Ch. 17 Drugs - Psychoses

Question 1

Schizophrenia Positive Symptoms

Answer 1

ADD to normal behavior
Hallucinations, delusions, or paranoia
Strange and irrational behavior, actions
Rapid alternation between extreme hyperactivity and stupor

Question 2

Schizophrenia Negative Symptoms

Answer 2

SUBTRACT from normal behavior
Lack of motivation; detachment
Deterioration of hygiene, job, academic performance
Withdrawal from social and interpersonal relationships

Question 3

Conventional or “typical” antipsychotics

Answer 3

First Generation Psych Meds

Question 4

Example of first generation psych med

Answer 4

chlorpromazine
(early 1950s, “first generation”)

Question 4

Second generation psych meds

Answer 4

Atypical antipsychotics with fewer side effects

Question 4

Third generation psych meds

Answer 4

also atypical; dopamine-serotonin system stabilizers

Question 5

Example of third generation psych med

Answer 5

aripiprazole (Abilify)

Question 5

chlorpromazine MOA

Answer 5

blocks positive symptoms

Question 6

chlorpromazine pharmacologic class

Answer 6

D2 dopamine receptor antagonist; phenothiazine

Question 6

Adverse Effects of First Generation Psych Meds

Answer 6

Acute dystonia
Akathisia
Anticholinergic effects
Disparity
Hypotension
Neuroleptic malignant syndrome
Secondary parkinsonism
Sedation
Sexual dysfunction
Tardive dyskinesia

Question 7

Severe Adverse Effects of First Generation Psych Meds

Answer 7

Increased risk of suicide
Agranulocytosis
Pancytopenia
Sudden unexplained death

Question 8

Body Systems to Monitor when taking First Generation Psych Meds

Answer 8

Decrease of psychotic symptoms, side effects
Anticholinergic side effects
Alcohol, illegal drug, caffeine, and nicotine use
Cardiovascular changes
Seizures and patient’s environment
Neuroleptic malignant syndrome (NMS)

Question 9

haloperidol (Haldol) Pharmacologic class

Answer 9

D2 dopamine receptor antagonist; NONphenothiazine

Question 10

haloperidol (Haldol) MOA

Answer 10

blocks positive symptoms

Question 11

Adverse effects of nonphenothiazine (haloperidol [Haldol])

Answer 11

SAME AS PHENOTHIAZINES

Acute dystonia
Akathisia
Anticholinergic effects
Disparity
Hypotension
Neuroleptic malignant syndrome
Secondary parkinsonism
Sedation
Sexual dysfunction
Tardive dyskinesia

Question 12

risperidone (Risperdal) - atypical antipsychotic treats what symptoms?

Answer 12

Both positive and negative symptoms

Question 13

risperidone (Risperdal) MOA

Answer 13

block dopamine type 2 receptors, serotonin and alpha-adrenergic receptors

Question 14

Atypical antipsychotic side effects

Answer 14

Less dramatic side effects than first generation, but still significant

Question 15

Dopamine-serotonin system stabilizers

Answer 15

Third generation psych meds
Newest antipsychotic class
New drug class, approved in 2002

Question 16

Example of third generation psych med

Answer 16

Aripiprazole (Abilify)

Question 17

Aripiprazole (Abilify) controls what schizophrenia symptoms?

Answer 17

Positive and negative

Question 18

Third generation psych med side effects

Answer 18

Low incidence of serious side effects compared to other antipsychotic drugs

Question 19

Severe spasms, particularly the back muscles, tongue, and facial muscles; twitching movements

Answer 19

Acute dystonia

Question 20

Constant packing with repetitive compulsive movements

Answer 20

Akathisia

Question 21

Dy mouth, tachycardia, blurred vision, orthostatic hypotension, and urinary retention

Answer 21

Anticholinergic effects

Question 22

High risk of suicide among patients receiving antipsychotic therapy

Answer 22

Disparity

Question 23

Particularly severe when the patient when the patient moves quickly from a recumbent to an upright position

Answer 23

hypotension

Question 24

High fever, tachycardia, incontinence, confusion, muscle rigidity, and high serum creatine kinase; can be fatal

Answer 24

Neuroleptic malignant syndrome

Question 25

Tremor, muscle rigidity, stooped posture and shuffling gait

Answer 25

Secondary parkinsonism

Question 26

Usually diminishes with continued therapy

Answer 26

Sedation

Question 27

Impotence and diminished libido

Answer 27

Sexual dysfunction

Question 28

Bizarre tongue and face movements, such as lip smacking and wormlike motions of the tongue; puffing of cheeks, uncontrolled chewing movements

Answer 28

Tardive dyskinesia

Question 29

Acute dystonia Akathisia Secondary Parkinsonism Tardive Dyskinesia

Answer 29

Extrapyramidal Symptoms

Question 30

Most common EPS

Answer 30

Akathisia - inability to rest or relax. Patient paces, has trouble sitting or remaining still, and has difficulty sleeping

Question 31

Drugs that cause anticholinergic side effects

Answer 31

phenothiazine drugs -chlorpromazine

Question 32

haloperidol (Haldol) may be given with what other drugs?

Answer 32

Short-acting benzodiazepines - Lorazepam

Question 33

Normal side effects of haloperidol (Haldol)

Answer 33

Dystonic Behavior in EPS

Question 34

Killer Side Effect of haloperidol (Haldol)

Answer 34

Neuroleptic Malignant Syndrome

Question 35

Potential life-threatening reaction most often seen with typical antipsychotics

Answer 35

Neuroleptic Melignant Syndrome (NMS)

Question 36

High fever and diaphoresis Change in mental status Muscle Rigidity Tremors

Answer 36

Signs & Symptoms of NMS

Question 37

Chlorpromazine and haloperidol (Haldol) treat what symptoms of schizophrenia?

Answer 37

Positive symptoms

Question 38

Risperidone (Risperdal) treat what symptoms of schizophrenia

Answer 38

Positive and negative symptoms

Question 39

Priority nursing actions for NMS

Answer 39

Hold haloperidol (Haldol) Assess the patient Notify HCP IMMEDIATELY

Question 40

Risperidone (Risperdal) indication for use

Answer 40

Schizoprenia, schizoaffective disorder & patient's not responding to other antipsychotics

Question 41

Common side effects of risperidone (Risperdal)

Answer 41

Weight gain, hypersalivation (drooling), & sedation

Question 42

Major Adverse effects of risperidone (Risperdal)

Answer 42

Agranularocytosis Leukopenia - low WBCs & low immunity - decreased neutrophils High risk for infections Sore throat, fever, flu like symptoms

Question 43

Priority action for adverse effects of risperidone (Risperdal)

Answer 43

IMMEDIATELY report to HCP

Question 44

risperidone (Risperdal) contraindications

Answer 44

Patients with dementia - increased mortality

Question 45

Can occur early in treatment or with an increased dose of medication

Answer 45

Acute Dystonia

Question 46

Severe form of restlessness associated with a compulsion to move. Usually the legs or torso, not the head

Answer 46

Akathisia

Question 47

Drug-induced movement disorder which mimics (or reveals) the S&S of idiopathic Parkinson's Disease

Answer 47

Parkinsonism (Secondary Parkinson's)

Question 48

Collective term for a set of late-onset and sometimes irreversible movement disorders which can include cborea, dysphonia, dystonia, tics, and myoclonus

Answer 48

Tardive Dyskinesia

Question 49

Increase in dose or addition of medication that increases the levels of serotonin above the threshold that induces toxicity

Answer 49

Serotonin Syndrome

Question 50

Acute onset of symptoms

Answer 50

Serotonin Syndrome

Question 51

Signs of Serotonin Syndrome

Answer 51

Tremors & hyperreflexia

Question 52

NMS symptoms arise when?

Answer 52

Days, weeks, or months

Question 53

NMS is thought to be mediated by what?

Answer 53

Dopamine antagonism

Question 54

Signs of NMS

Answer 54

Slowed movements and lead pipe rigidity