Medical Pharmacology Chapter 16: Pharmacology of Antipsychotics Drugs
First Generation Antipsychotic Medications
Clinical Monitoring and APA Guidelines
The APA 2021 Practice Guideline for the Treatment of Patients with Schizophrenia provides the most current evidence-based framework for antipsychotic management.13
Key monitoring recommendations relevant to FGA use include:
Baseline evaluation
Complete metabolic panel, fasting lipids, fasting glucose, CBC, ECG (especially for thioridazine or other QTc-prolonging agents), weight and BMI, and AIMS.
Neurological monitoring
AIMS every 3–6 months for patients on FGAs.
SAS or Barnes Akathisia Rating Scale (BARS) as clinically indicated.
Metabolic monitoring
Weight at 4, 8, and 12 weeks then quarterly. Fasting glucose and lipids at 3 months and annually.
Prolactin
Check if symptoms of hyperprolactinemia (galactorrhea, amenorrhea, sexual dysfunction) are present.
Medication adherence
Assess at every visit.
Consider depot formulation if adherence is uncertain.
The APA guideline recommends that patients with schizophrenia be treated with antipsychotic medication (Grade 1A) and that medication be continued for those whose symptoms have improved (Grade 1A).
The guideline specifically addresses tardive dyskinesia by recommending systematic monitoring with a validated rating scale and prompt modification of the antipsychotic regimen if TD is detected.13
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DISCLAIMER
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