Exam 3 Flashcards
(50 cards)
1
Q
Anticonvulsant Mood Stabilizers
A
- Valproate (depakote)
- Carbamazepine (tegretol)
- Lamotrigine (lamictal)
2
Q
What meds do you treat bipolar disorders?
A
- Lithium
- Depakote
- Tegretol
- Lamictal
3
Q
What are the first gen antipsychotics?
A
- Chlorpromazine (thorazine)
- Loxapine (adasuve)
- Haldol (haloperidol)
4
Q
Chlorpromazine (thorazine)
A
- low potency
- significant reduction in agitation
- treats positive sx of schizophrenia
- SE: orthostatic hypotension, photosensitivity, lowers seizure threshold
5
Q
Haldol (haloperidol)
A
- high potency
- targets positive symptoms
- low anticholinergic effects
- high EPS
- low sedative properties
- decanoate (Haldol D) prolixin is also administered in a decanoate form
6
Q
Loxapine (Adasuve)
A
- inhaled
- black box warning for bronchospasm
- medium potency
7
Q
What are the second gens antipsychotics?
A
- Olanzapine (Zyprexa)
- Risperidone (Risperdal)
- Asenaprine (Saphris)
- Lurasidone (Latuda)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
- Clozapine (Clozaril)
8
Q
Olanzapine (Zyprexa)
A
- High risk of metabolic syndrome
- weight gain
- hypoglycemia
- agrunulocytosis
- metabolic syndrome
- WBC’s monitor
9
Q
Risperidone (Risperdal)
A
- Low potential for agranulocytosis or convulsions
- Highest risk of EPS among second generation
- Risperdal Consta (INJ) every 2 weeks: increased compliance
10
Q
Asenaprine (Saphris)
A
sublingual
11
Q
Quetiapine (Seroquel)
A
- High sedation
- weight gain
12
Q
Ziprasidone (Geodon)
A
- Take with food
- avoid in cardiac patients/hx of QT prolongation
13
Q
Clozaril
A
- treats + and - symptoms of schizo
- 1st atypical antipsychotic
- Low EPS and ACH
- slow dosage increases
- Monitor wbc’s
- weekly blood levels
- incidence of seizures
- monitor smoking habits of patients
side effects: sedation, hypotension, tachycardia, and severe drooling
14
Q
1st gen adverse effects (typical)
A
- SEA
- sedation
- EPS: pill rolling, parkinsonian-like sx
- anticholinergic (dry mouth, constipation, urinary retention and hesitancy, blurred vision, nasal congestion, photophobia, dry eyes, inhibits ejaculation tachycardia)
- TANS
- tardive dyskinesia (lip smacking, tongue protruding, neck jerking)
- agranolucytosis
- neuroleptic malignant syndrome
- seizures
15
Q
2nd gen adverse effects (atypical)
A
- lowers the risk of EPS and tardive dyskinesia
- added risk for weight gain, diabetes, dyslipidemia
- agranulocytosis, seizures, ortho hypo
16
Q
What’s the highest risk of EPS?
A
Haldol
17
Q
What medication needs close monitor of CBC
A
Clozapine (Clozaril)
18
Q
What antipsychotic somnolence? (sleepiness)
A
Quetiapine (Seroquel)
19
Q
What’s the lowest risk of EPS but causes weight gain and gynecomastia (male gets breast)?
A
Risperidone (risperidal)
20
Q
What causes hyperglycemia?
A
Olanzapine (Zyprexa)
21
Q
What are the nursing interventions for agranulocytosis?
A
- if there’s infection, obtain WBC
- if WBC <3000 discontinue
22
Q
agranulocytosis patient teaching?
A
- notify provider if they have signs of infection especially fever, more than 104 degrees
23
Q
anticholinergic nursing actions?
A
- for dry mouth, chew sugarless gums or sip water
- avoid hazardous activities
- eat high food in fiber for constipation
- wear sunglasses outdoors cuz of photophobia
- exercise
- 2 to 3 liters of water
- pee before taking medication
24
Q
EPS adverse side effects; acute dystonia
- manifestations
A
severe spasm of neck, face, and back
25
acute dystonia nursing actions
begin to monitor 1-5 days after first dose
| - monitor airway until spasm subsides 5-15 mins
26
EPS psuedoparkinsonian manifestations
- bradykinesia (slowness of movement)
- rigidity (stiff)
- shuffling gait
- drooling
- tremors
27
Nursing actions of pseudoparkinsonian
- observe the symptoms between 15-30 days after first dose
| - implement fall precautions
28
EPS Akathisia manifestations
- unable to sit or stand still
- restlestness
- continously pacing
- it can occur between 5-6 days after first dose
29
Akathisia nursing actions
- monitor for suicide
30
Tardive dyskinesia
- it takes months to year
| - involuntarily movements of face and tongue (lip smacking, lip protrusion, movements of body)
31
nursing actions of TD
- evaluate them after 12 months then every 3 months
- lower the dose or switch to another med
- once there is TD, it usually doesnt decrease NOT CURABLE
- teach them make purposeful movements
32
2nd gen/atypical neuroendocrine effects
| manifestations
- gycomasta )breast in male patients)
- weight gain
nursing actions
monitor for weights
education
notify provider if they exist
33
Neuroleptic malignant syndrome
| manifestations
- sudden high fever, more than or equal to 104
- high BP
- diaphoresis, excessive sweating
- tachycardia
- muscle rigidity
- decrease LOC
- coma, death
34
Nursing actions of NMS
- THIS IS MEDICAL EMERGENCY within the first week of their first dose
- stop the med!!!
- monitor vital signs
- apply cooling blankey
- administer antipyretics
- increase fluid intake
- muscle relaxant for rigidity
- meds for arryhtmias
- go to ICU if they were hospitalized
- gotta wait for 2 weeks before they start another antipsychotic med (usually 2nd gen)
35
Orthostatic hypotension (second gen;nursing actions)
- to monitor bp and heart rate and hold med, notify provider
| - increase fluid intake = more blood in circulation
36
Seizures
- higher risk if they have history
- increase their anti-seizure medication
- report to provider
37
Contraindications (antipsychotics)
- coma
- parkinsons disease
- liver damage
- severe hypotension
38
1st gen contraindications
- dementia patients
39
lithium
- 10-21 days onset of action
40
lithium used for
- elation
- flight of ideas
- anxiety
- irritability
- suicidal ideation
- self injury
41
Lithium contraindications
- mus asses renal and thyroid function
EKG
- bresatfeeding
42
Lithium therapeutic dose
less than 1.5 mEq/L
43
How often do you have to measure for lithium?
- 5 days after beginning and any after dosage change until therapeutic reached
- blood levels checks 6 to 1 year after stable, every 3 mo
- drawn in the morning 10-12 hrs after last dose
44
Lithium side effects
-polyuria
- fine hand tremor
- mild thirst = may persist during treatment
- mild nausea
general discomfort
- weight gain = often subside, managed by diet = exercise
45
Lithium Early signs of toxicity
- 1.5-2.0 mEq/L
- GI upset
- course hand tremor
confusion
- hyperirritability of muscles
- EKG changes
- sedation
- incoordination
46
Lithium Early signs of toxicity interventions
- hold dose
- close eval
- blood draw
47
lithium advanced signs toxicity
2. 0-2.5mEq/L
- ataxia
- giddiness
- serious EKG changes
- blurred vision
- clonic movements
- large output of dilute urine
- seizures
- stupor
- hypotension
- coma
- death associated with pulmonary
48
lithium advanced signs of toxicity interventions
- hospitalization
- stop drug and hasten excretion
- - whole bowel irrigation
49
lithium severe toxicity
more than 2.5 mEq/L
- convulsions
- oliguria = none or small amounts of urine
- death
50
lithium severe toxicity interventions
in addition to previously mentioned interventions, hemodialysis may be needed
