An older client on lorazepam requiring a wakeful procedure and with a history of violence and hypotension. Which antipsychotic medication is appropriate to administer during the procedure?

An older client on lorazepam requiring a wakeful procedure and with a history of violence and hypotension. Which antipsychotic medication is appropriate to administer during the procedure?

• A. Perphenazine
• B. Haloperidol
• C. Risperidone
• D. Olanzapine

Answer: (B)

Focus on choosing an antipsychotic that calms agitation quickly without causing deep sedation or dropping blood pressure, since the patient is older, needs to stay wakeful for a procedure, and has hypotension. Haloperidol is a potent D2 receptor antagonist that provides rapid tranquilization suitable for acute agitation and aggression. It tends to cause less overall sedation and has fewer immediate hypotensive effects than many phenothiazines, making it a safer option in someone with a history of hypotension. Compared with atypical antipsychotics like risperidone and olanzapine, haloperidol has less tendency toward orthostatic hypotension from alpha-1 blockade and less lingering sedative effect, which helps keep the patient awake for the procedure. Of course, it can still cause extrapyramidal symptoms and, less commonly, QT prolongation, so monitoring is important in older adults.

Focus on choosing an antipsychotic that calms agitation quickly without causing deep sedation or dropping blood pressure, since the patient is older, needs to stay wakeful for a procedure, and has hypotension.

Haloperidol is a potent D2 receptor antagonist that provides rapid tranquilization suitable for acute agitation and aggression. It tends to cause less overall sedation and has fewer immediate hypotensive effects than many phenothiazines, making it a safer option in someone with a history of hypotension. Compared with atypical antipsychotics like risperidone and olanzapine, haloperidol has less tendency toward orthostatic hypotension from alpha-1 blockade and less lingering sedative effect, which helps keep the patient awake for the procedure. Of course, it can still cause extrapyramidal symptoms and, less commonly, QT prolongation, so monitoring is important in older adults.