Term
| What do antipsychotic medications do? |
|
Definition
| Alleviate symptoms of schizophrenia but cannot cure underlying psychotic processes. |
|
|
Term
| When do psychotic symptoms return? |
|
Definition
| with medication noncompliance. |
|
|
Term
| What are antipsychotic drugs effective in treating? |
|
Definition
Acute exacerbations of schizophrenia
Preventing or mitigating a relapse |
|
|
Term
| What is the DRUG ACTION of ANTIPSYCHOTIC MEDICATIONS? |
|
Definition
| BLOCK the action of DOPAMINE |
|
|
Term
| What is the side effect of blocking dopamine? |
|
Definition
| extrapyramidal symptoms (EPS) of parkinsonism occur. |
|
|
Term
|
Definition
| Tremors, masklike faces, rigidity, shuffling gait may develop. |
|
|
Term
| What are the 2 major categories of neuroleptic/antipsychotic medications? |
|
Definition
Typical, or first-generation
Atypical, or second-generation |
|
|
Term
| What kind of symptoms do typical/first generation antipsychotics treat? |
|
Definition
|
|
Term
| What kind of symptoms do atypical/second generation antipsychotics treat? |
|
Definition
| Target positive and negative symptoms |
|
|
Term
| Which of the 2 neuroleptic agents have the LEAST amount of side effects? |
|
Definition
|
|
Term
| What the atypical agents treat? |
|
Definition
| anxiety, depression, and decrease suicidal behavior. |
|
|
Term
| What are the HIGH POTENCY, CONVENTIONAL antipsychotics? |
|
Definition
-trifluoperazine
-thiothixene (Navane)
-fluphenazine (Prolixin)
-Haloperidol (Haldol)
-Pirozide (Orap) |
|
|
Term
| What are the MEDIUM POTENCY, CONVENTIONAL antipsychotics? |
|
Definition
-loxaine (Loxitane)
-Molidone (Moban)
-Perphenazine (Trilafon) |
|
|
Term
| What are the LOW POTENCY, CONVENTIONAL antipsychotics? |
|
Definition
-Chloropromazine (Thorazine)
-Thioriadizine (Mellaril) |
|
|
Term
| What are the 3 groups of PHENOTHIAZINES (typical)? |
|
Definition
-Aliphatic
-Piperazine
-Piperidine |
|
|
Term
| What is an example of an aliphatic? |
|
Definition
| Chloropromazine (Thorazine) |
|
|
Term
| What are the side effects of aliphatic drugs? |
|
Definition
strong sedation,
severe orthostatic hypotension
moderate EPS |
|
|
Term
|
Definition
|
|
Term
| What are the side effects of piperazine drugs? |
|
Definition
low sedation
strong antiemetic effect
severe EPS |
|
|
Term
| What is an example of piperidine drug? |
|
Definition
| Mesoridazine besylate (Serentil) |
|
|
Term
| What are the side effects of a piperidine drug? |
|
Definition
strong sedation
hypotension
few EPS effects |
|
|
Term
| What is the drug action of Fluphenazine (Proloxin)? PIPERAZINE |
|
Definition
| Blocks dopamine receptors in the brain |
|
|
Term
| What is Fluphenazine (Proloxin) used for? PIPERAZINE |
|
Definition
| Manage symptoms of schizophrenia |
|
|
Term
| What interactions are there when taking Fluphenazine (Proloxin)? |
|
Definition
Increase depression when taken with alcohol or other CNS depressants
Kava kava may increase EPS |
|
|
Term
| What are the side effects of Fluphenazine (Prolixin)? PIPERAZINE |
|
Definition
Sedation,
dizziness,
headache,
seizures
Dry mouth,
nasal congestion,
blurred vision,
photosensitivity,
urinary retention
GI distress,
peripheral edema,
tachycardia,
EPS |
|
|
Term
| What is an example of a Nonphenothiazines? |
|
Definition
|
|
Term
| What is the action of Haloperidol (Haldol)? Nonphenothiazines |
|
Definition
| Blocks dopamine receptors |
|
|
Term
| What are the uses of Haloperidol (Haldol)? Nonphenothiazines |
|
Definition
Treat acute and chronic psychoses, dementia
Treat schizophrenia
Treat Tourette’s syndrome |
|
|
Term
| Who is Haloperidol (Haldol) contraindicated in? |
|
Definition
Narrow-angle glaucoma
Sedation
Severe liver, kidney, and cardiovascular disease
Blood dyscrasias |
|
|
Term
| What are the side effects of Haloperidol (Haldol)? |
|
Definition
Sedation, headache, seizures
EPS
Dry mouth, blurred vision, photosensitivity
Tachycardia, orthostatic hypotension, dysrhythmias
Urinary retention |
|
|
Term
| What are the interactions of Haloperidol (Haldol)? |
|
Definition
Increased sedation with alcohol, CNS depressants
Increased toxicity with anticholinergics
Decreased effects with phenobarbital, carbamazepine, caffeine |
|
|
Term
| What does S.T.A.N.C.E stand for? ANTIPSYCHOTICS in general |
|
Definition
S - Sedation & Sunlight Sensitivity
T - Tardive Dyskinesia & Tachycardia & Tremors
A - Anticholinergics & Agranulocytosis & Addiction
N - Neuroleptic Malignant Syndrome
C - Cardiac Arrythmias (ORTHOSTATIC HYPO.)
E - Extrapyramidal (akathesia) & Endocrine changes (libido) |
|
|
Term
| What are EPS symptoms sometimes confused for? |
|
Definition
| Pseudoparkinsonism symptoms |
|
|
Term
|
Definition
Stooped posture
Masklike features
Rigidity
Tremors at rest
Shuffling gait
Bradykinesia
Pill-rolling motion of the hand |
|
|
Term
| Is neuroleptic malignant syndrome common? |
|
Definition
| No. Rare and potentially fatal. |
|
|
Term
| What are the symptoms of neuroleptic malignant syndrome? |
|
Definition
Altered mental status, seizures
Muscle rigidity, sudden high fever
BP fluctuations, tachycardia, dysrhythmias
Rhabdomyolysis, acute renal failure
Respiratory failure, coma |
|
|
Term
| How is neuroleptic malignant syndrome treated? |
|
Definition
Immediate withdrawal of antipsychotics,
-hydration,
-hypothermic blankets,
-antipyretics,
-benzodiazepines,
-muscle relaxants |
|
|
Term
| What are the ADVERSE RXNS of conventional/first generation antipsychotics? |
|
Definition
-EPS
-Tardive Dyskinesia
-Neuroleptic Malignant Syndrome
-Agranulocytosis - DECREASED WBC
-Blood Work
-Anticholinergic Effects
-Orthostasis
-Lowered Seizure Threshold |
|
|
Term
| What are the EPS symptoms associated with typical/first generation antipsychotics? |
|
Definition
Akathisia
Acute Dystonia
Pseudoparkinsonism |
|
|
Term
|
Definition
| those with akathisia often have difficulty sitting at all |
|
|
Term
|
Definition
| acute dystonia is characterized as a syndrome of sustained muscle contractions, frequently causing twisting and repetitive movements or abnormal postures. |
|
|
Term
| What is tardive dyskinesia? |
|
Definition
Grimacing
Tongue movements
Lip smacking
Lip puckering
Pursing of the lips
Excessive eye blinking |
|
|
Term
| What are the treatment options for EPS? |
|
Definition
Lowering the dose
Prescribing antiparkinsonian drugs: |
|
|
Term
| What are the antiparkinsonian drugs? |
|
Definition
- trihexyphenidyl (Artane)
• benztropine mesylate (Cogentin)
• diphenhydramine hydrochloride (Benadryl)
• biperiden (Akineton)
• amantadine hydrochloride (Symmetrel) |
|
|
Term
| What are the ATYICAL/SECOND GENERATION antipsychotics? |
|
Definition
-Aripiprazole (Abilify)
-Clozapine (Clozaril)
-Olanzapine (Zyprexa)
-Paliperidone (Invega)
-Quetiapine (Seroquel)
-Risperidone (Risperdal)
-Aiprasidone (Geodon) |
|
|
Term
| What are the 2 disadvantages of ATYPICAL/2ND GEN. antipsychotics? |
|
Definition
-Metabolic syndrome
-More expensive |
|
|
Term
| What is metabolic syndrome? |
|
Definition
Weight gain, dyslipidemia, altered glucose
Risk of diabetes, hypertension, atherosclerotic and increase in heart disease |
|
|
Term
| What are the advantages of Clozapine (Clozaril), Risperidone (Risperidal), Ziprasidone (Geodon), Aripiprazole (Abilify)? |
|
Definition
- Effective in treating BOTH POSITIVE AND NEGATIVE symptoms
-Less likely to cause EPS or tardive dyskinesia |
|
|
Term
| What is the drug action of atypical antipsychotics? |
|
Definition
| Block serotonin and dopaminergic D4 receptors |
|
|
Term
| What is the ADVERSE effect of Clozapine (Clozaril)? |
|
Definition
|
|
Term
| What is the PRIORITY nursing intervention with Clozapine (Clozaril)? |
|
Definition
|
|
Term
| What does Olanzapine (Zyprexa) do that Clozapine (Clozarile) does not? |
|
Definition
| DOES NOT CAUSE EPS OR AGRUNLOCYTOSIS |
|
|
Term
| What are the side effects of olanzapine (zyprexia)? |
|
Definition
HA
Dizziness
Agitation
Insomnia
Somnolence |
|
|
Term
| What is risperidone (Risperidol) used for? |
|
Definition
| Manage symptoms of psychosis and schizophrenia |
|
|
Term
| What are the S/E and adverse reactions of Risperidone (Risperdol)? |
|
Definition
Sedation
HA
Photosensitivity
EPS
Seizures
Dry Mouth
Weight Gain
Tachycardia
Orthostatic Hypotension
Urinary Retention
Sexual Dysfxn |
|
|
Term
| Who is Risperidone (Risperidol) contraindicated in? |
|
Definition
| Dysrhythmias, blood dyscrasias, liver damage |
|
|
Term
| What are the drug interactions of Risperidone (Risperidol)? |
|
Definition
Increased effects of antihypertensives
Decreased risperdol levels with concurrent use of carbamazepine
Concurrent use of cisapride may cause dysrhythmias |
|
|
Term
| What are the nursing interventions of ALL antipsychotics? |
|
Definition
-Monitor vitals
-Monitor client for "checking" meds
-Give oral w/ food or milk
-IM injection Z track
-Do not massage site
-Rotate injection sites
-Do not allow drug to remain in plastic syringe
-Administer drugs within 15 mins of prep |
|
|
Term
| What labs and symptoms should be monitored when administering antipsychotics? |
|
Definition
|
|
Term
| When do antipsycotics take effect? |
|
Definition
|
|
Term
| Do antipsychotics have an effect on urine? |
|
Definition
| Yes, may turn urine pink or red brown. |
|
|
Term
| Should clients combine antipsychotics with alcohol, narcotics, or any other CNS depressants? |
|
Definition
|
|
Term
| What happens when the antipsychotics are stopped abruptly? |
|
Definition
|
|
Term
| What are some adjuncts to antipsychotic drug therapy? |
|
Definition
-Antidepressants for severe depression
-Lithium as a mood stabilizer
-Benzodiazepine augmentation improves positive and neg. symptoms
-Clonazepam decreases anxiety, agitation, and possibly psychosis |
|
|
Term
| What are the first line drugs used to treat anxiety disorders? |
|
Definition
| SSRI'S and Dual-Action SNRI's |
|
|
Term
| What are 2 SSRI's that are NOT helpful in the treatment of SAD or PD? |
|
Definition
Citlopram (Celexa)
Escitalopram (Lexapro) |
|
|
Term
| What are the rest of the SSRI's? |
|
Definition
-Fluoxetine (Prozac)
-Fluvoxamine (Luvox)
-Paroxetine HCL (Paxil)
-Sertraline (Zoloft) |
|
|
Term
| What are the 2 dual action SNRI's? |
|
Definition
-duloxetine (Cymbalta)
-venlafaxine (Effexor) |
|
|
Term
| How long do SNRI's take to work? |
|
Definition
|
|
Term
| What are the regular benzodiazepines? |
|
Definition
-Alprazolam (Xanax)
-Diazempam (Valium)
-Lorazepam (Ativan)
-Oxazepam (Serax)
-Chlordiazepoxide (Librium)
-Clorazepate (Traxene) |
|
|
Term
| What are benzodiazepines used for? |
|
Definition
| Short-term treatments for anxiety |
|
|
Term
| What are the atypical benzodiazepines? |
|
Definition
-Estazolam (ProSom)
-Eszopiclone (Lunesta)
-Zaleplon (Sonata) |
|
|
Term
| What is true of most atypical benzodiazepines? |
|
Definition
| suppress rapid-eye movement (REM) sleep, causing daytime fatigue and impaired concentration. |
|
|
Term
| What is different about Zaleplon? |
|
Definition
| preferable as a hypnotic agent (sleep aid). |
|
|
Term
| Is Busiprone Hydrochloride (Buspar) a single agent? |
|
Definition
|
|
Term
| Is there a classification for Busiprone Hydrochloride (Buspar)? |
|
Definition
|
|
Term
| What does Busiprone Hydrochloride do? |
|
Definition
|
|
Term
| When does Busiprone Hyrochloride work best? |
|
Definition
| Before benzodiazepines are used |
|
|
Term
| Are Busiprone Hydrochloride more or less sedative than benzodiazepines? |
|
Definition
|
|
Term
| Does Busiprone Hydrochloride have a physcial/psychologic dependence? |
|
Definition
|
|
Term
| When is Busiprone Hydrochloride effective? |
|
Definition
|
|
Term
| What are the 2nd or 3rd line treatments used for anxiety disorders? |
|
Definition
| TCA - tricyclic antidepressants |
|
|
Term
|
Definition
-Amitriptyline (Elavil)
-Desipramine (Norpramin)
-Doxepin (Sinequan)
-Imipramine (Tofranil)
-Clomipramine (Anafranil)
-Maprotiline (Ludiomil)
-Notriptyline (Pamelor)
-Trimipramine (Surmontil)
-Amoxapine (Asendin) |
|
|
Term
| What are the side effects of TCA's? |
|
Definition
H - hypotension
A - Anticholinergic
T - Tachycardia
S - Sedation |
|
|
Term
| What is clomipramine (Anafranil) effective in treating? |
|
Definition
OCD, PD, GAD, and SAD.
May also respond to Surmontil. |
|
|
Term
| What are the 2 beta blockers? |
|
Definition
-Propanolol (Inderal)
-Anteolol (Tenormin) |
|
|
Term
| What do beta blockers treat? |
|
Definition
| Relieve physical symptoms of anxiety, as in performance anxiety (stage fright). |
|
|
Term
| What else do beta blockers treat? |
|
Definition
| In addition, β-blockers treat a variety of conditions, such as hypertension, glaucoma, and migraine headaches. |
|
|
Term
| What are the anxiolytics? |
|
Definition
Alprazolam (Xanax)
Lorazepam (Ativan) |
|
|
Term
| What is the drug action of anxiolytics? |
|
Definition
Act on the limbic, thalamic, and hypothalamic level of CNS
Produce rapid calming effect |
|
|
Term
| When are anxiolytics used? |
|
Definition
| Anxiolytic, anticonvulsant, sedative-hypnotic, preoperative drug |
|
|
Term
| What is the drug action of Lorazepam (Ativan) anxiolytic? |
|
Definition
| Inhibits GABA neurotransmission by binding to specific benzodiazepine receptors |
|
|
Term
| When is Lorazepam (Atvian) used? |
|
Definition
| Anxiolytic, anticonvulsant, preoperative drug |
|
|
Term
| What are the side effects of Lorazepam (Ativan)? |
|
Definition
Drowsiness, dizziness, confusion
Blurred vision
Weakness, restlessness
Sleep disturbance, hallucinations
GI distress |
|
|
Term
| What are the interactions of Lorazepam? |
|
Definition
Increases CNS depression with alcohol, other CNS depressants, cimetidine
Increases lorazepam plasma levels
Increases phenytoin levels
Decreases levodopa effects
Smoking decreases antianxiety effects
Kava kava may potentiate sedation |
|
|
Term
| How long does withdrawal from anxiolytics take? |
|
Definition
| Develops slowly, in 2 to 10 days, and may last several weeks |
|
|
Term
| What are the withdrawal symptoms of anxiolytics? |
|
Definition
Tremor, agitation, nervousness
Sweating
Insomnia
Anorexia, muscle cramps |
|
|
Term
| What are the nursing interventions with anxiolytics? |
|
Definition
-Monitor vitals
-Rise slowly to avoid dizziness
-Response may take 1-2 weeks
-Not to drive or operate equipment
-Should not use for more than 2-4 months as tolerance develops
-Watch for checking |
|
|
Term
| Should anxiolytics be taken with other CNS depressants, alcohol, or other anxiolytics? |
|
Definition
|
|
Term
| Should you take anxiolytics with caffeine or antacids at the same time? |
|
Definition
|
|
Term
| What does Kava Kava do when taken with anxiolytics? |
|
Definition
| Increases the sedative effects |
|
|
Term
| What if there is GI discomfort with anxiolytics? |
|
Definition
| Take with meals or shortly after |
|
|
Term
| Should you abruptly stop anxiolytics? |
|
Definition
|
|
Term
The nurse realizes more medication teaching is
necessary when the 30-year-old female client taking
lorazepam (Ativan) states? |
|
Definition
B. “I can stop this drug after 3 weeks if I feel better.”
Lorazepam should not be discontinued abruptly, but gradually, over a period of several days. Caffeine and alcohol should be avoided when taking lorazepam, a benzodiazepine. This drug should not be taken during pregnancy because of possible teratogenic effects. |
|
|
Term
A client is receiving risperidone (Risperdol). The nurse should monitor the client for which of the following? (Select all that apply.)
A. weight loss
B. bradycardia
C. urinary incontinence
D. orthostatic hypotension
E. hyperglycemia |
|
Definition
Answer: D, E
Common side effects of risperidone include orthostatic hypotension and hyperglycemia. Other side effects are weight gain, not weight loss; tachycardia, not bradycardia; and urinary retention, not urinary incontinence. |
|
|
Term
| Rene, a restaurant manager, is hospitalized after working 15-hour days for several weeks. Her anxiety level is severe upon admission. She has not slept well during the past 2 weeks. Her psychiatrist has ordered amitriptyline (Elavil) 25 mg, to be administered orally, three times daily. Rene asks you, her nurse, why she is so drowsy. What is your best response? |
|
Definition
A. “Drowsiness is a side effect of this medication.”
*A. Giving an anxious patient a simple and accurate answer helps the patient understand that she is experiencing something that is expected. |
|
|
