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Mental Health
Chapter 22: Medications for Psychotic disorders
| Term | Definition |
|---|---|
| Clinical course of schizophrenia usually involves: | Acute exacerbations w intervals of semi remission where symptoms are less severe |
| Meds can treat positive symptoms which are? | Hallucinations, delusions, alterations in speech, agitation) -alterations in speech, though and behavior |
| Meds are used to tx negative symptoms which are? | Social withdrawal, lack of emotion, lack of energy, flat affect, decreased motivation, decreased pleasure in activities |
| Goal of med therapy? | Suppress acute episodes, prevent acute recurrence, maintain highest level of functioning |
| First-generation antipsychotics also known as? | Conventional |
| 1st gen (conventional) are used to tx? | Positive symptoms |
| 1st gen are used for clients who..? | can handle the adverse effects & are violent or particularly aggressive |
| Second generation antipsychotics also called? | Atypical |
| 2nd gen are the..? | Current meds of choice for initial tx, and for tx breakthrough episodes in clients on 1st gen -more effective & less s/e |
| Advantages of 2nd gen? -symptoms they treat? -decrease in? -improvement in? -less.. | tx both neg and pos, decrease affective findings (depression/anxiety) & suicidal behaviors, improve neuro defects (poor memory), fewer to no EPS (tardive dyskinesia) |
| 2nd gen also have fewer ___ effects? | Anticholinergic; except clozapine (clozaril) -bc most 2nd cause little to no blockage of cholinergic receptors |
| First generation (Conventional) meds -Select protocol med: | Chloropromazine (Thorazine), low potency |
| Way to remember the 1st gen: abbreviation | TTTPLFH T3 people like fancy hair |
| TTTPLFH; name them | Thioridazine, low potency Thiothixene (Navane), high potency Trifluperazine, high potency Perphenazine, medium potency Loxapine, medium potency Haloperidol (Haldol), high potency |
| How do 1st generation's work/act? | Block dopamine (D2), acetylcholine, histamine and NE receptors in the brain and periphery. -Inhibition of psychotic symptoms is believed to be a result of D2 blockade in the brain |
| Uses of 1st gen? | tx acute/chronic psychotic disorders, schizophrenia spectrum, bipolar disorders, tourette's, prevent N/V by blocking dopamine in medulla. |
| Complications of 1st gen 1. agranulocytosis | Observe for infection; (fever, sore throat), notify provider -Get baseline WBC if infection s/s -Discontinue if so |
| Complications of 1st gen 2. Anticholinergic effects | Dry mouth, blurred vision, photophobia, urinary hesitancy/retention, constipation, tachycardia |
| Methods of reducing anticholinergic effects: | Chew sugarless gum, sip water, avoid hazardous activities, wear sunglasses outside, eat foods high in fiber, regular exercise, fluid intake 2-3L, void before medication |
| 3. EPS (Extrapyramidal symptoms) | Acute dystonia, parkinsonism, akathisia, tardive dyskinesia |
| EPS examples Acute dystonia: s/s | Severe spasm of the tongue, face, neck, & back -Crisis requires rapid tx |
| Nursing w/ acute dystonia's? When to look for them? and what to tx with? | Begin to monitor for them between 5hr to 5 days after administration of 1st dose. Tx with anticholinergics such as benztropine (convention) or diphenhydramine (benadryl). |
| EPS examples Parkinsonism s/s | Bradykinesia, rigidity, shuffling gait, drooling, tremors |
| Nursing w/ parkinsonisms? When to look for and what to tx with? | -Look for the first month after initial therapy -Tx with benzotropine, diphenhydramine, or amantadine (Symmetrel) |
| EPS examples Akathisia s/s | Inability to sit still, continual pacing and agitation |
| Nursing w/ akathisia? When to look for and what to tx with? | -first 2 months after initial tx -BB, benzodiazepines & anticholinergic meds |
| EPS examples Tardive dyskinesia (TD) | Late EPS -Involuntary movements of the tongue and face, such as lip smacking & tongue fasciculations -Involuntary movements of the arms, legs and trunk |
| Nursing w/ TD: Dose & look for when? | Administer lowest dose possible (if occurs or switch) -Evaluate after 12 months of therapy & then q3months -s/s can occur months to years after initial tx |
| 4. Neuroendocrine effects | Gynecomastia, galactorrhea, menstrual irregularities -notify provider if you observe |
| 5. Neuroleptic malignant syndrome s/s | Sudden high fever, BP fluctuations, dysrhythmias, muscle rigidity, changes in LOC, coma |
| Nursing for NMS? -when does it occur? what do you do? | first 2 weeks, stop med, VS, cooling blankets, antipyretics (aspirin, tylenol), increase fluid |
| What can you administer to relax the muscles in NMS? | Dantrolene (Dantrium) and bromocriptine (Parlodel) |
| How long should you wait before resuming therapy with NMS? | 2 weeks or consider switching |
| 6. orthostatic hypotension | should develop a tolerance in 2-3 months, monitor HR, BP. Hold med. |
| 7. Sedation | effects should diminish in a few weeks, take med at bedtime to avoid daytime sleepiness, don't drive |
| 8. Seizures | Risk if existing seizure disorder, may need to increase AED if necessary |
| 7. Severe dysrhythmias | Baseline ECG & potassium prior to tx |
| 8. Sexual dysfunction | F/M, maybe lower dose |
| 9. Skin effects | Photosensitivity; severe sunburn -contact dermatitis from handling meds -avoid direct contact w meds |
| 1st gen (conventional) are contraindicated in what? | Coma, severe depression, parkinson's disease, prolactin-dependent cancer of the breast or severe hypotension, elderly w dementia |
| Levadopa use: | Avoid! activates dopamine receptors (counteracts antipsychotic agents) |
| How should you screen for EPS? | AIMS |
| Do antipsychotic meds cause addiction? | No |
| How long do the meds take to work? | Some effects seen in a couple days but may take 2-4 weeks or several months for full effects |
| Depot preps advantages? | IM, q2-4wks, lower doses, decreases adverse effects and TD |
| How do you begin dosing? | 2x daily then decrease to 1x at bedtime |
| Second-generation antipsychotics also called? | Atypical antipsychotics |
| 2nd gen prototype med: | Risperidone (Risperdal) |
| Abbreviation to help remember 2nd gen: | AACILOPQZ: alligators are careful in lakes of piranhas QZ |
| What does AACILOPQZ stand for? | Aripiprazole (Ablify), Asenapine (Saphris), Clozapine (Clozaril), Iloperidone (Fanapt), Lurasidone (Latuda), Olanzapine (Zyprexa), Paliperidone (Invega), Quetiapine (Seroquel), Ziprasidone (Geodon) |
| 2nd gen action? | Block serotonin, and to a lesser degree-dopamine receptors. Also block NE, histamine & acetylcholine. |
| Uses of 2nd gen? | Negative & positive symptoms of schizophrenia spectrum disorders -psycosis induced by levodopa therapy -relief in other psychotic disorders; bipolar |
| Adverse effects of 2nd gen? 1. new onset of DM or loss of control w/ current DM | baseline glucose, report s/s of hyperglycemia to provider |
| Adverse effects of 2nd gen? wt | Wt gain |
| Adverse effects of 2nd gen? Cholesterol levels | Hypercholesterolemia w/ ^ risk for htn and cad |
| Adverse effects of 2nd gen? BP | Orthostatic hypotension |
| Adverse effects of 2nd gen? Anticholinergic effects | Dry mouth, urinary hesitancy/retention |
| Adverse effects of 2nd gen? behavior/sleep | Agitation, dizzy, sedation & sleep disruption |
| Adverse effects of 2nd gen? Mild EPS, | ex. tremor -use AIMS to test |
| Risperidone monitoring parameters? | Preg C, avoid dementia clients, and heart issues, DM (baseline sugars), avoid alcohol |
| Aripiprazole (Abilify) | Low or no risk EPS/DM/wt. gain/dyslipidemia/hypotension/anticholinergic -adverse: sedation, headaches, anxiety, insomnia, GI upset |
| Asenapine (Saphris) (Pg. 219) | low risk DM/WT/DYL/antichol -drowsy, prolonged QT, EPS, numbing of mouth -avoid eating/drinking 10 min after each dose |
| Clozapine (Clozaril) | 1st atypical developed no longer first-line d/t adverse effects -risk for fatal agranulocytosis -wt gain, dylip, DM!! |
| Avoid immunosuppressants especially with? | Clozapine (Clozaril) |
| Risperidone can be administered how? | IM injection |
Created by:
mary.scott260!
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