A nurse new to psychiatry asks her colleague why the newer antipsychotic medications do not cause as many EPSEs as do the conventional antipsychotic medications. Which response, if made by the nurse, is correct?
1. The newer antipsychotics also have a muscle relaxing effect that masks the EPSEs.
2. The newer antipsychotics do not impact dopamine.
3. The newer antipsychotics only act in the lower extrapyramidal dopamine pathways.
4. The newer antipsychotics have less affinity for dopamine receptors and also bind to serotonin receptors.
4
Rationale: The conventional antipsychotic medications have a greater affinity for the dopamine receptors, and occupancy of the dopamine receptors above 80% leads to EPSEs. The newer antipsychotic medications have less affinity for dopamine and some affinity for serotonin, both of which reduce the risk for EPSE. The newer antipsychotics do not have a muscle relaxing effect and must work in the higher dopamine pathways to be effective.
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