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MH Drugs
| Question | Answer |
|---|---|
| ANTIPSYCHOTICS (NEUROLEPTICS) MECH. OF ACTION | Blocks the action of dopamine (DA) primarily, ACH, Alpha Receptors, Histamine Receptors. Basal Ganglia |
| S/E of blocked DA with antipsychotics | EPS_ which includes akinesia, akathesia,dyskinesia tardive dyskinesia, pseudoparkinsonian features. |
| S/E of increased pituitary secretion of prolaction with antipsychotics | amenorrhea and gynecomastia in men |
| S/E ofblocked ACH with anitpsychotics | blurred vision, dry mouth, consti[ation, and urinary hesitancy |
| S/E of blocked Alpha receptors with anitpsychotics | orthostatic hypotension, also affects the vas deferens causing failure to ejaculate |
| S/E of blocked histamine with antipsychotics | sedation and substantial weight gain |
| First generation antipsychotics | Haloperidol (Haldol), Fluphenazine (Prolixin), Stelazine, Navane, Chlorpromazine (Thorazine), Mellaril, Teractin,Perphenazine (Trilafon), Serentil, Loxatane |
| Pharmacokinetic considerations of antipsychotics | Accumulate in fatty tissue, absorption affected by foods and stomach acidity- take at least 2 hours after eating- not to be used concurrently with antacids (Tums,MOM) or H2 blockers (Tagamet, Pepcid, Zantac) |
| Contraindications of anipsychotics | Known allergic response, CNS depression, Parkinson disease (will exacerbate), Blood dyscrasias, Hepatic and renal disease, acute narrow angle glaucoma (never give),BPH |
| Extrapyramidal S/E | *Pseudoparkinoism *dystonia *acute dytonic reaction *akathisia *tardive dykinesia |
| Management of pseudoparkinonism | CAB protocol C-Benztropine *(Cogentin)or A-Trihexydphenidyl *(Artane)or B- *Benadryl IM |
| Dystonia | muscle spasms |
| Acute dystonic reaction | tightening of jaw, stiff neck,swollen tongue are early signs- late signs are swollen tongue and oculogyric crisis |
| Akathisia | inability to sit or stand still, foot tapping or pacing |
| Tardive dykinesia | abnormal involuntary movements- may be irreversible (mouth, tongue, facial movements) |
| other S/E | *Agranulocytosis (WBC<2000)especially with Clozaril *Seizures *Hepatotoxicity (jaundice, nausea, abd pain) *NMS (Neuroleptic Malignant Syndrome) |
| Compliance Education- DRY MOUTH | use of sugarless candy/gum rinse mouth with water frequently(avoid commercial mouth washes-avoid anything with ETOH) |
| Compliance Education- BLURRED VISION | Avoid driving and operating heavy machinery ACUTE EYE PAIN--SEE MD STAT! |
| Compliance Education- URINARY RETENTION | teach patient to report sensation of bladder fullness or incomplete emptying. Assess for bladder distention. Teach bladder emptying techniques. |
| Compliance Education- CONSTIPATION | 6-8 glasses of water daily, increase/add fiberto diet. increase exercise. |
| Compliance Education- PHOTOSENSITIVY | brief exposures are problematic. WEAR SUNBLOCK! WEAR PROTECTIVE CLOTHING! |
| Compliance Education- WEIGHT GAIN | increases with lenght of time on the drug and rise in the hormone leptin. teach to discourage frequent snacking of high caloric foods. Exercise daily. Eat only those calories needed for normal weight. difficult because of increased appetite with drugs. |
| Compliance Education- AMENNORRHEA | teach to still use birth control |
| Compliance Education- GYNECOMASTIA | teach that this can be a side effect for men |
| Compliance Education- SEXUAL DYSFUNCTION | Anorgasmia in women, Erectile Dysfunction in men. Must report to HCP. Medications may be changed or dosages altered. |
| Compliance Education- ORTHOSTATIC HYPOTENSION | (a drop in systolic reading 20mmHg or more) Teach to change positions slowly, especially from lying to standing position. Assess BP x3 poaitions. Arrhythmia's- May need baseline ECG, assess for racing pulse, lightheadedness or dizziness. |
| Pseudoparkinsonism | evidenced of stooped posture, shuffling gait, drooling, and fine tremors "pill-like" rolling of finger and thumb. drugs used are Artane, Cogentin and Akineton |
| OCULOGYRIC CRISIS | eyes roll upward and sideways and remain this way for several hours. will see in dystonia |
| LARNGYOSPAMS | sudden occusion of the larynx may see in dystonia |
| treatment for dystonia | Anticholinergics drugs such as- Benzatroping (Cogentin)or diphenydramin (Benadryl) 50mg usually brings rapid relief. |
| Neuroleptic Malignant Syndrome | potentially fatal side effect of antipsychotics related to SNS hyperactivity. (Due to DA blockage in the brain) |
| NMS symptoms | *Hyperpyrexia (101-107) *Muscle ridgity *Diaphoresis *tachycardia *Hypertension *Respiratory distress *Urinary incontinence *Confusion (Delirium) |
| NMS management | *STOP DRUG *Administer Parlodel (Bromocriptine) to halt the DA receptors. *Prepare to transfer to ICU |
| Care for Agranulocytosis | caused by exertion toward bone marrow suppression. WBC<2000. Assess for sore throat, low grade fever, malaise, sore in mouth. Clozaril may be causative factor. Monitor WBC wkly for 1st 6mos then every other wk. notify HCP of S/S, place in prot. isolation. |
| Q-T Prolongation Syndrome | a prolonged Q-T interval leads to ectopic firing which can cause lethal arrythmis'a such as V-Tach and V-Fib. may see periodic ECG's ordered. |
| ATYPICAL ANTIPSYCHOTICS | this group produces fewer EPS S/E and also targets both NEGATIVE and POSITIVE symptoms. |
| ATYPICAL ANTIPSYCHOTIC DRUGS | Aripiprazole (Abilify) Clozapine (Clozril) Olanzapine (Zyprexia) Palperdione (Invega) Quetiapine (Seroquel) Risperdone (Risperdal) |
| Clozapine (Clozaril) | Blocks DA receptors in limbic system. Potential for BMS (bone marrow suppression)monitor WBC. Can cause seizures and convulsions. most common S/E-drowsiness, sedation, hypersalivation, tachycardia,and dizziness. |
| Risperidone (Risperdal) | Blocks Alpha receptors- can cause orthostatic hypotension, sedation. Wt gain and sexual dysfunction can occur. risk of CVA in elderly with dementia (black box warning). Can be given deaconate form (last 4 weeks) |
| Quetiapine (Seroquel) | Binds to and antagonizes DA, 5-HT, and Hreceptors. useful in tx of psychosis but does cause sedation, drowsiness, wt gain. |
| Aripiprazole (Abilify) | known as DA stabilizer |
| Ziprasidine (Geodon) | used for short term management for patients with acute onset psychosis and agitation. Safety concer prolonged Q-T interval syndrome. Check mg+ and k+ prior to use. effective in 30 min. given IM and PO |
| MOOD STABILIZERS | Lithium Carbonate and Lithium Citrate (Eskalith, lithane and lithobis) |
| Lithium levels | 0.5-1.5meq/L On initiation levels will be checked 2-3 times weekly until therapeutic level is achieved. |
| lithium toxicity | If Na+ in take is redused or levels are depleted, Lithium takes over and is reabsorbed, which results in toxicity. |
| lithium toxicity prevention | restrict caffiene intake, maintain 6-8 glasses/day of water, maintain 2g/day of Na+, Drink fluids with electrolytes when exercising, Monitor blood levels, Contact HCP of GI distress (diarrhes, vomiting, drowsiness muscle weakness, lack of coordination) |
| Adverts effects of Lithium | tremors, ataxia, confusion, convulsion, N/V/D, arrhythmias, polyuria, polydipsia, edema goiter, and hypothyroidism. |
| lithium considerations | Determine thyroid status (T3,T4), assessment of renal function before drug use, Evaluation of dementia due to drug has poor response with disease, ECG may be ordered for baseline, in elderly start slow go slow. |
| Antiepileptic drugs | Useful in reducing excitement in the manic phase and reduction of mood swings in bipolar disorder. Blood levels must be monitored |
| Antiepileptic drug names | Carbamazepine(Tegretol) Gabepentin (Neurontin) Lamotrigine (Lamictal) Levetiracetum (Keppra) Phenobarbital (Luminal) Phenytoin (dilantin) Topiramate (Topamax) Valproic acid (Depakote, Depakene) |
Created by:
csnodgrass5
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