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Antipsychotics & Mood Stabilizers

Examples of mood stabilizers Depakote (divalproex sodium); Neurontin (gabapentin); Lamictil (lamotrigine); Topamax (topirimate); Lithium (lithium carbonate)
Nursing considerations for mood stabilizers (esp lithium): monitor liver & kidney function tests, monitor for lithium levels and for signs of toxicity
Signs & symptoms of lithium toxicity? abdominal pain, nausea, vomiting, diarrhea, lethargy, tremor, speech difficulties,ataxia
a.Therapeutic serum lithium level b.Maintenance range a. 0.8-1.4 range varies between laboratories b. 0.4-1.3
Baseline labs needed prior to start of Lithium Thyroid and renal
Therapeutic index of Lithium The therapeutic index for Lithium is low because there the blood level that can cause death is not far above the level required for it to be effective (therapeutic)
Name 3 disturbances in fluid volume that Lithium may cause. 1. polydipsia 2. polyuria 3. edema
Action of antipsychotics? Antagonize dopamine
What are extrapyramidal symptoms associated with antipsychotics? Identify S & S of each. Akathisia (restlessness, rocking, pacing); Dystonia (muscle stiffness & rigidity) Pseudoparkinsonism (mask like facies, pill rolling w/fingers, abnormal gait, drooling); Tardive dyskinesia (tongue thrusting, lip smacking, facial grimacing, swinging jaw)
Examples of antipsychotics: Thorazine (chlorpromazine); Mellaril (thioridazine); Haldol (halperidol); Seroquel (quatiapine); Zyprexa (olanzapine); Risperdal (resperidone); Clozaril (clozapine)
SE of antipsychotics: chronic fatigue; drowsiness; orthostatic hypotension; anticholingeric effects; weight gain, EPS/TD, NMS
Sx of NMS: Mental status change, fever; muscle rigidity, tachycardia, labile HTN, diaphoresis, elevated WBC & CPK
Treatment for NMS: dopamine agonists Parlodel (bromocriptine) or Symmetrel (amantadine)
Which antipsychotics are available in injectable form – Depot injection haloperidol (Haldol), (fluphenazine) Prolixin, risperidone (Risperdal Consta) , Abilify, olanzapine (Zyprexa), palperidone (Invega Sustenna)
What is the frequency of administration of depot formulations of antipsychotics. Every 2 – 4 weeks, depot injection Also know as long acting injection (LAI)
Clozapine (Clozaril)* a. Major side effect b. lab test needed before treatment. a.Agranulocytosis b. Baseline WBC count/differential. Initially weekly WBC count; (also continue WBC count for 4 weeks after d/c)
Benztropine (Cogentin)* a. Class b. Indicated for: a. Anticholinergic b. EPS
Olanzapine (Zyprexa)* a. Class b. Side effect a. Atypical b. Weight gain
Antipsychotic Side Effects 1. EPS 2. Anticholinergic 3. Tardive Dyskinesia 4. Neuroleptic Malignant Syndrome
Extrapyramidal Side Effects (3) 1. Acute dystonia 2. Pseudoparkinsonism 3. Akathisia
EPS: Acute dystonia Name 3 types. Torticollis, opisthonus, oculogyric crisis
EPS: Acute dystonia is treated with? Which route? Benadryl, Cogentin, or Artane IM (can't swallow, twisted neck)
EPS: What is Akathisia? Usually standing up, pacing, rocking, shifting weight from one leg to the other.
a.Synonym for Antipsychotic b.Mechanism of action a. Neuroleptic b. Block dopamine receptors
lithium toxicity – what causes increased risk? Can be caused by fluid loss, sweat, vomiting, diarrhea, resulting in dehydration is at risk for toxicity b/c Lithium is a salt & acts just like Na.
metabolic syndrome - what drugs cause this syndrome? Atypical antipsychotics
What is metabolic syndrome Hyperlipidemia, obesity (wt. gain), elevated blood sugar – all contribute to development of heart disease.
Created by: 1197333586