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27 Cards in this Set
- Front
- Back
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Thorazine versus Haldol in terms of onset?
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Thorazine: has a big first pass effect leaving bio-availability of the drug at 30%. The effect is increased 10x when given IV or IM instead of orally.
Haldol: both initially 1-2 days, substaintially 2-4 weeks, full in several months |
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Thorazine versus Haldol in terms of Relative incidence in CNS/PNS effects?
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Thorazine: is a lower potency FGA than Haldol and so that decreases the EPS effects.
- anticholinergic effects are frequent in the lows Also... -Agranulocytosis (rare) -NMS (rare) Haldol: Stronger risk the 4 EPS. Very rare to have the anti-cholinergic effects also... - Neuroleptic Malignant Syndrome (rare) -dysrythmias by prolonging the QT interval) Risk of TD is the same in both |
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Why do Anti-psychotics produce adverse side effects similar to the S/S of Parkinson's Disease?
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Anti-psychotics block Dopamine receptors in CNS. Similarly PD is characterized by a lack of Dopamine secreting cells.
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What are the main EPS's caused by Anti-psychotics?
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Acute dystonia, Parkinsonism, Akathisia all occur early in therapy and these can be fixed with drugs.
Tardive Dyskinesia occurs later in therapy and there is not satisfactory therapy for it. |
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Neuroleptic Malignant Syndrome:
What is its cause and what are some characteristics of the syndrome? How is treated? |
Caused by an Adverse reaction to High potency FGA's.
S/S: high fever, muscular rigidity (lead pipe), confusion, autonomic instability. Tx: Dantrolene or bromicriptine |
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Clozapine is the prototype of Atypical Antipsychotics BUT NOT a first-line drug for Schizophrenia yet its preferred specifically for Levodopa induced Pyschosis. Why?
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It's risk of Agranulocytosis makes it a last resort despite it being the most effective drug for treating Schizophrenia.
It is used specifically for Levodopa induced Psychosis because... |
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What is used to treat the ESP's; acute dystonia and parksinsonism?
Intense dystonia? |
Anticholinergic drugs
Benadryl Vital signs should be take AFTER the initial management of the psychological crisis caused by acute dystonia. |
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To what degree do spams need to present in order for it to be termed Acute Dystonia?
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SEVERE of the tongue, face neck and back
MILD doesnt cut it |
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TD is a late EPS and has no reliable treatment. For patients with TD what might help?
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switching to an atypical anti-psychotic
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Thorazine is the prototype for Low potency FGA's. What patient teaching point needs to be made regarding the use of this drug?
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the drug should not make contact with the skin because it will cause dermatitis. This may a teaching point with any anti-psychotic but not sure.
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Which anti-psychotic is the most effective?
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Clozapine (chlorpromazine) which was the first SGA
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Clozapine can cuase potentially fatal _________?
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Agranulocytosis
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Two distinguishing pro's and con's of Atypical Anti-depressants?
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Atypical Anti-depressants pose a weight gain and DM risk but they have a lower rate of relapse in patients.
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How do conventionals (FGA's) compare to atypicals (SGA's) with regards to + and - symptoms?
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same effect on + symptoms
The atypicals have a fewer - symptoms related to their use ( EPS and cognitive dysfunction). |
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What atypical tend to cause small moderate and beyond moderate weight gain?
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Geodon (ziprasidone) = small
Thoridazine and Quetiapive= moderate Zyprexa (olanzapine) = beyond moderate |
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Where are FGA’s and SGA's in the therapeutic index?
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200
very low risk of overdose toxicity |
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What drug interactions in particular should you be monitoring while using Anti-pshychotics?
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Anti-cholinergics, CNS depressants, and Levodopa in particular will potentiate the Dopamine effect of blocking the effects.
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What is the tx onset of FGA’s?
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Alleviation of symptoms NOT curative. Initial onset in 1 to 2 days, substantial effect in 2-4 weeks, full effect in several months.
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What is the difference between FGA’s and SGA’s in their mechanism of action?
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FGA’s block Dopamine receptors while SGA’s block Dopamine receptors to a lesser degree and block Serotonin receptors additionally. This means less EPS symptoms with SGA’s
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How High potency FGA’s differ from Low potency FGA’s?
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All FGAs are equally effective. Differences relate to side effects.
High-potency agents produce fewer side effects than the low potency agents. High potency agents produce more early EPS but less sedation, orthostatic hypotension and anticholinergic effects; therefore, high potency agents are generally preferred for initial therapy. |
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Which assessment best determines tardive dyskinesia in a patient taking antipsychotic agents?
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Twisting, writhing, worm-like movements of the tongue and face
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Second- generation antipsychotic (SGA)drugs are commonly preferred over first generation antipsychotics (FGA) primarily because they:
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do not affect thinking
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A highly potent antipsychotic differs from low potency drugs in that it:
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Produces desired effects at low doses
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The priority nursing focus for a patient experiencing acute dystonia is
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Airway clearance
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Which of these findings, if identified in a patient who has been receiving a neuroleptic antipsychotic, should the nurse report to the prescriber immediately?
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Sudden, whole-body muscle contractions.
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Which of the following symptoms of an adverse effect, if identified in a patient who is receiving thioridazine (Mellaril) or haloperidol (Haldol), should the nurse report to the prescriber immediately?
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Red skin
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A patient’s daughter has read that clozapine (Clozaril) is the most effective second-generation antipsychotic. Which of the following should the nurse include in the explanation of why this drug is not used until other agents have failed?
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Clozaril can have an effect on white blood cell production.
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