Antipsych Meds

Question 1

Antipsychotic Medications alleviate the symptoms of schizophrenia BUT

thinkcompliance

Answer 1

-cannot cure the underlying psychotic processes
-Psychotic symptoms return with medication noncompliance
-Even with medication compliance, relapse of psychosis can occur

Question 2

Antipsychotic drugs are effective for…

Answer 2

-Acute exacerbations of schizophrenia
-Reducing the number of relapses
-Lessening the effects of relapses

Question 3

what are the two classes of antipsychotic drugs

Answer 3

*Neuroleptics (Typical antipsychotics) (FGAs)
*Atypical antipsychotics (SGAs & TGAs)

Question 4

Neuroleptics (Typical antipsychotics) (FGAs) target…

Answer 4

positive symptoms

Question 5

Atypical antipsychotics (SGAs & TGAs) target..

Answer 5

positive and negative symptoms
*Atypical agents also treat anxiety, depression, & decrease suicidal behavior

Question 6

Extrapyramidal symptoms (EPS)

Answer 6

are involuntary, drug-induced movements that include acute and tardive (delayed) symptoms.
-akathisia
-dystonia
-Pseudoparkinsonism

Question 7

EPS can develop into…

Answer 7

tardive dyskinesia (irregular, jerky movements), which is a permanent condition

Question 8

Examples of typical antipsychotics (first generation)

Answer 8

-chlorpromazine
-fluphenazine
-haloperidol
-perphenazine

Question 9

what are the advantages of First-generation antipsychotics

Answer 9

-Inexpensive
-Available in oral and IM injection forms - both immediate and long-acting injections (LAIs)

Question 10

Neuroleptic Malignant Syndrome (NMS) can be caused by

Answer 10

The high potency 1st generation antipsychotics (like Haldol)

Question 11

Neuroleptic Malignant Syndrome (NMS) S/S

Answer 11

-Sudden high fever
-Sweating
-Rigidity
-Dysrhythmias
-Fluctuations in BP
-Decreased LOC
-Respiratory failure

Question 12

treatments for symptoms of Neuroleptic Malignant Syndrome (NMS)

Answer 12

bromocriptine (Parlodel) or dantrolene (Dantrium)

Question 13

acute dystionia is treated with

Answer 13

IM (diphenhydramine) Benadryl or (benztropine) Cogentin

Question 14

Acute dystonias

Answer 14

a series of uncontrollable cramping, muscle movements, and spasms of the tongue, face, neck, and back

Question 15

acute dystonia: oculogyric crisis

Answer 15

uncontrolled rolling back of the eyes

Question 16

acute dystonia: Torticollis

Answer 16

head tilt due to shortening or spasm of one sternomastoid muscle

Question 17

acute dystonia: glossospasm

Answer 17

spasm of the tongue

Question 18

acute dystonia: Opisthotonus

Answer 18

The back is rigid and arching, and the head is thrown backward.

Question 19

Pseudoparkinsonism s/s

Answer 19

*Rigidity (lead pipe, cogwheeling)
*Bradykinesia
*Mask-like face
*Shuffling gait
*Tremor
*Postural deficits
*Chorea
*Hemiballismus
*Athetosis
*Certain dystonias
*Tics

Question 20

Pseudoparkinsonism is treated with

Answer 20

anticholinergics

Question 21

Akathisia

Answer 21

is an inner restlessness. The patient twitches and moves and wiggles. There is a constant urge to be moving, and while this is abnormal, it is still voluntary movement, the urge cannot be ignored.

Question 22

what must be stopped when Tardive Dyskinesia (TD) develops

Answer 22

*Offending med must be stopped
*Anticholinergics are stopped

Question 23

Tardive dyskinesia s/s

Answer 23

*consists of abnormal, involuntary movements usually involving the tongue, fingers, toes, trunk, and/or pelvis

Question 24

early symptoms of TD

Answer 24

*Tongue fasciculations
*Constant lip smacking

Question 25

Later (permanent) TD symptoms

Answer 25

*Oral movements (e.g., uncontrollable biting, chewing, or sucking motions; an open mouth; lateral movements of the jaw) *Thrusting, serpentine, or choreic movements of the neck, trunk, or pelvis *Torticollis *Facial tics (including abnormal involuntary blinking or chewing)

Question 26

treatment for EPS

Answer 26

-IV/IM administration of anticholinergic meds -Benztropine (Cogentin) -Diphenhydramine (Benadryl)

Question 27

preventative assessment fro EPS

Answer 27

-Abnormal Involuntary Movement Scale (AIMS) (Psychiatrist to test for EPS every 3 months)

Question 28

anticholinergics

Answer 28

*trihexyphenidyl (Artane) *benztropine mesylate (Cogentin) *diphenhydramine hydrochloride (Benadryl) *amantadine hydrochloride (Symmetrel)

Question 29

Tardive Dyskinesia Treatment

Answer 29

-There is no cure for TD. -The drug that caused the client's TD must be stopped to prevent worsening of movements.

Question 30

as of 2019, what drugs are now used for TD

Answer 30

valbenazine and deutetrabenazine

Question 31

Atypical (2nd- & 3rd-Generation) Antipsychotics examples

Answer 31

clozapine olanzapine paliperidone quetiapine risperidone ziprasidone iloperidone aripiprazole

Question 32

Atypical Antipsychotics: Side Effects

Answer 32

*CONSTIPATION - significant & very common side effect *Lowered seizure threshold *Metabolic side effects *Weight gain, hyperglycemia, hyperlipidemia, cardiac myopathy *Can lead to METABOLIC SYNDROME

Question 33

clozapine SE

Answer 33

Agranulocytosis

Question 34

clozapine interventions

Answer 34

*Strict monitoring protocols including weekly CBC *Client education - immediately report any signs or symptoms of infection (e.g., sore throat, fever, flu-like symptoms, leukopenia)

Question 35

risperidone SE

Answer 35

*Gynecomastia & hyperprolactinemia

Question 36

ziprasidone SE

Answer 36

cardiac dysrhythmias -QT prolongation

Question 37

Metabolic Syndrome

Answer 37

*Increased risk of diabetes, hypertension, heart disease *Weight gain - need baseline weight & waist circumference and monitor during treatment for changes *Dyslipidemia - monitor lipid levels (cholesterols & triglycerides) *Altered glucose metabolism - monitor labs for blood sugar and Hgb A1C changes

Question 38

Overview: Typical (1st Generation) SE

Answer 38

*Extrapyramidal Symptoms (EPS) *Dystonic reaction *Akathisia *Drug-induced parkinsonism *Tardive dyskinesia (TD) *Orthostatic hypotension *Body temp alterations (hypothermia) *Neuroleptic Malignant Syndrome (NMS)-fever

Question 39

Overview: Atypical (2nd & 3rd Generation) | monitor...

Answer 39

*EPS& TD possible, but less likely *Risk for Metabolic Syndrome: *Increased weight, blood glucose, triglyceride levels, insulin resistance *Constipation *QT prolongation *Agranulocytosis (with clozapine) *Gynecomastia (with risperidone) *Cardiac dysrhythmias (with ziprasidone)

Question 40

3rd generation antipsychotic (aripiprazole) advantage

Answer 40

has even less side effects than 2nd generation

Question 41

Chorea

Answer 41

sudden, involuntary, irregular, and jerky movements that can affect any part of the body.

Question 42

Hemiballismus

Answer 42

violent, flinging movements of one side of the body

Question 43

Athetosis

Answer 43

Slow, writhing, continuous movements, especially in fingers and toes.

Question 44

Dystonia

Answer 44

involves involuntary muscle contractions that cause repetitive or twisting movements.

Question 45

Rigidity

Answer 45

Rigidity refers to stiffness and inflexibility of the muscles. In drug-induced pseudoparkinsonism, rigidity can be observed as a resistance to passive movement. (lead pipe or cog wheel)

Question 46

Postural deficit

Answer 46

Difficulty maintaining an upright posture, stooped posture, and balance issues.

Question 47

Bradykinesia/Akinesia

Answer 47

Drug-Induced Pseudoparkinsonism: Both are hallmark features. Bradykinesia: This term means slowness of movement. People with drug-induced pseudoparkinsonism may have difficulty initiating movements and once started, the movements are slow and difficult to carry out. Akinesia: This is a more severe form of bradykinesia, referring to the inability to initiate movement.