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24 Cards in this Set
- Front
- Back
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Typical Antipsychotics
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Chlorpromazine (Thorazine)
Fluphenazine (Prolixin) Perphenazine (Trilafon) Thioridazine (Mellaril) Trifluoperazine (Stelazine) Haloperidol (Haldol) |
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Atypical Antipsychotics
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Aripirazole (Abilify)
Clozapine (Clozaril) Olanzapine (Zyprexa) Quetiapine (Seroquel) Risperidone (Risperdal) Ziprasidone (Geodon) |
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ExtraPyramidal Side Effects
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Dystonia
Pseudoparkinsonism Akathisia Tardive Dyskinesia |
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Dystonia
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Spasms of the eye (oculogyric crisis), neck (torticollis), back (retrocollis), tongue (glossospasm). readily reversed with IM injection of Benedyrl, or benztropine (Cogentin).
Usually occur beginning of treatment. seldom occurs after 3 months |
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Pseudoparkinsonism
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-decreased movements (bradykinesia, akinesia), muscle rigidity, resting hand tremor, drooling, mask-like expression and shuffling gate.
Often misdiagnosed, nurse needs to be able to recognize medication-related symptoms versus illness-generated symptoms. Treatment: reduction of antipsychotic, change of antipsychotic, use of an oral anti-parkinson agent such as cogentin, artane, benadryl or symmetrel. |
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Akathisia
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restlessness, pacing, rocking or inability to sit still. often dose related. sometimes confused with anxiety/agitation
Treatment: propranolol (inderal) usually effective. watch pt's BP. Lorazepam (Ativan) is also helpful. |
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Tardive Dyskinesia
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abnormal movements of any voluntary muscle groups after a prolonged period of Dopamine blockade. Most common muscles include: facfe, mouth, tongue, and digits resulting in grimacing, lip smacking, tongue poking, and writing movements. Often severe and disabling.
No effective treatment. Atypical has much lesser risk for causing TD. TD occurs as a result of up-regulation of dopamine receptors. Decreasing dose temporarily worsens TD but improves EPS. Increasing dose temperorarily improves TD but worsens EPS |
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Cardiovascular side effects of antipsychotics
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Postural Hypotension: dizziness associated w/ lying down and gettingup. resulting from a-adrenergic receptor blockade.
Arrythmia's,palpitations, changes in QT intervals. do a baseline ECG and repeat at maximum dose titration. |
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Neuroleptic Malignant Syndrome (NMS)
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Medical Emergency. symptoms include: decreased LOC, greatly increased muscle rigidity, autonomic dysfunction ( hyperpyrexia, labile hypertension, tachycardia, tachypnea, diaphoresis, and drooling). Muscle necrosis, or rhabdomyolysis is sometimes so severe that it causes myoglobinuric renal failure as large amounts of myoglobin are released from muscle tissue and excreted in the urine causing myoglobinuria.
Lab findings include: leukocytosis (15,000-30,000) and myoglobinuria. |
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NMS treatment
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Immediate discontinuation of all antipsychotic medications
Hydration of client, including administration of IV fluid. Administration of tylenol along with cooling blankets for hyperthermia. Consideration of IV heparin to reduce risk of pulmonary emboli. Management of arrythmias IV infusion of Dantrium, a direct muscle relaxant to reduce muscle rigidity and to treat hyperthermia resulting from breakdown of muscle tissues. Considertaion of dopaminergic drugs such as parlodel, amantadine or anticholinergic drugs |
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1st line treatment of Schizophrenia
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-Olanzapine
-Risperidone -Quetiapine -Aripiprazole |
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Inappropriate uses of atypical Anti-Psychotics includes...
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-Combination with other atypical antipsychotics or with other atypical antipsychotics
-High doses (increase side effects and is more expensive) -Subtherapeutic doses (too low) (often ineffective and lead to treatment with combination therapy resulting in polypharmacy, especially with the elderly.) |
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Clozapine (dibenzodiazepine)
-First atypical antipsychotic introduced for use in the United States. |
-For refractory illness due to the risk of Agranolocytosis. Clients on Clozapine are required to register on the
Clozaril National Registry. -weekly WBC is drawn for the 6 months of therapy -Weight gain is often significant and clients need nutritional counseling before initiation of therapy |
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Risperidone
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Blocks D2 receptors
effective in treating both positve and negative symptoms of psychosis. Side effects: common include insomnia, hypotension, agitation, and headache. lower incidence of EPS, administrering an anticholingergic drug suchc as benztropiine is helpful. |
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Olanzapine (Atypical antipsychotic)
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-Similar to Olanzapine but no risk of Agranulocytosis. effective in treatment of pos/neg symptoms of schizophrenia, monotherapy for bipolar disorder in manic episodes, schizoaffective disorders.
-The rapidly disintegrating Olanzapine tab is usefull. also available in IM injection and treats agitation (overexcited, hostile, or threatening behavior) in schizophrenic or bipolar disorder. -Weight gain is a significant side effect. |
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Imipramine
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First modern antidepressant medication. TCA
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Biologic Theory of Depression
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Depression occurs because of a decreased amount or inadequate function of teh catecholamine neurotransmitters norepinephrine or serotonin. Antidepressant drugs affect the responses of these neurotransmitters.
-A client who fails to respond to one antideppresant will respond more favorably to a different antidepressant. |
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Down Regulation
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The cyclic antidepressants partially block re-uptake of norepinephrine and serotonin. Initially this results in increased amounts of neurotransmitter in the synapse, which reduces the number of receptors on the post-synaptic membrane. This change in recepotr density is called down regulation and takes several weeks to occur and is temporarily associated with the antidepressant response.
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Selective Serotonin Reuptake Inhibitors (SSRI's)
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-1st line drug therapy for the treatment of depression.
-Inhibits the reuptake of 5-HT, which results in an increase of 5-HT concentrations in the synapse -6 SSRI's approved by FDA: 1. Citalopram (Celexa) 2. Fluvoxamine (Luvox) 3. Fluoxetine (Prozac) 4. Paroxetine (Paxil) 5. Sertraline (Zoloft) 6. escitalopram Oxalate (Lexapro) |
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Serotonin Syndrome
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-life threatening.
-confusion -hypomania -restlessness -myoclonus -hyperreflexia -disphoresis -shivering -tremor -diarrhea |
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Serotonin syndrome interventions
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-Discontinuation of medications causing the increase in serotonin
-Supportive measures such as cooling blanket for hyperthernia, benzodiazepines (clonazepam) for myoclonus (sudden twitching muscles) anticonvulsants for seizures, and antihypertensives for increased blood pressure |
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Tricyclic Antidepressants (TCA's)
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-2nd line therapy due to unfavorable adverse effects profile.
-Acts by blocking the reuptake of 5-HT and norepinephrine. -tertiary amines are frequently metabolized to secondary amines and these are more potent in blocking the reuptake of norepinephrine. |
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TCA drugs
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- Amitriptyline (Elavil, Endep)
-Clomipramine (Anafranil) -Desipramine (Norpramin) -Doxepin (Sinequan) -Imipramine (Tofranil) -Nortriptyline (Aventyle) -Maprotiline (Ludiomil) |
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TCA side effects
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Anticholinergic side effects: dry mouth, blurred vision, GI upset. Very sedating. take before bed.
-Cause cardiotoxicity, an ECG before initiating therapy recommended. |
