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Mental Health

Chapter 22: Medications for Psychotic disorders

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!