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Antipsychotics and Anxiolytics
N/A
53
Pharmacology
Undergraduate 1
05/11/2012

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Cards

Term
Antipsychotics (typical) are used to inhibit which neuro trans mitter?
Definition
Dopamine also called dopamine antagonists because they block D2 dopamine receptors in the brain reducing psychotic symptoms.
Term
True or False some antipsychotics can act as antiemetic drugs
Definition
True; may glock the chemorecrptor trigger zine and vomiting center in the brain.
Term
Antipsychotics treat which symtoms (choose all that apply)
Definition

incoherent speech

hallucinations

delusions

paranoia

 

Term
Antipsychotics (atypical) block?
Definition
serotonin; receptors D4 and have less EPS (extrapyramidal symtoms)
Term
Pseudoparkinsonism (AKA Extrapyramidal symptoms [EPS]) is a major side effect of typical antipsychotic drugs. What are the s/s?
Definition

stooped posture

mask like facies

rigidity

remors at rest

shuffling gait

pill-rolling motion of the mand

bradykinesia

Term
True or False patients who take lower strength antipsychotics (like Thorazine) are less likely to have pseudoparkinsonism?
Definition
True
Term
An adverse extrapuramidal reaction that may occur is dystonia. What are the s/s?
Definition

muscle spasm of the face, tounge, neck, and back

facial grimacing

abnormal or involuntary upward eye movement

laryngeal spasms that can impair respiration

(these are treated with anticholinergic/antiparkinsonism drugs:Cogentin)

Term

akathisia also an adverse reaction to antipsychotics. What are the s/s?

 

Definition

trouble standing still

restless

paces the floor

in constant motion (rocks back and forth)

best treated with lorazepam or propranolol

 

Term
serous advers reaction that occurs in clients taking antipsychotic drugs for more than a year strait can develop tardive dyskinesia. What are the s/s?
Definition

protrusion and rolling of the tongue

sucking and smacking movement of the lips

chewing motion

facial dyskinesia

involuntary movement of the body and extremites

(antipsychotic drugs should be stopped in all who experience this reaction)

Term
Antipsychotics are highly protein bound >90% what is this patient at risk for if they are taking Asprin, warfarin, digioxin?
Definition
Toxicity all of these are fighting for protein binding sites which could result in toxicity
Term
Antipsychotics are broken up into two major categories: typical and atypical. Typical antipsychotics are further broken down into two catagories what are they?
Definition
phenothiazines and nonphenothiazines
Term
urine that is pinkish or red brown when a patient is taking Phenothiazine is (expected, not expected) side effect?
Definition
expected but the patient should be informed of this ahead of time and that it is harmless.
Term
Phenothaiazines are broken into three sub groups differenciated by there side effects. What are the three groups? (select all that apply)
Definition

aliphatic phenothiazines (Ex:Thorazine)

piperazine(Ex: Proxlin, Trilafon)

piperidine (Ex: Mellaril)

Term
Adverse reactions (remeber these are the worst of the worst reactions that can happen not the side effects) of phenothiazines are?
Definition

hypertension

hypotension

tachycardia

extrapyramidal symptoms (tardive dyskinesia)

impaired thermoregulation

convulsions

life-threatening: agranulocytosis

Term
Antacids and should be given how many hours before or after antipsychotics to aid absorbtion?
Definition
1 hour before or 2 hours after
Term
Nonphenothiazines groups include?
Definition

butyrophenone (Ex: Haldol)

dibenzoxazepine (Ex: Loxitane)

dihydroindolone (Ex: Moban)

thioxanthenes (Ex: Navane)

Term
Most common side effects of antipsychotics are?
Definition

Drowsiness

anticholinergic effects (dry mouth, increased heart rate, urinary retnetion, constipation)

Term
Adverse reactions of nonphenothiazines are?
Definition

dystonia

tardive dyskinesia

blood dyscrasias (blood cell disorder such as agranulocytiosis /watch and report low WBC's)

marked photosensitivity (wear the sunscreen)

Term
Phenothiazine lowers the seizure threshold what does this mean for someone on anticonvulsants?
Definition
They may need to increase the dosage of the anticonvulsant to maintain the same level of theraputic effect of preventing seizure.
Term
Antipsychotics interact with alcohol, hypnotics, sedatives, narcotics, and benodiazepines by?
Definition
potentiating the sedative effect so watch the respiration rate with people on these other drugs and no alcohol please.
Term
Since antipsychotics are metabolised through the liver how would the dosage compair from a younger person to a older person?
Definition
the dosage in an older person or a person with liver damage is lower because in both cases there is reduced liver function.
Term
Atypical antipsychotics include which drugs? Select all that apply)
Definition

closapine (Clozaril) watch WBC's and seizures

risperidone (Risperdal)

olanzapine (Zyprexa)

quentiapine (Seroquel)

paliperidone (Invega) ER swallow hole

siprasidone (Geodon) watch ECG's

aripiprazole (Abilify)

all patients taking these should be monitored for hyperglycemia and other symptoms of diebetes millitus

Term
Assessment for pt. on phenothiazine or nonphenothiazine would include?
Definition

baseline vitals

health history of drug therapy

mental status, cardiac, eye and repiratory disorders

Term
liquid concentrait phenothiazine and nonphenothiazine should be diluted with and protected from?
Definition
Fruit (avoid apple though), light
Term
Phenothiazine and nonphenothiazine can cause hypotension what vital sign should we monitor?
Definition
BP
Term
While giving an oral dose phenothiazine and nonphenothiazine what can we do to prevent gastric irritation?
Definition
give with food or milk
Term
Why do we have to administer phenothiazine and nonphenothiazine deep IM?
Definition
because they are irritating to fatty tissue. DO NOT ADMINISTER INTRAVENOUSLY!
Term
Listed under Risperdal there is a life threatening adverse reaction called?
Definition
Neuroleptic malignant syndrome (NMS): s/s = increased fever, pulse, and blood pressure; muscle rigidity; increased creatine phosphokinase and WBC count; altered mental status; acute renal failure; varing levels of consciousness; pallor; diaphoresis; tachycardia and dysrhythmias (even though this is only listed under the one drug I beleive it may be possible in all the drugs listed as antipsychotics)
Term
Since some of the antipsychotics have anticolinergic properties we should not give them to people with (          ) and we should monitor ( & 's).
Definition
glaucoma; I&O's
Term
With any patient on atypical antipsychotics you must monitor their (             ) level.
Definition
serum glucose
Term
A client on antipsychotics (clozapine) comes into the hospital complaining of malaise, fever, and sore throat what tests might you expect the doctor to order?
Definition
WBC's; all these could point to agranulocytosis a blood dyscrasia associated with antipsychotics
Term
A client calls the health care clinic and says he feels stable and has decided to stop taking his antipsychotics. What would you tell him?
Definition
You should talk to your health care provider before reducing you antipsychotics it is not recomended to stop them abruptly
Term
A client comes in hysterical, and says he thinks he's pissing blood. On admission you discover that the client is on and antipsychotic. You obtain a specimen of urine from him that is red-brown in color and a dip stick test indicates that there is no protein in the urine. What teaching opertunity with this client was over looked.
Definition
Informing the client that pink or redish - brown urine is a harmless side effect of antipsychotics.
Term
Anxiolytics are used to treat?
Definition

anxiety

insomnia

 

Term
A major group of antiolytics are Benzodiazepines they enhance the action of (    ) an inhibitory neurotransmitter within the CNS.
Definition
GABA(gamma-aminobutyric acid)
Term
prolonged use of benzodiazepines is not recomended because?
Definition
tolorence developes within weeks or months in less than 2-3 months in clients taking meprobamate or phenobarbital
Term
Benzodiazepines primarily work as an anxiolytic but are also used for?
Definition

anticonvulsant

sedative-hypnotic

preoperative

Term
Benzodiazepines are metabalized in the (     ) and secreated by the (       )?
Definition
liver; kidneys; are highly protein bound 80-98% (be careful with ppl who have decreased renal or hepatic function)
Term
Most frequently perscribed benzodiazapine is?
Definition
lorazepam (Ativan)
Term
Ativan side effects/adverse reactions are?
Definition
drowsiness, dizziness, weakness, confusion, blurred vision, nausea, vomiting, anorexia, sleep disturbance, restlessness, hallucinations/hypertension, hypotension
Term
Benzodiazepine Antagonists (antidote) is?
Definition
flumazenil (Romazicon)
Term
Bensodiazepines used for anxiety are?
Definition

alprazolam (Xanax)

chlordiazepoxide (Librium)

chlorazepate (Tranxene)

diazepam (Valium)

ketazolam (Loftan)

lrazepam (Ativan)

Term
Benzodiazepines used for aniety associated with depression
Definition

alprzolam (Xanax)

clonazepam (Klonopin)

lorazepam (Ativan)

Term
benzodiazepines used as treatment for insonia (short term)?
Definition

estazolam (Prosom)

flurazepam (Dalmane)

quazepam (Doral)

temazepam (Restoril)

triazolam (Halcion)

 

Term
benzpdiazepines use to treat seisures and epilepticus are?
Definition

clonazepam (Klonopin)

clorazepate (Tranxene)

diazepam (Valium) - status epilepticus

lorazepam (Ativan) - status epilepticus

 

Term
benzodiazepines used to treat alcohol withdrawl are?
Definition

clorazepate (Tranxene)

chlordiazepoxide (Librium)

diazepam (Valium)

 

Term
benzodiazepine used to treat skeletal muscel spasms are?
Definition

diazepam (Valium)

 

 

 

Term
benzodiazepines used in preoperative medications are?
Definition

chlordiazepoxide (Librium)

diazepam (Valium)

lorazepam (Ativan)

midazolam (Versed)

Term
Ativan contraindications are?
Definition
Hypersensitivity, CNS depression, shock, coma, narrow-angle glaucoma, pregnancy, lactation and use caution with anyone who has hepatic or renal dysfunction or suicidal thoughts
Term
The Herbal OTC to watch for with any of the antipsychotics or anxiolytics (Benzodiazepines) is?
Definition

Kava Kava

in benzodiazepines it inhances sedation

in antipsychotics (phenothiazines - increase risk of dystonic reaction) (fluphenazine - risk of severity of dystonia when taken concurrently)

Term
Warn clients not to drink (       ) while taking bensociazepines.
Definition
alcohol
Term
psychological dependency can occure with most anxiolytics. (True or False)
Definition
True
Term
A patient comes into the ED he looks emasiated is sweating and you notice when he sign in at the desk that his hands are trembling; when you speak with him he seems agitated says he hasn't slept in days and that he stopped taking his medicine a week ago. What medicine do you think he means?
Definition
Benzodiazepines; all of the aboved mentioned (anorexia, insomnia, remr, muuscular cramps, sweating, agitaion, and nervousness) are signs that this patient abruptly stopped taking benzodiazepines. These effects can last several weeks and take up to 2-10 days to develop. 
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