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29 Cards in this Set

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Which meds are better for positive symptoms of Schizophrenia?
Traditional Conventional Antipsychotics: act on dopamine receptors

Haloperidal (Haldol), Trifluoperazine (Stelazine), Chlorpromazine (Thorazine), Deconoate (Haloperidol deconoate and Fluphenaziine deconoate).
What are the positive symptoms of Schizophrenia?
delusions, ideas of reference, persecution, grandiosity, somatic sensations, jealousy, control, thought broadcasting, thought insertion, thought withdrawal, delusion of being controlled, alterations in speech: associative looseness, neoglisms, echolalia, clan association, word salad.
Alterations in perception: (hallucinations: sensory perception for which no external stimulus exists)
Personal Boundary difficulties
Alterations in behavior: extreme motor agitation, stereotyped behaviors, automatic disobedience, waxy flexibility, stupor, negativism.
What are the negative symptoms of Schizophrenia?
affective blunting, anergia (lack of energy), anhedonia (no pleasure), avolition (lack of motivation), poverty of content of speech, thought blocking (lost ability to think), flat affect/inappropriate affect
What are the side effects to watch for with typical conventional antipsychotics?
EPS, Anticholinergic effects, lower seizure threshold
what are the EPS symptoms?
akathisia (inner restlessness), dystonia (sustained muscles contractions, twitching), parkisoniasm, tardive dyskinesia (twitching of face, tongue rolling, lip smacking, limbs- rapid, purposeless, slow, complex movements), rocking, twisting pelvic thrust.
what are delusions?
false, fixed beliefs that cannot be corrected by reasoning
what meds are best for negative symptoms of Schizophrenia
Atypical Or Novel Antipsychotics
Serotonin, dopamine ,(5HT4) Antagonists

diminishes negative and positive s/s


Clozapine (Clozaril), Quetiapine (Seroquil), Risperidone (Risperdal), Zipreasidone (Geodon), Olanzapine (Zyprexa), Aripoprazole (Abilify)
What meds are typical?
Haloperidal (Haldol), Trifluoperazine (Stelazine), Chlorpromazine (Thorazine), Halperidol deconoate (haldol), Fluphenazine deconoate (prolixin)
What meds are Atypical
Clozapine (Clozaril), Quetiapine (Seroquil), Risperidone (Risperdal), Zipreasidone (Geodon), Olanzapine (Zyprexa), Aripoprazole (Abilify)
If patient has EPS what prn med would be ordered?
Dantrium (dantrolene) - tx to reduce muscle spasms

antiparkinsonian meds (use of this may make ACH effects go up)

anticholinergic drugs: (Benadryl) Diphenhydramine HCL - first choice, (Artane) trihexyphenidyl, benztropine (cogentin), (Symmetryl) amantadine HCL, (Akineton) Biperidon, Procyclidine HCL (Kemadrin), Bromocriptine mesylate (Parlodel)
What side effects to watch for with atypical antipsychotics meds?
less side effects: wt gain and metabolic abnormalities (glucose dysregulation and hypercholesterolemia) which increase cardiac adn diabetes issues, ACH s/e, less eps s/e
what are the anticholinergic side effects?
blurred vision, dry mouth, constipation, urinary retention and hesistancy, photosensitivity, dry eyes, inhibition of ejaculation or impotence in men
What are some of the rare yet toxic effects of typical antipsychotics?
ACH s/e and EPS s/e, Hypotension, postural hypotension, tachycardia

Rare: Agranulocytosis, Cholestatic jaundice, NMS (neuroleptic malignant syndrome)
Severe EPS, Hyperpyrexia, Autonomic dysfunction (decreased LOC, hyperprexia,
neuroleptic malignant syndrome
Clozapine (Clozaril) side effects? what type of drug?
atypical antipsychotic

agranulocytosis
high seizure rate
excessive salivation
tachycardia
Risperidal (Risperidone) side effects and what type of drug?
atypical antipsychotic

Hypotension
insomnia
sedation
sexual dysfunction
Olanzapine (Zyprexa)
atypical antipsychotic
34% wt gain
drowsiness
insomnia
possible akathisia and parkinsonism
Quetiapine (Seroquel)
atypical antipsychotic
orthostasis
HA
Ziprasidone (Geodon)
atypical antipsychotic
ECG changes
Low wt gain
Target depressive episodes
Aripiprazole (Abilify)
atypical antipsychotic
New class
little or no wt gain
increase in glucose, HDL, LDL, or triglyceride levels
Haloperidal (haldol)
Typical Antipsychotic
low sedative
large doses for assaultive behaviors also same in elderly
(avoid s/e of hypotension)
Less falls and dizziness
High EPS
Trifluoperazine (Stelazine)
Typical Antipsychotic
low sedative
use for paranoia and withdrawal
High EPS
NMS
Chlorpromazine (Thorazine)
Typical Antipsychotic
Increase sensitivity to sun
Highest sedative and hypotensive
Retinitis Pigmentosa (800 mg/day)
Haloperidol deconoate (Haldol)
Typical Antipsychotic
long lasting
z track IM
given q3-4 wks
Fluphenazine deconoate (Prolixin)
Typical antipsychotic
long acting
Z track IM
given q2-4 wks
How often do you need to get blood work for agranulocytosis?
q wk for 6 months
How do u treat a patient with Cholestatic Jaundice?
stop meds, give high protein and high carb diet. LFT q 6 months

S/e of typical antipsychotic
TX of NMS?
dantrium (reduce muscle spasms) and Bromocriptine (Parlodel) relieve muscle rigidity, cool body temp, stop neuroleptic, fluids, electrolytes, tx arrythmias, heparin for emboli, early detection
Autonomic dysfunction?
tachycardia, hypertension, diaphoresis, incontinence