Antipsychotics & Mood Stabilizers
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| Examples of mood stabilizers | Depakote (divalproex sodium); Neurontin (gabapentin); Lamictil (lamotrigine); Topamax (topirimate); Lithium (lithium carbonate)
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| Nursing considerations for mood stabilizers (esp lithium): | monitor liver & kidney function tests, monitor for lithium levels and for signs of toxicity
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| Signs & symptoms of lithium toxicity? | abdominal pain, nausea, vomiting, diarrhea, lethargy, tremor, speech difficulties,ataxia
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| a.Therapeutic serum lithium level b.Maintenance range | a. 0.8-1.4 range varies between laboratories
b. 0.4-1.3
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| Baseline labs needed prior to start of Lithium | Thyroid and renal
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| 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)
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| Name 3 disturbances in fluid volume that Lithium may cause. | 1. polydipsia
2. polyuria
3. edema
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| Action of antipsychotics? | Antagonize dopamine
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| 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)
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| Examples of antipsychotics: | Thorazine (chlorpromazine); Mellaril (thioridazine); Haldol (halperidol); Seroquel (quatiapine); Zyprexa (olanzapine); Risperdal (resperidone); Clozaril (clozapine)
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| SE of antipsychotics: | chronic fatigue; drowsiness; orthostatic hypotension; anticholingeric effects; weight gain, EPS/TD, NMS
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| Sx of NMS: | Mental status change, fever; muscle rigidity, tachycardia, labile HTN, diaphoresis, elevated WBC & CPK
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| Treatment for NMS: | dopamine agonists Parlodel (bromocriptine) or Symmetrel (amantadine)
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| Which antipsychotics are available in injectable form – Depot injection | haloperidol (Haldol), (fluphenazine) Prolixin, risperidone (Risperdal Consta) , Abilify, olanzapine (Zyprexa), palperidone (Invega Sustenna)
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| What is the frequency of administration of depot formulations of antipsychotics. | Every 2 – 4 weeks, depot injection
Also know as long acting injection (LAI)
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| 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)
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| Benztropine (Cogentin)* a. Class b. Indicated for: | a. Anticholinergic
b. EPS
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| Olanzapine (Zyprexa)* a. Class b. Side effect | a. Atypical
b. Weight gain
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| Antipsychotic Side Effects | 1. EPS 2. Anticholinergic 3. Tardive Dyskinesia 4. Neuroleptic Malignant Syndrome
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| Extrapyramidal Side Effects (3) | 1. Acute dystonia 2. Pseudoparkinsonism
3. Akathisia
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| EPS: Acute dystonia Name 3 types. | Torticollis, opisthonus, oculogyric crisis
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| EPS: Acute dystonia is treated with? Which route? | Benadryl, Cogentin, or Artane IM (can't swallow, twisted neck)
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| EPS: What is Akathisia? | Usually standing up, pacing, rocking, shifting weight from one leg to the other.
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| a.Synonym for Antipsychotic b.Mechanism of action | a. Neuroleptic
b. Block dopamine receptors
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| 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.
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| metabolic syndrome - what drugs cause this syndrome? | Atypical antipsychotics
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| What is metabolic syndrome | Hyperlipidemia, obesity (wt. gain), elevated blood sugar – all contribute to development of heart disease.
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