2 medications Flashcards
treatment of schizophrenia has 3 main phases
1 acute phase
2 stabilization
3 maintenance phase
schizophrenia is a ____ state and requires ___ medication
psychotic state
-antipsychotic med
1st generation medications
1 Chlorpromazine (THORazine) 2 Haloperidol (Haldol) 3 Fluphenazine (Prolixin) 4 Thioridazine (Mellaril) 5 Loxapine (Loxitane)
1st generation meds are also called…
- conventional
- typical
- neuroleptic
If chlorpromazine is administered, make sure to monitor ______
resp.rate (12-20 breaths)
when pt is starting a new med, let them come in after ___ for evaluation
2 weeks
haloperidol is ___ potency
HIGH
1st gen [conventnl, typcl, neuroleptc]
MOA
-block dopamine, acetylcholine, histamine, + norepinephrine
1st gen [conventnl, typcl, neuroleptc]
A/E
- agranulocytosis
- antichol effects
- EPS (acute dystonia, pseudoparkinsonism, akathisia, tardive dyskinesia, neuroendocrine, neuroleptic malignant syndrm, etc)
- sedation
- wt gain
- orthostatic hypotension
- seizures
if pr has WBC less than ____, hold the 1st gen med
3k mm3
anticholinergic manifestations
- dry mouth
- blurred vision
- photophobia
- urinary hesitancy/retention
- constipation
- tachycardia
nursing actions to decr antichol effects
- chew sugarless gum
- sip on water
- avoid hazardous activities
- wear sunnies
- high fiber food
- reg exercise
- 2-3L fluid
- void before taking med
acute dystonia
severe spasm of tongue, neck face, back
**crisis situation, requires rapid treatment!!!
begin to monitor for acute dystonia anywhere between ______ after admin of first dose
1-5 days
treat acute dystonia with…
antiparkinsonian agent
- BENZOTROPINE or trihexyphenidyl
- IM or IV of diphenhydramine (benadryl)
if pt is experiencing acute dystonia,
- stay w client
- monitor airway until spasms subside (5-15min)
pseudoparkinsonism
manifestations
- bradykinesia
- rigidity
- shuffling gait
- drooling
- tremors
observe for pseudoparkinsonism for _____ after initiation of therapy. can occur _____ following first dose
- first month
- 5-30 days
pseudoparkinsonism is a ___ risk
fall
treat pseudoparkinsonism w…
antiparkinsonian agent
-BENZOTROPINE or trihexyphenidyl
THOR the 1st TRIed CHLOrine, he got the FLU + got LOX
CHLOrpromazine (THORazine)
check pt’s BP (90/60),
pulse ox (99%)
1st gen/typical/neuroleptic/conventional treat ____ symptoms of schizo
POSITIVE
Neuroleptic malignant syndrome - FEVER
Fever Encelopathy Vitals Elevated bld enzyme lvl Rigidity
meds to cure NMS
dantrolene + bromocriptine
w/ 1st gen meds… ___ is common
diarrhea
NMS occurs when _____ and is ____
too much antipsychotic is given
likely permanent brain damage
akinesia
spontaneous mvmt
akathisia
cant sit still
-muscle quivering
tardive dyskinesia
repetitive face mvmt
akathisia can be managed with…
- antiparkinsonian agents (BENZOTROPINE or trihexyphenidyl)
- beta blockers
- lorazepam/diazepam
severe akathisia is at risk for ___
suicide
late EPS
tardive dyskinesia
for tardive dyskinesia, evaluate pt ____ after therapy, and then Q___
12 months after therapy,
Q3months after
TD is permanent but pt can try to ____ to minimize the effects
use purposeful muscle mvmt
haloperidol is used to control…
aggressive + impulsive behavior
with haloperidol, monitor for clinical findings of …
parkinsonian + anticholinergic effects
nursing actions with haloperidol
- keep client hydrated
- check VS
- test for muscle rigidity (NMS)
2nd generation aka
- unconventional
- atypical
2nd gen medications
1 prisperidone (Risperdal) 2 clozapine (clozaril) 3 olanzapine (zyprexa) 4 quitiapine (seroquel) 5 ziprasidone (Geodon)
which 2nd gen med is considered a last resort? and why?
clozapine (Clozaril)
-bc pt often die fr agranulocytosis
which med is linked w obesity and what is it also used to treat?
olanzapine (Zyprexa)
-also used for bipolar bc its a mood stabilizer
normal range for WBC
5-10k
when pt is started on clozapine (Clozaril), we monitor ____, Q___
WBC
for 6 months, Qweek
pt on clozapine (Clozaril) will be…
put on national registrar
if pt is allergic to haloperidol, then u can give ___
olanzapine
before you admin ziprasidone, make sure to obtain…
a baseline EKG
we use ___ generation meds first because it treats ___ symptoms + it has a lower risk for ___
2ND gen
POS+NEG
EPS
2nd gen MOA
blocks serotonin + dopamine
-blocks receptors for norepinephrine, histamine, + acetylcholine
3RD generation s/e
- insomnia
- akathisia
tardive dyskinesia can be treated w…
- deutetrabenazine
- valvalbenazine
anticholinergic meds + MOA
- benztropine, diphenhydramine, trihexyphenidyl
- used to treat EPS s/e fr antipsychotics
long term use of diphenhydramine can lead to…
dementia
