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schizo drugs and tm

Schizophrenia drugs and treatments

another word for antipsychotics neuroleptics major tranquilizers
how neuroleptics work 1) block dopamine receptors 2) block dopamine and serotonin receptors
time frame for neuroleptic results full effect in 3-6 weeks
problem with neuroleptics 10% of pts don't respond
paradigm of thirds 1) 1/3 achieve significant and lasting improvement 2) 1/3 achieve some improvement with intermittent relapses and residual disability 3) 1/3 experiences severe and permanent incapacity and do not respond to meds
sex that responds better to antipsychotics women
overall effects of neuroleptics 1) decrease hallucinations 2) decrease delusions 3) improve cognitive state
imperative education for pts and their families when neuroleptics are started they need to know that results are not immediate and improvement may not happen until over a month after the drug therapy is started
classes of neuroleptics 1) typical 2) atypical
typical neuroleptics 1) older class 2) work on positive signs and symptoms 3) more side effects
atypical neuroleptics 1) newer generation 2) work on positive and negative symptoms
Forms of neuroleptics 1) oral (tabs, liquids) 2) parenteral 3) long-acting 4) decanoate forms
contraindications: typical neuroleptics 1) known hypersensitivity 2) comatose state 3) CNS depression evident 4) parkinson's or narrow angle glaucoma 5) liver, renal or cardiac insufficiency 6) controlled seizure disorders
typical neuroleptics that are not compatible and why prolong the QT interval 1) thioridazine 2) pimozide 3) haloperidol 4) molindone
contraindications: atypical neuroleptics 1) hypersensitivity 2) comatose 3) severe depression 4) dementia-related psychosis 5) lactation
atypical neuroleptics that are not compatible and why prolong QT interval 1) ziprasidone 2) risperidone 3) paliperidone 4) iloperidone
interactions: typical 1) additive hypotensive effects (anti-HTN) 2) additive CNS effects (CNS depressants) 3) additive anticholingeric effects (anticholinergics)
side effects: DA blockage 1) extrapyramidal symptoms (EPS) 2) prolactin elevation
side effects: cholinergic blockage 1) dry mouth 2) blurred vision 3) constipation 4) urinary retention 5) tachycardia
side effects: alpha1 adrenergic blockage 1) dizziness 2) orthostatic hypotension 3) tremors 4) reflex tachycardia
side effects: histamine blockage 1) weight gain 2) sedation
other side effects 1) photosensitivity 2) seizures 3) agranulocytosis 4) diabetes 5) skin rash 6) ECG changes
treatment: dry mouth 1) give sugarless candy, gum, ice, frequent sips of water 2) strict oral hygiene
treatment: blurred vision 1) explain that it will subside after a few weeks 2) don't drive car until vision clears 3) clear small items from pathways to prevent falls
hormonal side effects in men 1) decreased libido 2) retrograde ejaculation 3) gynecomastia
hormonal side effects in women reversible amenhorrhea. continue on contraceptives.
agranulocytosis: what, which drug, when 1) low WBC 2) typical, clozapine 3) usually occurs during first 3m of treatment
agranulocytosis: symptoms, reaction 1) sore throat, fever, malaise 2) get a count
special precautions for clozaril 1) baseline WBC and absolute neutrophil count before 2) weekly counts for the first 6m of treatment 3) only 1w supply dispensed at a time
hypersalivation: what drug, treatment 1) clozaril 2) sugar free gum to increase swallowing rate 3) anticholingeric meds like scopolamine patch or clonidine
EPS: states, causes 1) 75% of ppl get them 2) caused by low DA
EPS 1) pseudoparkinsonism 2) akinesia 3) akathisia 4) acute dystonia
pseudoparkinsonism 1) tremor 2) shuffling gait 3) drooling 4) rigidity 5) lack of arm swing 6) masked fascies
pseudoparkinsonism: when, who 1) 1-5d after initiation of meds 2) women, elderly, dehydrated pts
masked fascies face not animated bc muscles aren't moving
treatment of pseudoparkinsonism 1) anticholinergics 2) reduce dose
pseudoparkinsonism: drugs 1) artane 2) cogentin
akinesia 1) muscle weakness 2) fatigue 3) slow movement 4) painful muscles
akinesia: treatment anticholinergics (same as pseudoparkinsonism)
akinesia: drugs same as pseudoparkinsonism 1) artane 2) cogentin
akathisia 1) continuous restlessness and fidgeting 2) restless legs/can't sit still 3) anxiety
akathisia: stats, dangers, who, when 1) 20-50% pts affected 2) most linked w non-compliance and suicide 3) can be misinterpreted as exacerbation of symptoms 4) women 5) 50-60d after start of therapy
akathisia: treatment 1) change antipsychotic 2) anti-anxiety drugs 3) anticholinergics
akathisia: anti-anxiety drugs 1) inderal 2) ativan 3) valium
akathisia: anticholinergics 1) artane 2) cogentin 3) benadryl 4) symmetrel
acute dystonia 1) involuntary spasms 2) abnormal postures 3) rigidity in face, arms, legs, neck
types of dystonia 1) oculogyric crisis 2) torticollis 3) laryngeal/pharyngeal constriction
oculogyric crisis contracted positioning of the eyes. Eyes pulled in one direction or rolled back
torticollis contracted positioning of neck muscles. Pull neck to one side
laryngeal/pharyndeal constriction 1) gagging 2) cyanosis 3) respiratory distress
acute dystonia: treatment 1) IV cogentin 2) IV benadryl
tardive dyskinesia abnormal muscle movement, especially of face, tongue, mouth, fingers or toes
tardive dyskinesia: treatment 1) no effective treatment 2) often irreversible 3) withdraw drugs at first sign
tardive dyskinesia: first sign vermiform movements of the tongue
neuroleptic malignant syndrome (NMS) hyperactivity of sympathetic nervous system 1) muscle rigidity 2) tachypnea 3) hyperpyrexia 4) tachycardia 5) fluctuations in BP 6) incontinence 7) confusion/delirium
NMS: cardinal sign hyperpyrexia: 101-107 degree fever
NMS: stats, when 1) rare. 1-2% of pts 2) 14-30% mortality rate 3) onset can happen at any point in treatment form hours to years, but progression is rapid
NMS: treatment 1) d/c antipsychotics immediately 2) place on medical unit 3) drugs to counteract 4) cool pt 5) hydration 6) cardiac monitoring
NMS: meds and what they do 1) parlodel: relieve muscle rigidity/DA blockage decreased 2) dantrium: relax muscles
NMS: caution w geodon have baseline EKG before it bc it causes electrical abnormalities in the heart
education for meds 1) review side effects 2) caution about OTC meds 3) don't d/c meds without talking to dr 4) use sunscreen and protective clothing 5) report sore throat, fever, bleeding 6) WBC every week for clozaril
OTC meds that may interact 1) cold meds 2) diet pills
general principles when around schizophrenic patients 1) be calm around pt 2) keep promises 3) be consistent in care 4) set limits 5) don't touch without warning in paranoid pts 6) avoid laughing/whispering
how to treat the schizophrenic pt 1) don't reinforce hallucinations or delusions 2) reality orientation 3) encourage verbalization 4) if withdrawn, spend one on one time
effects of smoking on neuroleptics increases metabolism
Created by: rkasiejka27