Ch. 4 Psychopharm 2 - Meds

Question 1

What happens when there’s too much dopamine? What happens when there’s too little dopamine?

Answer 1

+ Schizophrenia
+ parkinsonism

Question 2

Signs of parkinsonism

Answer 2

+ Shuffle
+ pill rolling
+ challenge initiating movement
+ challenge initiating speech 

Question 3

Medication given for EPS due to antipsychotic meds

Answer 3

+ Anticholinergic: Benztropine / cogentin
+ CNS depressant/anticholinergic: diphenhydramine (Benadryl)
+Anti convulsant Benzo: clonazepam
+ beta 2 blocker: (not 1st choice) propranolol

Question 4

What are 5 EPS symptoms/groups

Answer 4

+ acute dystonia
+ parkinsonism
+ akathesia
+ tardive dyskinesia
+ NMS - neuroleptic malignant syndrome

Question 5

Symptoms of acute dystonia

Answer 5

Uncontrolled muscle spasms - mostly face, neck (torticaulis) throat

Question 6

Symptoms of parkinsonism

Answer 6

+ pill rolling
+ shuffling
+ trouble initiating movement & speech
+ rigidity & tremors
+ bradykinesia

Question 7

Symptoms of akathesia

Answer 7

+ restlessness
+ irresistible urge to move legs & arms, whole body

Question 8

Symptom of tardive diskynesia

Answer 8

+ involuntary movements of face mainly
+ Lipsmacking
+ cheek, puffing
+ I blinking and rolling assign tongue movements

Question 9

What is NMS?
Symptoms of NMS?
What is so important about NMS?

Answer 9

+ neuroleptic malignant syndrome
+ High fever
+ muscular rigidity - lead pipe, stiff posture
+ altered mental status, reduced consciousness
+ autonomic disturbances - hyperpyrexia, HBP, tachycardia, oculogryation
*** it can be deadly if not treated

Question 10

What causes NMS?
What is the antidote/treatment, nursing interventions?

Answer 10

+ antipsychotic medications - MAINLY 1st gen

+ STOP ANTPSYCHOTICS
+ administer:
- dopamine agonist: bromocriptine
- muscle relaxer: dantrolene
- benzodiazepines / diazepam for CNS depression agitation
* ASSESS VITALS, ABCs
* reduce temp - cooling measures
* IV fluids, monitor, ICU

Question 11

What preparations to antipsychotic meds come in

Answer 11

+ Oral
+ IM
+ depot - long acting injectable: 1-3 month

Question 12

Atypical - antipsychotic name endings

Answer 12

_zole - Aripiprazole
_pine - clozapine, olanzapine, quetiapine
_done - risperidone, ziprasidone

Question 13

Typical - antipsychotic name endings

Answer 13

_zine - chlorpromazine (Thorazine)
_dol - haloperidol (Haldol)

Question 14

What is the action of first generation antipsychotics?
What symptoms do the effect?

Answer 14

• Block/inhibit release of dopamine in brain
• positive symptoms only: hallucinations, delusions

Question 15

What is the action of second generation atypical antipsychotics?
What symptoms do the effect?

Answer 15

• block/modulate dopamine & serotonin
• both positive & negative (inward, flat affect, withdrawal, avolition, anhedonia, alogia) symptoms

Question 16

What kind of drug is benz(a)tropine/Cogentin

Answer 16

Anticholinergic – blocks acetylcholine

Question 17

What is benztropine/Cogentin used for?

Answer 17

Parkinsonism
dystonia
EPS symptoms

Question 18

Anticholinergic drugs of choice for dystonia and parkinsonism

Answer 18

+ Cogentin/banzatropine
+ Benadryl/diphenhydramine
+ Artane/trihexaphenadryl

Question 19

What needs to be in balance to combat EPS?

Answer 19

Balance between dopamine and acetylcholine

Question 20

What is anticholinergic overdose?
What are nursing implications of anticholinergic crisis/overdose?

Answer 20

+ Potentially life-threatening anticholinergic delirium.
+ Occurs in patients taking multiple medications with anticholinergic effects
+ mad as a hatter, red is a beat, hot as a hair, blind as a bat, dry as a bone
+ confusion and hallucinations
+ discontinue medication
+ gastric lavage
+ Charcoal

Question 21

What needs to be in balance in order to maintain smooth muscle movement

Answer 21

Dopamine and acetyl choline

Question 22

Which dopamine pathway is related to extraparametal syndromes, and increased cholinergic activity?

Answer 22

Nigrostriatal - 3rd

Question 23

What is the extraparametal system responsible for?

Answer 23

Modulating movement – particularly walking, to make smooth, rhythmic transitions

Question 24

Telltale signs of dystonia

Answer 24

+ Involuntary muscle spasms mainly in upper body/neck
+ abnormal postures
+ oculogyric crisis
+ torticollis
+ oropharyngeal dysphasia 

Question 25

What is akathisia?

Answer 25

Inability to sit, still, restlessness

Question 26

chronic syndrome that comes from long-term antipsychotic use and is irreversible?

Answer 26

Tardive dyskinesia

Question 27

Risk factors of NMS

Answer 27

+ dehydration + history of NMS + recent dosage increase + psycho motor agitation

Question 28

Early signs of NMS

Answer 28

+ Low-grade fever + tachycardia + elevated blood pressure + catatonia + diaphoresis

Question 29

classic or late signs and symptoms of NMS

Answer 29

FEVER (mnemonic) + fever + elevated enzymes - CPK (from rhabdomyolysis) + vital sign instability + encephalopathy + rigidity + autonomic instability - smooth muscle issues (organs)

Question 30

Side effects of second generation, atypical antipsychotics

Answer 30

+ Metabolic syndrome + Agranulocytosis – blood disorders (clozapine) + NMS

Question 31

Symptoms of agranulocytosis

Answer 31

+ Decreased granulocytes/wbc’s (mainly neutrophils) + fever/chills/weakness + sore throat, sores in the mouth or throat + bleeding gums + bone pain + ⬇️ BP, tachycardia + trouble breathing

Question 32

What labs do you check for 2nd gen. antipsychotics? patient teaching?

Answer 32

+ Blood sugar, LDL, triglycerides + can cause metabolic syndrome – advised to exercise, low calorie, diet, monitor weight

Question 33

Major side effects of first GEN antipsychotics

Answer 33

+ Higher risk of TD, EPS, NMS + orthostatic hypotension

Question 34

Depression is related to deficiency in what neurotransmitters?

Answer 34

+ Serotonin + norepinephrine + dopamine

Question 35

What is the intention or action of antidepressants? How long does it take for antidepressants to work?

Answer 35

+ To increase the level of Neuro transmitters up to normal level equaling normal mood +4 to 6 weeks

Question 36

What does MDD cause – major depressive disorder?

Answer 36

+ Psycho motor retardation – slowing down or hampering of mental or physical activities

Question 37

What causes serotonin syndrome? Signs and symptoms?

Answer 37

+ Overstimulation of serotonin receptors – when SSRIs are used together + Agitation, fever, hypertension, hyperthermia, muscle rigidity, myoclonus (jerky) 

Question 38

First line medication mood stabilizer? What does it treat?

Answer 38

+ lithium + bipolar swings - depression/mania

Question 39

adverse reactions/SE of lithium

Answer 39

+ Nausea + drowsiness/fatigue + thirst + dry mouth + weight gain

Question 40

Signs of toxicity from lithium? What is the therapeutic level?

Answer 40

+ 0.6-1.2 + Toxicity begins at 1.5 + Severe toxicity above 3 + Confusion, blurred vision, diarrhea + slurred speech + coma, convulsions, tremors/ataxia + vomiting/diarrhea

Question 41

Other drugs that can be mood stabilizers a second line of defense

Answer 41

+ Antiepileptic drugs – valproic acid, Tegretol + they raise GABA - for rapid -/+ of biploar

Question 42

Contra indications and education of lithium

Answer 42

+ Pregnancy, breast-feeding - teratogenic + renal, cardiovascular disease + severe dehydration + on thiazide diuretics + low sodium levels + avoid NSAIDs + serum lithium levels checked 1 to 2 months + avoid excess water and low salt diet

Question 43

How does lithium toxicity occur?

Answer 43

+ Dehydration + hyponatremia + impaired thyroid + patients over 50 + kidney failure

Question 44

What neurotransmitters does lithium affect?

Answer 44

+ ⬇️ Dopamine (excitatory) + ⬇️ glutamate (excitatory) + ⬆️ GABA (inhibitory)

Question 45

Class of antianxiety drugs – anxiolytics What do they treat? Which neurotransmitter do they work on?

Answer 45

+ Benzos – benzodiazepines + acute anxiety, seizures, alcohol withdrawal + Also a sedative/muscle relaxer - EPS, NMS + ⬆️ GABA – slows/calms nerve/brain activity

Question 46

Antidote for lorazepam/Ativan - antianxiety

Answer 46

Flumazenil - “ I flu fast in my Mercedes Benz”

Question 47

Adverse reactions of benzos

Answer 47

+ Sedation + lightheadedness, dizzy + visual disturbances + anger/restlessness + G.I. upset + apathy, fatigue + dry mouth