Pharmacology Ati Psychotic Disorders (Chapter 10; Unit 2)

Front 1

what is the primary reason for the administration of antipsychotic medications?

Back 1

the treatment of schizophrenia spectrum disorders

Front 2

the clinical course of schizophrenia usually involves ___________

Back 2

acute exacerbations with intervals of semiremissions

Front 3

what are the positive symptoms of schizophrenia spectrum/psychotic disorders?

Back 3

agitation, delusions, hallucinations, tangential speech patterns

Front 4

what are the negative symptoms of schizophrenia spectrum/psychotic disorders?

Back 4

social withdrawal, lack of emotion, lack of energy (anergia), flattened affect, decreased motivation, decreased pleasure in activities

Front 5

what are the goals of treatment for psychotic disorders/schizophrenia?

Back 5

1. suppressing acute episodes

2. preventing acute recurrence

3. maintaining the highest possible level of functioning

Front 6

what is another name for first-generation antipsychotic medications?

Back 6

conventional

Front 7

first-generation antipsychotic meds are control mainly _________

Back 7

positive symptoms such as hallucinations, delusions and bizarre behavior of psychotic disorders

Front 8

firt-generation (conventional) antipsychotic meds are usually reserved for clients who are _____

Back 8

1. using them successfully and can tolerate the adverse effects

2. violent or particularly aggressive

Front 9

second-generation antipsychotic agents are also referred to as _________

Back 9

atypical

Front 10

atypical antipyshotic agents are the meds of choice for what type of clients?

Back 10

those receiving initial treatment and for treating breakthrough episodes in clients on conventional med therapy, because atypicals are more effective with fewer adverse effects

Front 11

what are the advantages of atypical/second-generation antipsychotic agents?

Back 11

1. relief of both the positive and negative symptoms of the disease

2. decrease in affective manifestations (depression, anxiety) and suicidal behaviors

3. improvement of neurocognitive deficits such as poor memory

4. fewer or no extrapyramidal side effects (EPSs) including tardive dyskinesia (TD), because of less dopamine blockade

5. fewer anticholinergic adverse effects because most atypical antipsychotics withe the exception of clozapine (Clozaril) cause little or no blockade of cholinergic receptors

6. less relapse

Front 12

clozapine

Back 12

Clozaril

Front 13

first-generations (conventional) antipsychotics used to treat psychotic disorders (also name their potencies)

Back 13

1. chlorpromazine (Thorazine) - low potency

2. haloperidol (Haldol) - high potency

3. fluphenazine - high potency

4. thiothixene (Navane) - high potency

5. perphazine - medium potency

Front 14

what is the MOA of chlorpromazine (Thorazine)/conventional antipsychotics?

Back 14

1. blocka dopamine (Dsub2), acetylcholine, histamine, and norepi (NE) receptors in the brain and periphery

2. inhibition of psychotic manifestations, believed to be a result of Dsub2 blockade in the brain

Front 15

Therapeutic uses of first-generation/conventional antipsychotics

Back 15

1. treatment of acute and chronic psychotic disorders

2. schizophrenia specturm disorders

3. bipolar disorders (primarily the manic phase)

4. Tourette's disorder

5. prevention of nausea/vomiting through blocking of dopamine in the chemoreceptor trigger zone of the medulla

Front 16

what are the categories of adverse effects for chlorpromazine (Thorazine) when treating psychotic disorders?

Back 16

1. extrapyramidal side effects (EPSs)

2. Neuroleptic malignant syndrome

3. anticholinergic effects

4. neuroendocrine effects

5. seizures

6. skin effects

7. additional

Front 17

what are the EPSs of chlorpromazine (Thorazine)

Back 17

1. acute dystonia

2. parkinsonism

3. akathisia

4. tardive dyskinesia (TD)

Front 18

describe adverse side effects of chlorpromazine: acute dystonia

Back 18

client experiences severe spasms of tongue, neck, face, or back. this is a crisis situation which requires rapid treatment

Front 19

describe adverse side effects of chlorpromazine: parkinsonism

Back 19

clinical findings include bradykinesia, rigidity, shuffling gait, drolling and tremors

Front 20

describe adverse side effects of chlorpromazine: akathisia

Back 20

client is unable to stand still or sit and is continually pacing and agitated

Front 21

describe adverse side effects of chlorpromazine: tardive dyskinesia (TD)

Back 21

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 movemnts of arms, legs, or trunk

Front 22

nursing interventions for acute dystonia from chlorpromazine

Back 22

1. monitor for acute dystonia between 5 hrs to 5 days after administration of first dose

2. treat with anticholinergic agents such as benztropine (Cogentin) or diphenhydramine (Benadryl); use oral doses for less acute efects and IM or IV doses for serious effects

Front 23

benztropine

Back 23

Cogentin

Front 24

diphenhydramine

Back 24

Benadryl

Front 25

chlorpromazine

Back 25

Thorazine

Front 26

haloperidol

Back 26

Haldol

Front 27

fluphenazine

Back 27

no brand name

Front 28

Thiothixenen

Back 28

Navane

Front 29

what are the nursing interventions for Parkinsonism from chlorpromazine (Thorazine)

Back 29

1. observe for parkinsonism within one month of initiation of therapy

2. treat with benztropine, diphenhydramine, or amantadine (Symmetrel); discontinue these meds to determine if they are still needed; if manifestations return, administer atypical antipsychotic as prescribed

Front 30

what are the nursing interventions for akathisia from chlorpromazine (Thorazine)

Back 30

1. observe for akathisia within 2 months of the initiation of treatment

2. manage effects with beta-blockers, benzodiazepine, or anticholinergic medication

Front 31

what are the nursing interventions for tardive dyskinesia (TD) from chlorpromazine (Thorazine)?

Back 31

1. TD is a late EPS that may occur months to years after the start of therapy and may improve following med change or may be permanent

2. administer lowest dose possible to control manifestations

3. evaluate client after 12 months of therapy and then every 3 months; if indications of TD appear, dosage should be lowered or the client should be switched to an atypical agent

Front 32

what are the manifestations of neuroleptic malignant syndrome as an adverse effect of chlorpromazine (Thorazine)?

Back 32

sudden high-grade fever, BP fluctuations, dysrhythmias, muscle rigidity, and change in level of consciousness developing into coma

Front 33

what are the nursing interventions of neuroleptic malignant syndrome from chlorpromazine (Thorazine)?

Back 33

1. stop antipsychotic med

2. monitor vitals

3. apply cooling blankets

4. administer antipyretics (aspirin, acetaminophen)

5. increase fluid intake

6. admin diazepam (Valium) to control anxiety

7. admin dantrolene (Dantrium) to induce muscle relaxation

8. wait 2 weeks before resuming therapy; consider switching to atypical agent

Front 34

what are the adverse anticholinergic effects from chlorpromazine (Thorazine)?

Back 34

dry mouth, blurred vision, photophobia, urinary hesitancy/retention; constipation; tachycardia

Front 35

what are the nursing interventions for adverse anticholinergic effects from chlorpromazine (Thorazine)?

Back 35

1. chewing sugarless gum

2. sipping water

3. avoid hazardous activities

4. wearing sunglasses when outdoors

5. eating foods high in fiber

6. participating in regular exercise

7. maintatining fluid intake of 2 to 3L of water each day from food and bev sources

8. voiding just before taking medication

Front 36

what are the adverse neuroendocrine effects of chlorpromazine (Thorazine)? (name nursing intervention)

Back 36

gynecomastia (breast enlargement); galactorrhea, and menstrual irregularities -> manifestations inform and notify provider

Front 37

what are the nursing interventions for seizures from chlorpromazine (Thorazine)?

Back 37

1. advise clients to report seizure activity to the provider

2. an increase in antiseizure med may be necessary

Front 38

what puts someone at greatest risk for developing seizures as an adverse effect of a medication?

Back 38

previously exisiting condition of seizures/previous seizure disorders

Front 39

what are the adverse skin effects of chlorpromazine (Thorazine) (name nursing interventions)

Back 39

photosensitivity resulting in severe sunburn and contact dermatitis from handling meds -> 1. advise client to avoid sunlight exposure/use sunscreen/protective clothing 2. advise avoid direct contact with meds

Front 40

what are the additional adverse effects of chlorpromazine (Thorazine)

Back 40

1. orthostatic hypotension

2. sedation

3. sexual dysfunction

4. agranulocytosis

5. severe dysrhythmias

Front 41

in which gender is sexual dysfunction more common as an adverse effect of chlorpromazine (Thorazine)

Back 41

common in both males/females

Front 42

name nursing interventions for orthostatic hypotension effects of chlorpromazine (Thorazine)

Back 42

1. should develop tolerance in 2 to 3 months

2. in the hospital setting, monitor BP and HR for orthostatic changes; if significant decrease in BP/HR is noted don't administer med and notify provider

3. instruct clients about signs of postural hypotension (lightheadedness, dizziness). advise client to lie or sit down if occur; changing positions slowly

Front 43

nursing intervention for chlorpromazine (Thorazine): sedation

Back 43

1. inform clients that effects shoudl diminish within a few weeks

2. clients may take med at bedtime to avoid daytime sleepiness

3. advise not to drive

Front 44

nursing intervention for chlorpromazine (Thorazine): sexual dysfunction

Back 44

1. advise of possible adverse effects

2. encourage clients to report adverse effects to provider

3. client may need a lower dosage or switched to a high-potency agent

Front 45

nursing intervention for chlorpromazine (Thorazine): agranulocytosis

Back 45

1. advise clients to observe for indications of infection (fever, sore throat, and to notify the provider if these occur)

2. if indications of infection appear, obtain the client's baseline WBC. med should be discontinued if labs indicate presence of infection

Front 46

nursing intervention for chlorpromazine (Thorazine): severe dysrhythmias

Back 46

1. obtain baseline ECG and potassium level prior to treatment and throughout

2. avoid concurrent use with other meds that prolong QT interval

Front 47

first-generation/conventional antipsychotics are contraindicated for clients who ________

Back 47

are in a coma, have severe depression, parkinson's disease, prolactin-dependent cancer of the breast, and severe hypotension, older clients who have dementia

Front 48

use conventional antipsychotics cautiously in clients who have _________

Back 48

glaucoma, paralytic ileus, prostate enlargement, heart disorders, liver/kidney disease, and seizure disorders

Front 49

med/food interactions of chlorpromazine (Thorazine)

Back 49

1. use with anticholinergic agents with other anticholinergic meds will increase anticholinergic effects

2. alcohol, opiods, and antihistamines have additive CNS depressant effects

3. by activating dopamine receptors, levodopa counteracts the effects of antipsychotic agents

Front 50

nursing interventions of med/food interactions of con

Back 50

1. anticholinergic additive effects -> advise clients to avoid OTC meds that contain anticholinergic agents such as sleep aids

2. alcohol, opiods, antihistamine -> advise to avoid alcohol and CNS depressants, advise against hazardous activity such as driving

3. levodopa -> avoid concurrent use and other dopamine receptor agonists

Front 51

how should you screen for the presence of EPS?

Back 51

the Abnormal Involuntary Movement Scale (AIMS)

Front 52

to control early EPS of conventional antipsychotics, what should be used; if adverse effects are intolerable what is the next step?

Back 52

1. anticholinergics, beta-blockers, benzodiazepines

2. switch to low-potency conventional or atypical antipsychotic

Front 53

do antipsychotic meds cause addiction?

Back 53

no

Front 54

do antipsychotic meds work immediately?

Back 54

no, therapeutic within a few days but significant improvement can be up to 2-4 weeks and possibly months for full effects

Front 55

if client is having difficulty maintaining med regime for conventional antipsychotics, what is an option?

Back 55

depot regime, IM once every 2 to 4 weeks; lower doses can be used with depot which decreases risk of adverse effects and development of TD (tardive dyskinesia)

Front 56

how should you plan the dosing for conventional psychotics?

Back 56

start with twice-a-day dosing then switch to daily dosing at bedtime to decrease daytime drowsiness and promote sleep

Front 57

name the second-generation (atypical) antipsychotics

Back 57

1. risperidone (Risperdal)

2. olanzapine (Zyprexa)

3. quetiapine (Seroquel)

4. aripiprazole (Abilify)

5. ziprasidone (Geodon)

6. clozapine (Clozaril)

7. asenapine (Saphris)

8. lurasidone (Latuda)

9. paliperidone (Invega)

10. iloperidone (Fanapt)

Front 58

MOA of atypical antipsychotics

Back 58

work mainly by blocking serotonin and to a lesser degree, dopamine receptors; these meds also block receptors for norepi, histamine, and acetylcholine

Front 59

what are the therapeutic uses for atypical antipsychotics?

Back 59

1. schizophrenia spectrum disorder (negative and positive symptoms)

2. psychotic episodes induced by levodopa therapy

3. relief of psychotic manifestations in other disorders such as bipolar disorders

Front 60

what are the different sort of formulations you can find for atypical antipsychotics (note not all are found in each form)

Back 60

1. tablets

2. quick-dissolving tabs

3. oral solution

4. IM depot preparation (Risperdal Consta)

Front 61

what are the adverse effects of risperidone (Risperdal)

Back 61

1. new onset of DM or loss of glucose control in clients who have diabetes

2. weight gain

3. hypercholesterolemia with increased risk for hypertension and other cardiovascular disease

4. orthostatic hypotension

5. anticholinergic effects

6. agitation, dizziness, sedation, and sleep disruption

7. mild EPS such as tremor

Front 62

what are the anticholinergic effects of risperidone (Risperdal)?

Back 62

urinary hesitancy or rentention, dry mouth

Front 63

what are the nursing interventions for the adverse effects of risperidone (Risperdal)?

Back 63

1. onset of DM -- obtain baseline fasting blood glucose and monitor, instruct to report indications (thirst, urination and appetite)

2. weight gain -- advise client to follow a healthy low-calorie diet, engange in regular exercise, monitor weight gain

3. hypercholesterolemia -- monitor cholesterol, triglycerides, and blood glucose if weight gain is more than 14 kg (30 lbs)

4. anticholinergic -> monitor for effects and report to provider, educate measure to relieve dry mouth such as sipping fluids

5. agitation etc -> monitor/notify; alternate med if prescribed

6. milds EPS -> monitor for/teach to recognize EPS, use AIMS assessment to screen for EPS

Front 64

risperidone is Pregnancy Risk Category ______

Back 64

C

Front 65

atypical antiosychotics like risperidone (Risperdal) are contraindicated for which clients? what can happen?

Back 65

clients who have dementia; can cause death related to CVA or infection

Front 66

clients taking atypical antipsychotics should avoid use of _________

Back 66

alcohol

Front 67

use atypical antipsychotics cautiously in clients who have __________

Back 67

cardiovascular or cerebrovascular disease, seizures, or DM; obtaining a fasting blood glucose for clients who have DM and monitor blood glucose carefully

Front 68

formulations and complications of olanzapine

Back 68

Forms -- tablets, short-acting injectable, extended release injections

comps -- low risk of EPS, high risk of DM, weight gain, and dyslipidemia, others include sedation, orthostatic hypotension and anticholinergic effects

Front 69

quetiapine formulations and complications

Back 69

forms -- tablets, extended release tablets

comps -- low risk of EPS, moderate risk for DM,weight gain and dyslipidemia; others include cataracts sedation, orthos hypotension, and anticholinergic effects, clients should have screening eye exam and then every 6 months

Front 70

aripiprazole formulations and complications

Back 70

forms -- tablets, orally disintegrating tablets, oral solution, short-acting injectable

comps -- aripiprazole has low or no risk of EPS, DM, weight gain, dyslipidemia, hypotension, and anticholinergic effects; other adverse effects include headache, anxiety, insomnia, sedation, and GI upset

Front 71

formulations and complications of ziprasidone (1 comment)

Back 71

comment: affects both dopamine and serotonin, can be used for clients who have concurrent depressions

forms -- capsules; short-acting injectable

comps -- low risk of EPS, DM, weight gain, and dyslipidemia; other effects include sedation, ortho hypotension, anticholinergic effects, and rash; ECG changes and QT prolongation may lead to torsades de pointes

Front 72

forms and complications of clozapine (comments)

Back 72

comments: first atypical antipsychotic developed; despite its effectiveness for schizo spectrum disorders, no longer considered first-line b/c of adverse effects

forms -- tablets, orally disintegrating tablets

comps -- low risk of EPS, high risk of weight gain, DM, and dyslipidemia; agranulocytosis may occur (obtain baseline WBC and monitor weekly); monitor for indications of infection (fever, sore throat, lesions in mouth, notify provider); other adverse effects include sedation, ortho hypotensionl and anticholinergic effects

Front 73

formulations and complications of paliperidone

Back 73

forms -- extended-release tablets, extended-release injections

comps -- high risk for DM, weight gain, and dyslipidemia; other include sedations, prolonged QT interval ortho hypotension, anticholinergic effects, and mild EPS

Front 74

formulations and complications of asenapine

Back 74

forms -- sublingual tablets

comps -- adverse effects include drowsiness, prolonged QT interval and EPS (higher doses); contemporary numbing of mouth, low risk for DM, weight, dyslipidemia, and antichol effects

Front 75

iloperidone formulations ad complicatoins

Back 75

forms -- tablets

comps -- dry mouth, sedation, fatigue, nasal congestion; significant risk for weight gain, prolonged QT interval and orthostatic hypotension (advise to follow titration schedule during initial therapy to minimize hypotension); low risk for DM, dyslipidemia and EPS

Front 76

lurasidone formulations and complications

Back 76

forms -- tablets

comps-- sedation, akathisia, parkinsonism, agitation, and anxiety; low risk for DM, weight gain, dyslipidemia; does not cause anitcholinergic effects

Front 77

med/food interaction of clozapine (nursing intervention)

Back 77

immunosuppressive meds such as anticancer medications (avoid use of these meds with clozapine)

Front 78

med/food interactions of atypical antipsychotics (nursing interventions)

Back 78

1. alcohol opioids and antihistamines have additive CNS depressant effects (avoid these avoid hazardous activities)

2. levodopa counteracts effects of antipsychotics (avoid concurrent use and with other direct dopamine receptor agonists)

Front 79

med/food interactions of ziprasidone

Back 79

TCAs amiodarone (Cordarone) and clarithromycin (Blaxin) prolong QT interval and thus increase risk of cardiac dysrhythmias in clients taking ziprasidone (atypical antipsychotics that prolong QT interval should nose be used with meds with same effect)

Front 80

med/food interactions of aripiprazole, quetiapine, and ziprasidone (nursing intervention)

Back 80

1. barbiturates and phenytoin (Dilantin) stimulate hepatic medication-metabolizing enzymes and thereby decreases drug levels of a,q,z ( monitor med effectivness)

2. fluconazole (Diflucan) inhibits hepatic medication-metabolizing enzymes and thereby increases levels of a,q,z (monitor for adverse effects of toxicity)

Front 81

name of risperidone depot injeciton, what do you need to know?

Back 81

Risperdal Consta; once every 2 weeks, therapeutic effects occur 4 to 6 weeks after first depot oftenoral preperations required until this is achievered

Front 82

are low or high doses given initially for antipsychotics?

Back 82

low then gradually increase

Front 83

what use do oral distengrating tablets have?

Back 83

for clients who attempt to cheek or pocket tablets or have difficulty swallowing

Front 84

what do clients taking asenapine need to know?

Back 84

avoid eating or drinking 10 min after each dose

Front 85

what do clients taking lurasidone need to know?

Back 85

administer with food to increase absorption

Front 86

what is a problem with antipsychotics with many clients? what can a nurse due to help?

Back 86

cost is a factor; assess need for case management intervention

Front 87

nursing evaluation of antipsychotics

Back 87

1. improvement of manifestations (prevention of acute psychotic manifestations, absence of hallucinations, delusions, anxiety, and hositility)

2. improvement in ability to perform ADLs

3. improvement in ability to interact socially with peers

4. improvement of sleeping and eating habits

Front 88

olanzapine

Back 88

Zyprexa

Front 89

quetiapine

Back 89

Seroquel

Front 90

aripiprazole

Back 90

Abilify

Front 91

ziprasidone

Back 91

Geodon

Front 92

clozapine

Back 92

Clozaril

Front 93

asenapine

Back 93

Saphris

Front 94

lurasidone

Back 94

Latuda

Front 95

paliperidone

Back 95

Invega

Front 96

iloperidone

Back 96

Fanapt