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Flashcards in Antipsychotics Deck (43):
1

Indications for Antipsychotics

Psychosis, agitation and hyperactivity in Schizophrenia, Tourette's syndrome, and also to augment treatment of biopolar disorder

2

Older antipsychotics

haloperidol (haldol) and chlorpromazine (thorazine)
Block dopamine

3

Newer antipsychotics

clozapine (Clozaril), risperdone (Risperdal), olanzapine (zyprexa), quetiapine (Seroquel), apriprazole (Abilify), ziprazadone (Geodon)
Regulate serotonin, norepinephrine, and dopamine

4

Side effects

Extrapyramidal side Effects (dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia)
Neuroleptic Malignant Syndrome
Agranulocytosis
Photosensitivity
Orthostatic hypotension
Sedation
Anticholinergic effects
Substantial weight gain
Seizures
Increase of prolactin levels

5

Serious side effect of ziprazadone (Geodon)

QT prolongation leading to sudden death

6

Serious side effect of clozapine (Clozaril)

agranulocytosis- monitor WBC lab biweekly. Watch for infection, sore throat or fever

7

Which new drugs cause substantial weight gain?

clozapine (Clozaril)
risperidone (Risperdal)- also causes increase in prolactin
**olanzapine (Zyprexa)
quetiapine (Seroquel)

8

Nursing considerations for NMS

Rare but lethal due to reaction to antipsychotics
Monitor VS for increase or fluctuation (increase in BP)
Assess for lead pipe rigidity of limbs, muteness, incontinence, fever, and confusion.
Can cause rhabdomyolysis.

9

Nursing consideration for serotonin syndrome

Can be confused for NMS
Due to reaction to antidepressants
S/S include confusion, agitation, restlessness, dilated pupils, headache, changes in VS- specifically BP and/or temp
Nausea, vomiting, diarrhea, rapid HR, tremor, loss of muscle coordination or twitching muscles, shivering, goosebumps, profuse sweating

10

Indications for Antidepressants

Mostly for depression, but also for anxiety disorders (social phobia, OCD), PMS, addictions, eating disorders, personality disorders, pain management, sleep problems

11

Side effects of SSRIs

Used most because of minimal side effects (except for sexual problems). This is due to their selectivity to block the serotonin reuptake receptors in the synaptic cleft.

12

Side effects of Tricyclics

Can cause cardiac dysrhythmias, orthostatic hypotension, sedation, anticholinergic effects, and rarely some EPS.
Overdose is quite lethal.
They inhibit the reuptake of both serotonin and norepinephrine in the synaptic cleft.

13

Side effects of MAOIs

require a low tyramine diet to prevent hypertensive crisis and could be lethal for a suicidal patient.
Cannot be mixed with SSRIs which could cause serotonin syndrome.
They do not mix very well because they are not selective in the fact that they bind to Monamine Oxidase Enzymes and prevent the breakdown of catecholamines like dopamine, serotonin, epinephrine and norepinephrine.

14

Examples of SSRIs

fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro)
All can cause HA, insomnia, tremors, sedation, weight loss/gain, sexual problems.

15

Examples of Tricyclics

amitriptyline (Elavil), tofranil, sinequan, norpramin
Cardiac problems, orthostatic hypotension, sedation, anticholinergic effects

16

Examples of MAOIs

phenelzine (Nardil)
Must be kept on a low tyramine diet: nothing pickled, aged, fermented; no cheese, wines, or beer
Could cause hypertensive crisis: stiff neck, high BP, severe HA

17

Example of Atypical Other

zyban (Wellbutrin) used for nicotine addiction (not for patients with seizure or anorexia)

18

Indications for mood stabilizers (antimanics)

Used with bipolar disorder.

19

Lithium

Requires good renal function and close monitoring of lithium levels.
Essential to balance fluids and have a normal salt intake.
Can have long term problems of the thyroid (goiter) or renal.
Dehydration will lead to toxicity (seizrues, coma, dea`th)

20

Other Anticonvulsants/ Mood stabilizers

divalproex sodium (Depakote)- liver problems, GI upset, tremors and weight gain, carbamazepine (Tegretol)- blood dyscrasias and agranulocytosis, gabapentin (Neurontin)- popular with less side effects, but might have increased suicidal thinking and Stevens-Johnson syndrome.

21

Lithium levels

1.0mEq/L is good
Toxic above 1.5
Levels should be drawn 12 hours post last dose.
Avoid diuretics and dehydration in summer, plus do NOT restrict salt.
Takes a week to reach therapeutic levels.

22

Lithium side effects

Mild: Fine tremor, polydipsia, polyuria, weight gain
Severe: Coarse tremors, confusion, oliguria, seizures, coma, death

23

Indications for Anxiolytics

Used for anxiety, alcohol detox, insomnia
Do not mix with alcohol or other CNS depressants
Major withdrawal symptom is seizures (anxiety and insomnia)
Can also cause drowsiness, ataxic gait, slurred speech
Addictive!

24

Benzodiazepines- addictives

chlordiazepoxide (Librium), lorazepam (Ativan), alprazolam (Xanax), oxazepam (Serax)
Effective for detox and anxiety

25

Non-addictive Anxiolytics

buspirone (Buspar), hydroxyzine (Vistaril)

26

clozapine

agranulocytosis

27

haloperidol

major EPS

28

ziparazidone

cardiac problems (QT prolongation)

29

olanzapine

metabolic syndrome- major weight gain, diabetes, high cholesterol

30

congentin

anticholinergic used for treating symptoms of EPS (dystonia, akathisia and pseudoparkinsonism)

31

risperidone

increase in prolactin- breasts in men

32

negative symptoms

apathy, social withdrawal, lack of motivation

33

positive symptoms

hallucinations, delusions

34

dystonia

muscle contractions of the neck, jaw, back, "oculogyric crisis" & risk of laryngospasm and airway problems

35

akithisia

restlessness, cannot stop moving, "jumping out of their skin"

36

pseudoparkinsonism

shuffling gait, tremors, maske like face, akinesia, "cogwheel" rigidity

37

tardive dyskinesia

irreversible and involuntary mouth and torso movements with lip smacking, chewing, blinking, tongue thrusting, cheek puffing
Prevention through testing with the AIMS test
Early sign is vermicular (worm like) tongue movements

38

SSRIs

sexual problems + HA, tremors, insomnia, sedation, weight loss/gain

39

Tricyclics

cardiac problems, orthostatic hypotension, sedation, anticholinergic effects
LETHAL overdose

40

MAOIs

low tyramine diet to avoid hypertensive crisis

41

Lithium

good renal function, toxic at 1.5, do not restrict salt

42

carbamazepine

blood dyscrasias, agranulocytosis (not as bad as clozapine)

43

divalproex sodium

liver problems, weight gain, tremors, GI upset