Flashcards in Pkarmacology Ch10 Deck (66)
What is the main reason for the administration of antipsychotics?
Schizophrenia spectrum disorders
What does the clinical course of schizophrenia usually involve?
It usually involves acute exasperation with intervals of semiremission.
What are the positive symptoms of schizophrenia?
Positive symptoms related to behavior, thought, and speech ( aggitation, delusions, hallucinations, tangential speech patterns)
What are the negative symptoms of schizophrenia?
Social withdrawal, lack of emotion,lack of energy ( anergia), flattened affect, decreased motivation, decreased pleasure in activities.
What are the goals of psychopharmacological treatment for schizophrenia spectrum and other psychotic disorders?
Suppressing acute episodes
Preventing acute reference
Maintaining the highest level of functioning
What drugs control mainly the positive symptoms of schizophrenia?
First generation(conventional) antipsychotic meds
Reserved for clients who use them successful and can tolerate adverse effects.
Or for clients who are particularly violent or aggressive
Second generation (atypical) antipsychotic meds are the choice of drug for clients who.....
For clients receiving initial treatment and for treating breakthrough episodes in clients on conventional meds, because they are more effective with fewer adverse effects.
Advantages of atypical antipsychotic drugs include....
Relief of both the positive & negative symptoms of the disease.
Decrease in affective manifestations ( depression, anxiety)& suicidal behaviors.
Improvement of neurocognitive deficits such as poor memory.
Fewer extrapyramidal side effects including TD because of less dopamine blockade.
Fewer anticholinergic adverse effects because most atypical antipsychotics, with the exception of clozapine, cause little or no blockade of cholinergic receptors.
What is the prototype drug of 1st generation ( conventional) antipsychotics?
chlorpromazine ( Thorazine)- low potency
What are other drugs in the 1st generation ( conventional) antipsychotic class of drugs?
haloperidol ( Haldol)- low potency
fluphenazine- high potency
thiothixene (Navane)- high potency
perphenazine- medium potency
What is the expected pharmacological action of 1st generation (conventional) antipsychotic drugs?
Blocks dopamine (D2), acetylcholine, histamine, & norepinephrine ( NE) receptors in the brain and periphery.
Inhibition of psychotic manifestations, believed to be a result of D2 blockade in the brain.
What are the therapeutic uses of 1st generation (conventional) antipsychotics?
Tx of acute & chronic psychotic disorders
Schizophrenia spectrum disorders
Bipolar disorders( primarily manic phase)
Prevention of nausea/ vomiting thru blockade of dopamine in the chemoreceptor trigger zone of the medulla.
What are the adverse effects/EXTRAPYRAMIDAL SIDE EFFECTSof 1st generation (conventional) antipsychotics?
Acute dysphonia/ the client experiences severe spasms of tongue, neck, face or back. This is a crisis situation, which requires rapid tx.
Monitor for acute dystopia between 5hr- 5 days after administration of 1st dose. Treat w/ anticholinergic agents such as benztropine or diphenhydramine. Use oral doses for less acute effects and IM OR IV doses for serious effects.
What are adverse/ extrapyramidal side effects of 1st generation (conventional) antipsychotic drugs?
Parkinsonism/ clinical findings include bradykinesia, rigidity, shuffling gait, drooling and tremors.
Observe for Parkinsonism within 1 month of initiation of therapy.
Treat w/ benxtropine, diphenhydramine or amantadine.discontinue these meds to determine if they are still needed. If manifestations return, administer atypical antipsychotic as prescribed.
What are adverse extrapyramidal side effects of 1st generation (conventional) antipsychotic drugs?
Akathisia/ the client is unable to stand still or sit, and is continually pacing or agitated.
Observe 4 akathisia within 2 months of initiation of tx.
Manage effects with beta-blocker, benzodiazepines, or anticholinergic meds.
What are adverse/ extrapyramidal side effects of 1st generation (conventional) antipsychotics?
Tardive dyskinesia TD/manifestations include involuntary movements of the tongue and face such as lip smacking, which cause speech and/ or eating disturbances. TD may also include involuntary movements of arms, legs or trunk.
TD is a late EPS that may occur months to yrs after the start of therapy, and may improve following med change and be permanent
Administer lowest possible dosage to control manifestations
Evaluate client after 12 months of therapy, then Q3 months.
If indications of TD appear, dosage should be lowered or the client should be switched to an atypical agent.
What are other adverse/extrapyramidal symptoms of 1st generation ( conventional) antipsychotics?
Neuroleptic malignant syndrome/ manifestations include sudden high grade fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, and change in level of consciousness developing into a coma.
Stop antipsychotic meds/ monitor vital signs/ apply cooling blankets/ administer antipyretics/increase fluid intake/administer diazepam(Valium) to control anxiety/administer dantrolene (Dantrium) to induce muscle relaxation.
Wait 2 weeks before resuming therapy, consider switching to an atypical agent.
What are adverse/extrapyramidal side effects of 1st generation ( conventional) antipsychotic drugs?
Anticholinergic effects such as dry mouth, blurred vision, photophobia, urinary hesitancy/ retention, constipation, tachycardia
What are adverse / extrapyramidal effects of 1st generation (conventional) antipsychotics?
Neuroendocrine effects which include gynecomastia ( breast enlargement), galactorrhea, and menstrual irregularities.
Advise clients to observe for manifestations and to notify the provider if these occur.
What are other adverse /extrapyramidal effects of 1st generational (conventional) antipsychotic drugs?
Seizures, skin effects such as sunburn, photosensitivity, and contact dermatitis for handling of the drug.
Orthostatic hypotension, sedation sexual dysfunction.
What is an effect that one must watch out for when taking 1st generation ( conventional) antipsychotics?
Advise clients to observe for indications of infection ( fever, sore throat) and to notify provider if these occur.
If indications of infection appear, obtain the clients baseline WBC.
Med should be discontinued if lab tests indicate infection.
What are possible effects of 1st generation (conventional) antipsychotics?
Obtain the clients baseline ECG and potassium level prior to tx, and periodically throughout tx.
Avoid concurrent use with other meds that prolong QT intervals.
1st generation (conventional) antipsychotics are contraindicated in clients who........
Contraindicated in clients in a coma, who have severe depression, Parkinson's, prolactin- dependent cancer of the breast, and severe hypotension.
Contraindicated in clients who have dementia
Use cautiously in clients who have glaucoma, paralytic ileus, prostate enlargement, heart disorders, liver or kidney disease and seizure disorders.
What are medication food interactions of 1st generation (conventional) antipsychotic drugs?
Concurrent use of anticholinergic agents with other anticholinergic meds will increase anticholinergic effects./ advise clients to avoid OTC meds w/ anticholinergic agents such as sleeping aids.
Alcohol, opiods, and antihistamines have additive CNS effects.
By activating dopamine receptors, levodopa counteracts the effects of antipsychotic agents./ avoid concurrent use of levodopa and other direct dopamine receptor agonists.
What tool should nurses use to screen for the presence of EPS?
Use the abnormal involuntary movement scale (AIMS)
What should be administered to control early EPS?
Administer anticholinergics, beta- blockers, and benzodiazepines to control early EPS.
Do antipsychotic meds cause addiction?
When should a pt. feel the effects of (conventional) antipsychotics?
Adivise clients that some therapeutic effects may be noticeable within a few days, but significant improvement may take 2-4 weeks and possibly several months for full effects.
How often should 1st generation (conventional) antipsychotics be administered?
Start administration with twice a day dosing, then switch to daily dosing at bedtime to decrease daytime drowsiness and promote sleep.
What is the prototype drug of atypical (second generation) drugs?
What are other atypical antipsychotic meds? ( 2nd generation)
What are the expected pharmacological actions of 2nd generation antipsychotics?
These antipsychotic agents work mainly by blocking serotonin, and to a lesser degree, dopamine receptors. These meds also block receptors for norepinephrine, histamine, and acetylcholine.
What are therapeutic uses of Atypical antipsychotic drugs?
Schizophrenia spectrum disorders ( negative and positive symptoms)
Psychotic episodes induced by levodopa therapy
Relief of psychotic manifestations in other disorders such as bipolar disorders.
What formulations do atypical 2nd generation antipsychotics come in?
Quick dissolving tablets
IM depot preparation ( Risperdal Consta)
What are adverse effects of 2nd generation atypical antipsychotics?
New onset of diabetes mellitus or loss of glucose control in clients who have diabetes.
Obtain baseline fasting blood glucose & monitor throughout tx.
Instruct clients to report indications( increased thirst, urination, and appetite)
What are other adverse effects that occur with 2nd generation atypical antipsychotics?
Wt gain, orthostatic hypotension, anticholinergic effects, agitation, dizziness, sedation and sleep disruption. Mild EP, such as tremors.
What are some facts about risperidone?
Pregnancy category C
Contraindicated in clients who have dementia.
All atypical antipsychotic medications can cause death related to cerebrovascular accident or infection.
Avoid use of alcohol
Use cautiously in clients who have cardiovascular or cerebrovascular diseases, seizures, or diabetes mellitus. Obtain a fasting blood glucose for clients who,have diabetes mellitus, and monitor blood glucose carefully.
What are the formulations and complications of olanzapine?
Formulations- tablets, short acting injectable, extended release injection
Olanzapine has a Low risk of EPS
Olanzapine has a high risk for diabetes mellitus, wt gain, and dyslipidemia.
Other adverse effects include sedation, orthostatic hypotension and anticholinergic effects.
What are the formulations and complications of quetiapine?
Formulations-tablets, extended release tablets
quetiapine has a low risk of EPS
quetiapine has a moderate risk for diabetes mellitus, wt. gain, and dyslipidemia.
Other effects include cataracts, sedation, orthostatic hypotension and anticholinergic effects.
Clients should have screening eye exam and then Q 6 months.
What are the formulations and complications of aripiprazole?
Formulations- tablets, orally disintegrating tablets, oral solution, short acting injectable.
Complications- aripiprazole has a low or no risk of EPS, diabetes mellitus, wt. gain, dyslipidemia, hypotension, and anticholinergic effects. Other adverse effects include headache, anxiety, insomnia, sedation, and gastrointestinal upset.
Affects both dopamine and serotonin; can b used for clients who have concurrent depression.
Formulation- capsules, short acting injectable
Ziprasidone has a low risk of EPS, diabetes mellitus, wt gain and dyslipidemia. Other effects include sedation, orthostatic hypotension, anticholinergic effects, and rash.
ECG changes and QT prolongation may lead to torsades de pointes.
What is the 1st atypical antipsychotic med developed?
Despite its effectiveness for schizophrenia spectrum disorders, it is no longer considered a first line med because of its adverse effects.
What formulations do clozapine come in?
Orally disintegrating tablets
What are complications of clozapine?
Clozapine has a low risk of EPS
high risk of wt. gain, diabetes mellitus, and dyslipidemia.
Agranulocytosis may occur/ obtain baseline WBC & monitor weekly.
Monitor for indications of infection( fever, sore throat, lesions in mouth)
Notify provider if manifestations occur.
Other adverse effects include sedation, orthostatic hypotension and anticholinergic effects.
What formulations do paliperidone come in?
Extended release tablets
Extended release injections
What are complications of paliperidone?
Has a high risk for diabetes mellitus, wt. gain, and dyslipidemia.
Other adverse effects include sedation, prolonged QT intervals, orthostatic hypotension, anticholinergic effects and mild EPS.
What formulations do asenapine come in?
What are complications of asenapine?
Adverse effects include drowsiness, prolonged QT intervals, and EPS( higher doses)
Causes temporary numbing of the mouth
Asenapine has a LOW risk of diabetes mellitus, wt gain, dyslipidemia and anticholinergic effects
What formulations do iloperidone come in?
What are complications of iloperidone?
Common adverse effects include dry mouth, sedation, fatigue, and nasal congestion.
Iloperidone has a significant risk for wt. gain, prolonged QT intervals, and orthostatic hypotension.
Advise clients to follow titration schedule during initial therapy to minimize hypotension.
Has a low risk for diabetes mellitus, dyslipidemia and EPS.
Lurasidone comes in what formulations?
What are the complications of lurasidone?
Common adverse effects include sedation, akathisia, Parkinsonism, agitation and anxiety.
Has a low risk for diabetes mellitus, wt. gain and dyslipidemia.
DOES NOT CAUSE ANTICHOLINERGIC EFFECTS!
What medication interactions react with clozapine?
Immunosuppressive meds such as ANTICANCER meds, can further SUPRESS immune function in clients taking clozapine.
Avoid use in clients taking clozapine.
What are interactions of antipsychotic drugs?
Alcohol, opiods, and antihistamines have additive CNS depressant effect.
By activating dopamine receptors, levodopa counteracts the effects of antipsychotic agents/ avoid concurrent use of levodopa and other direct dopamine receptor agonists.
What are contraindications of ziprasidone?
Tricyclic antidepressants, amiodarone ( cordarone) and clarithromycin ( biaxin) prolong QT intervals and thus increases the risk of cardiac dysrhythmias in clients taking ziprasidone.
What decreases the drug levels of aripiprazole, quetiapine, and ziprasidone?
Barbituates and phenytoin ( Dilantin) stimulate hepatic medication- metabolizing enzymes thereby decreasing the drug levels of these drugs.
Monitor for med effectiveness.
What increases the drug levels of aripiprazole,quetiapine, and ziprasidone?
Fluconazole ( Diflucan) inhibits hepatic medication metabolizing enzymes and thereby increases the levels of these drugs.
Monitor for adverse effects or toxicity.
What should a nurse advise clients to do when taking asenapine?
Avoid eating or drinking 10 minutes after each dose.
What should you educate a client to do when taking lurasidone?
Administer with food to increase absorption.
A nurse is teaching a client who has schizophrenia strategies to cope with anticholinergic effects of fluphenazine. What could the nurse suggest to the client?
Chew sugarless gum to moisten the mouth.
A nurse is assessing a male client who recently began taking haloperidol (Haldol). What is a high priority to report to the provider?
They are an indication of acute dystopia which is a crisis situation requiring rapid treatment.
A nurse is providing discharge teaching to a client who has a new prescription of clozapine ( Clozaril). What would b appropriate to include in the teaching?
The pt. Should have their WBC count monitored each week because due to,the risk for fatal agranulocytosis.
Lip smacking, tongue protrusion, and facial grimacing while taking locating for 2 years would possibly indicate what to the nurse?
Tardive dyskinesia which can occur months to years after initiation of therapy.
A nurse is preparing to perform a follow up assessment on a client who takes chlorpromazine ( Thorazine) for the treatment of schizophrenia. The nurse should expect the greatest improvement in what manifestations?
What are adverse effects of conventional 1st generation antipsychotic meds?
Acute dysphonia. Neuroendocrine effects
Akathisia. Skin effects
Tardive dyskinesia. Agranulocytosis
Neuroleptic malignant syndrome