry mouth, blurred vision, postual hypotension, weight gain, and sedation -- is the most serious. I questioned her and asked why not sedation. And she vaguely explained that it's urinary retention because of toxins (which I conclude if the drug is not excreted, the levels of the drug will escalate).

I thought anything that affects patient's breathing (which is sedation) should be more serious than urinary retention. I looked everywhere in our text to see if it did indicate that urinary retention is the most serious and so far I have not found it.

Thank you so much everyone for the feedback! I appreciate it.

Esme12, ASN, BSN, RN · Oct 26, 2012

I don't agree with her explanation about the toxins. Things that make me shake my head......

The side effects of the anti-cholenergic drugs (the parasympathetic nervous system).....ie: increased heart rate, urinary retention, dry mouth, in some cases causing fatal arrhythmia and acute MI...... are definitely the more serious and can be the more permanent of the side effects and therefore the more serious of the two.

She asked us which of the following list of anticholinergic side effects: constipation, dry mouth, blurred vision, postual hypotension, weight gain, and sedation -- is the most serious.

in the question I would choose ortho-static hypotension.....can casue the pateint the greatest harm from fainting and falls.

trudiegrl · Oct 26, 2012

that's a really good point. Thank you so much :)

Esme12, ASN, BSN, RN · Oct 26, 2012

YOu're welcome....!

hodgieRN · Oct 27, 2012

Although this is a stretch, urinary retention can lead to bladder rupture (it would have to be extreme retention), which is considered an emergency. Urinary retention (severe) can lead to hypertensive crisis and/or rupture/hemorrhaging. Pts taking anticholenergics and lasix are at risk. Severe urinary retention is usually seen in quadriplegia, GU cancer, prostate cancer, abdominal surgery, trauma, or maybe a recently removed foley. You could argue that postural hypotension is resolvable and even preventable with getting up slowly. Sedation is a common side effect which goes away with time. Sometimes, we tend to think the word "sedation" means conscious sedation, or anesthesia, or having respiratory depression/ arrest. But sedation can simply mean sleepiness or being tired. Nurses use the word "sedation" for propofol drips with ventilators or pts being knocked out before a procedure. Pharma companies use the word sedation for anything that makes you yawn. We assume that sedation equals being completely knocked out, but it is a very vague iword. If you charted "sedated" under the neurological section on the chart, it's assumed that the pt's is in a medically induced coma, but a drug company can say someone is "sedated" if a pt is sleepy b/c of benadryl. So, sedation isn't an emergency unless you are describing a specific level of consciousness. I agree with Esme12 that toxins aren't a good explanation. Things don't get reabsorbed through the bladder wall (maybe an insignificant amount into the tissue wall, but not enough to pass back into the bloodstream). I'm guessing your professor was trying to get you think critically.

trudiegrl · Oct 27, 2012

My rationale would be that when the patient is "sleepy" and not alert and oriented that they're more at risk hurting themselves by falling versus having a urinary retention that it can be easily managed with straight cath or foley?

Esme12, ASN, BSN, RN · Oct 27, 2012

Your professor already gave you the answer......right? urinary retention. Though I may not agree with her rationale....why are you sticking with the patient being sleepy? I have given you rationale for why the urinary retention would be more indicative of a serious side effect and the stimulation of the parasympathetic nervous system...which can lead to serious deleterious effect

A straight cath isn't always simple and has the risk of infection and complication.

Good luck! :)

hodgieRN · Oct 28, 2012

Try and remember to not get caught up in "This causes this, which can lead to this, which can cause a high risk potentialbased this, which will ultimately lead to this." If you had to pick the worst of two, urinary retention is far worse than being sleepy. Being at risk for falls doesn't compare to bladder distension. Think about what the nursing boards will be like. They always teach you to answer the question. Don't read into it. Just answer what is being asked. Don't assume that urinary retention is not a big deal b/c catheters exist. Urinary retention in itself is bad. It's asking you what's worse...one or the other...aside from possible treatments. It's good that you're considering different aspects of sedation b/c they can lead to falls and altered LOC. You will need to have that brain storming ability during your career for preventative purposes but when strictly picking between the two, ask yourself "Which is worse based on just the info in front of me." Urinary retention can be bad. If you were working triage and someone said "I've only peed a couple drops in a day and a half," that would set off an alarm!