Antipsychotics

Question 1

What causes parkinsons disease?

Answer 1

Lack of dopamine

Question 2

What causes schizophrenia?

Answer 2

Excess dopamine in the brain

Question 3

How do antipsychotics work?

Answer 3

By blocking dopamine receptor sites

Question 4

S/Sx of pseudoparkinsonism (6)

Answer 4

Rigidity, shuffling gait, mask like features, stooped posture, tremors, bradykinesia

Question 5

Typical antipsychotics MOA and classes

Answer 5

Block dopamine receptors

Pheno and nonphenothiazines

Question 6

Atypical antipsychotics MOA

Answer 6

Moderate blockage of dopamine receptors, stronger blockage of serotonin receptors

Question 7

Differences btw typical and atypical antipsychotics

Answer 7

MOA and likelihood of EPS sx

Question 8

Phenothiazine medications (3)

Answer 8

Chlorpromazine (Thorazine)
Thioridazine (Mellaril)
Fluphenazine (Prolixin)

Question 9

Nonphenothiazines (3)

Answer 9

Haloperidol (Haldol)
Loxapine (Loxitane)
Molindone (Moban)

Question 10

Which 2 phenothiazines are used as antiemetics?

Answer 10

Promethazine and prochlorperazine

Question 11

Typical antipsychotic uses (4) and adverse effects (4)

Answer 11

Schizophrenia, Tourette’s, etoh w/d
Intractable hiccups (Thorazine)

Drowsiness, orthostatic HoTN, EPS, anticholinergic effects

Question 12

What are EPS sx? (3)

Answer 12

Acute dystonia
Akathesia
Tardive Dyskinesia

Question 13

What is acute dystonia?

treatment & teaching

Answer 13

Muscle spasm of tongue/neck/face/back
Tx: antiparkinson/anticholinergics (benztropine)
Edu: possible laryngospasm

Question 14

What is akathesia?

Treatment

Answer 14

Inability to stand still

Tx: benzodiazepine, possibly beta blocker

Question 15

What is tardive dyskinesia?

Treatment and teaching

Answer 15

Protrusion/rolling of the tongue, lip smacking, chewing
Tx: valvenazine (Ingreza)
Edu: higher incidence in smokers and anticholinergic effects

Question 16

A patient taking fluphenazine would expectedly have these side effects? (5)

Answer 16

Constipation
Shuffling gait 
Mask like features
Tremors
Dry mouth

Question 17

Neuroleptic malignant syndrome

w/ sx (7) and tx (6)

Answer 17

Potentially fatal reaction to antipsychotics
Sx: muscle rigidity, high fever, AMS, seizures, tachycardia/dysrhythmias, rhabdo, acute renal failure
Tx: immediate attention, stop med, antipyretics, hypothermic blanket, benzo, muscle relaxants

Question 18

Typical agents
Nursing considerations (4)

Answer 18

Patients avoid alcohol, sedatives, hypnotics, narcotics
Dose individualized
D/C gradually
Monitor for cheeking

Question 19

Kava kava reaction with phenothiazines

Answer 19

Increased risk for dystonic reactions

Esp. W/ fluphenazine

Question 20

What does gingko biloba do to antipsychotics?

Answer 20

Potentiates the effects

haloperidol, olanzapine, clozapine

Question 21

St john’s wort effect on clozapine

Answer 21

Decreases levels of clozapine

Question 22

Atypical antipsychotic s/e (5)

Answer 22

Weight gain (esp. clozapine and olanzapine)
Increased prolactin
Teratogenic effects
Diabetes
Agranulocytosis

Question 23

Atypical antipsychotic nursing considerations

Answer 23

Monitor weight
Encourage healthy diet and exercise
Monitor BG
Monitor for cheeking

Question 24

Atypical antipsychotic teaching

Answer 24

Increased prolactin = menstrual disorders, sexual dysfunction and osteoporosis
Watch WBC, report signs of infection, schedule returns for labwork

Question 25

Reactive depression

Answer 25

Benzodiazepine

Question 26

Major depression

Answer 26

Antidepressants

Question 27

Bipolar

Answer 27

Mood stabilizer

Question 28

SJW MOA

Answer 28

Decreases reuptake of serotonin, dopamine and norepi

Question 29

How long does it take antidepressants to work?

Answer 29

1-3 weeks initially | 6-12 weeks for full response

Question 30

Serotonin syndrome sx (5) tx (2)

Answer 30

Sx: confusion, anxiety, restlessness, HTN, tremors Tx: stop med, treat symptoms

Question 31

``` Tricyclic antidepressants (TCA) MOA, s/e, meds ```

Answer 31

Amitriptyline (Elavil) Imipramine (Tofranil) MOA: blocks reuptake of norepi and serotonin S/e: sedation, orthostatic HoTN, drowsiness, anticholinergic effects

Question 32

Selective serotonin reuptake inhibitors (SSRI) | MOA, uses, s/e

Answer 32

MOA: blocks reuptake of serotonin Uses: OCD, panic disorder, social phobia, anorexia, PTSD S/e: sexual dysfunction, insomnia, nausea, risk of suicide

Question 33

SSRIs (6)

Answer 33

``` Fluoxetine (Prozac) Fluvoxamine (Luvox) Sertraline (Zoloft) Paroxetine (Paxil) Citalopram (Celexa) Escitalopram (Lexapro) ```

Question 34

Atypical antidepressants MOA, uses

Answer 34

MOA: effects reuptake of 1/3 or 2/3 of the neurotransmitters Uses: major and reactive depression

Question 35

Atypical antidepressant meds

Answer 35

SNRIs: Venlafaxine (Effexor) Desvenlafaxine (pristiq) Duloxetine (Cymbalta) NDRIs: bupropion (Wellbutrin) Serotonin antagonist: Mirtazapine (Remeron) Trazodone (Desyrel)

Question 36

Which atypical antidepressant may increase sexual desire and pleasure and is used for smoking cessation?

Answer 36

Bupropion (Wellbutrin)

Question 37

Monoamine oxidase inhibitor (MAOI) | MOA

Answer 37

Inhibits the deactivation of norepi, dopamine and serotonin

Question 38

MAOI meds

Answer 38

Tranylxypromine (Parnate) Isocarboxazid (Marplan) Phenelzine (Nardil)

Question 39

MAOI teaching

Answer 39

Avoid tyramine rich food

Question 40

Tyramine rich foods

Answer 40

Cheese, cream, yogurt, bananas, raisins, coffee, chocolate, italian green beans, liver, sausage, soy sauce, beer, red wine

Question 41

Drugs used for bipolar

Answer 41

Mood stabilizers (lithium, valproic acid, carbamazepine)

Question 42

Lithium therapeutic range/monitoring frequency | Sx of toxicity

Answer 42

0.5-1.5 needs checked q1-3 days | S/sx: n/v/d, ataxia, blurred vision, tinnitus

Question 43

Which electrolyte interacts with lithium?

Answer 43

Na, hyponatremia = reduced lithium excretion

Question 44

Lithoum teaching

Answer 44

Maintain adequate Na intake | Na effected by v/d, sweating, diuretics

Question 45

2 antiepileptic meds used for bipolar

Answer 45

Valproic acid and carbamazepine

Question 46

Valproic acid MOA

Answer 46

Increases GABA | which suppresses seizure activity, decreases manic episodes, and treats migraine headaches

Question 47

Carbamazepine MOA

Answer 47

Affects Na channels in neurons decreasing mania