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Pharmacology Quiz #2
NSG 2010 Adult Nsg I for Exam #2 antipsychotics, antiparkinsonism
| Question | Answer |
|---|---|
| Antipsychotic (also called major tranquilizers and neuroleptics) | used in the treatment of schizophrenia and other psychotic disorders. Classified as either typical or atypical. |
| Typical antipsychotics | primarily dopamine receptor blockers that cause several adverse effects associated with dopamine blockade, including hypotension, anticholinergic effects, and extrapyramidal side effects (EPS). |
| Atypical antipscyhotics | These are newer. They block both dopamine receptors and serotonin receptors. |
| Antipsychotics – African American response | respond more rapidly to antipsychotic meds; have greater risk of development of tardive dyskinesia. Start at lowest possible dose and monitor closely. |
| Antipsychotics – Patients in Asian countries response | receive lower doses of neuroleptics and lithium to achieve same therapeutic response as seen in pts in US. May be related to these individuals’ lower body mass as well as metabolic differences. |
| Antipsychotics – Arab American response | metabolize antipsychotic meds more slowly than Asian Americans do and may require lower does to achieve the same therapeutic effects as in Caucasians. |
| Dystonia | involuntary muscular movements (spasms) of the face, arms, legs, and neck; may occur as an extrapyramidal side effect of some antipsychotic meds; occurs most often in men and in people younger than 25 yrs of age. |
| Pseudoparkinsonism | tremor, shuffling gait, drooling, rigidity. Symptoms may appear 1 to 5 days following initiation of antipsychotic medication; occurs most often in women, the elderly and dehydrated pts |
| Akinesia | muscular weakness |
| Akathisia | continuous restlessness and fidgeting |
| Tardive dyskinesia | syndrome of symptoms characterized by bizarre facial and tongue movements, a stiff neck, and difficulty swallowing. It may occur as an adverse effect of long-term therapy with some antipsychotic medications. |
| Photophobia | morbid dread and avoidance of light. Although often an expression of undue anxiety about the eyes, photosensitivity and photalgia, past or present, should be considered |
| Extrapyramidal symptoms (EPS) | a variety of responses that originate outside the pyramidal tracts and in the basal ganglion of the brain. Symptoms may include tremors, chorea, dystonia, akinesia, akathisia and others |
| Neuroleptic malignant syndrome (NMS) | a rare but potentially fatal complication of treatment with neuroleptic drugs. Symptoms include severe muscle rigidity, high fever, tachycardia, fluctuations in blood pressure, diaphoresis, and rapid deterioration of mental status to stupor and coma; more |
| Agranulocytosis | Extremely low levels of white blood cells. Symptoms include sore throat, fever and malaise. This may be a side effect of long-term therapy with some antipsychotic medications |
| Gynecomastia | Enlargement of the breasts in men; may be a side effect of some antipsychotic meds |
| Retrograde ejaculation | ejaculation of the seminal fluid backwards into the bladder; may occur as a side effect of antipsychotic meds |
| Oculogyric crisis | An attack of involuntary deviation and fixation of the eyeballs, usually in the upward position. It may last for several minutes or hours and may occur as an extrapyramidal side effect of some antipsychotic meds |
| benztropine | Cogentin |
| diphenhydramine | Benadryl |
| chlorpromazine | Thorazine |
| risperidone | Risperdal |
| haloperidol | Haldol |
| clozapine | Clozaril |
| quetiapine | Seroquel |
| aripiprazole | Abilify |
| olanzapine | Zyprexa |
| ziprasidone | Geodon |
| benztropine (Cogentin) – Indications | adjunctive treatment of all forms of Parkinson’s disease, including drug-induced extrapyramidal effect and acute dystonic reactions |
| benztropine (Cogentin) – Action | Blocks cholinergic activity in the CNS, which is partially responsible for the symptoms of Parkinson’s disease; restores the natural balance of neurotransmitters in the CNS |
| benztropine (Cogentin) – Onset | 1-2 hr (PO) |
| benztropine (Cogentin) –Contraindications/Precautions | hypersensitivity; children <3 yr; angle-closure glaucoma; tardive dyskinesia. Use cautiously in prostatic hypertension, seizure disorders, cardiac arrhythmias |
| benztropine (Cogentin) – Adverse reactions/side effects | confusion, depression, dizziness, hallucinations, headache, sedative, weakness, blurred vision, dry eyes, mydriasis, arrhythmias, hypotension, palpitations, tachycardia, constipation, dry mouth, ileus, nausea, urinary hesitancy, urinary retention, decreas |
| risperidone (Risperdal) – Indications | schizophrenia in adults and adolescents 13-17 yrs; bipolar mania |
| risperidone (Risperdal) – Action | may act by antagonizing dopamine and serotonin in the CNS |
| risperidone (Risperdal) – Onset | 1-2 wk (PO) |
| risperidone (Risperdal) – Contraindications/Precautions | hypersensitivity, in lactating mothers. Use cautiously in debilitated pts, pts with renal or hepatic impairment, underlying cardiovascular disease, hx of seizures, hx of suicide attempt or drug abuse, diabetes or risk factors for diabetes, pts at risk fo |
| risperidone (Risperdal) – Adverse reactions/side effects | NEUROLEPTIC MALIGNANT SYNDROME, aggressive behavior, dizziness, extrapyramidal reactions, headache, increased dreams, increased sleep duration, insomnia, sedation, fatigue, impaired temperature regulation, nervousness, tardive dyskinesia, pharyngitis, rhi |
| risperidone (Risperdal) – Nursing implications | monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, HTN or hypotension, pallor, tiredness). Notify health care professional immediately if these symptoms occur |
| risperidone (Risperdal) – Patient/Family Teaching | Advise pt to use sunscreen and protective clothing when exposured to sun to prevent photosensitivity reactions. Extremes in temperature should also be avoided; this drug impairs body temperature regulation. Caution pt to avoid concurrent use of ETOH, ot |
| haloperidol (Haldol) – Indications | Acute and chronic psychotic disorders including; schizophrenia, manic states, drug-induced psychoses; useful in managing aggressive or agitated pts; Tourette’s syndrome; severe behavioral problems in children. Considered second-line treatment after failu |
| haloperidol (Haldol) – Action | Alters the effects of dopamine in the CNS. Also has anticholinergic and alpha-adrenergic blocking activity |
| haloperidol (Haldol) – Onset | 2 hr (PO) |
| haloperidol (Haldol) – Contraindications/precautions | hypersensitivity, angle-closure glaucoma, bone marrow depression, CNS depression, severe liver or cardiovascular disease (Q-T interval prolonging conditions). Some products contain tartrazine, sesame oil, or benzyl alcohol and should be avoided in pts wi |
| haloperidol (Haldol) – Adverse reactions/side effects | SEIZURES, extrapyramidal reactions, blurred vision, dry eyes, constipation, dry mouth, NEUROLEPTIC MALIGNANT SYNDROME, hypersensitivity reactions |
| haloperidol (Haldol) – Nursing implications | Monitor for onset of akathisia. Observe closely for EPS. Monitor for tardive dyskinesia. Report immediately; may be irreversible. MONITOR FOR DEVELOPMENT OF NEUROLEPTIC MALIGNANT SYNDROME. Report symptoms immediately. May also cause leukocytosis, el |
| haloperidol (Haldol) – Patient/family teaching | Take medication as directed. Take missed doses as soon as remembered, with remaining doses evenly spaced throughout the day. May require several weeks to obtain desired effects. Do not increase dose or discontinue med without consulting HCP. Abrupt wi |
| clozapine (Clozaril) – Indications | schizophrenia unresponsive to or intolerant of standard therapy with other antipsychotics (treatment refractory). To reduce recurrent suicidal behavior in schizophrenic pts |
| clozapine (Clozaril) – Action | binds to dopamine receptors in the CNS. Also has anticholinergic and alpha-adrenergic blocking activity. Produces fewer extrapyramidal reactions and less tardive dyskinesia than standard antipsychotics but carries high risk of hematologic abnormalities |
| clozapine (Clozaril) – Onset | Unknown |
| clozapine (Clozaril) – Contraindications/precautions | hypersensitivity, bone marrow depression, severe CNS depression/coma, uncontrolled epilepsy, granulocytopenia, contraindicated in lactating mothers. Use cautiously in prostatic enlargement, angle-closure glaucoma, malnourished pts or pts with CV, hepatic |
| clozapine (Clozaril) – Adverse reactions/side effects | NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, dizziness, sedation, hypotension, tachycardia, constipation, AGRANULOCYTOSIS, LEUKOPENIA |
| clozapine (Clozaril) – Nursing implications | monitor pt’s mental status (orientation, mood, behavior) before and periodically during therapy. Monitor for signs of myocarditis (unexplained fatigue, dyspnea, tachypnea, fever, chest pain, palpitations, other s/sx of HF, ECG changes, such as ST-T wave a |
| clozapine (Clozaril) – Lab test consideration | Monitor WBC, absolute neutrophil count (ANC), and differential count before initiation of therapy and WBC and ANC weekly for the first 6 months, then biweekly during therapy and weekly for 4 wk after discontinuation of clozapine. Because of the risk of a |
| clozapine (Clozaril) – Patient/family teaching | instruct pt to take medication exactly as directed. Pts on long-term therapy may need to discontinue gradually over 1-2 wk. Inform pt of possibility of EPS and instruct to report these symptoms immediately. Inform pt that cigarette smoking can decrease |
Created by:
mlewellen
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