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Mental Health Exam > Antipsychotic Medication > Flashcards

Antipsychotic Medication Flashcards

1
Q

What are antipsychotics?

A

medication used to treat forms of psychosis in an individual

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2
Q

What are typical antipsychotics?

A

first generation antipsychotics that act as a dopamine receptor antagonist

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3
Q

What are typical antipsychotics indicated for?

A

-acute psychosis
-psychotic disorders e.g schizophrenia
-effective for treating the positive symptoms of schizophrenia NOT the negative symptoms
-an increase amount of dopamine in the brain is thought to contribute to the cause of psychosis

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4
Q

Explain the role of dopamine receptors in terms of typical antipsychotics

A

Dopamine 1 (D1):
Dopamine 2 (D2):
-Typical antipsychotics work by antagonising postsynaptic D2 receptor sites, this blocks dopamine transmission and decreases the amount of dopamine in the brain therefore eliminating the symptoms of psychosis

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5
Q

What are some examples of typical antipsychotics?

A

-haloperidol
-chlorpromazine
-thioridazine
-flupentixol

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6
Q

What are depots?

A

they are long-acting sustained release injectable antipsychotic medication
-administered every two to four weeks
-ensures people recieve their prescribed antipsychotic
-people may choose to have depots for convenience

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7
Q

What are nursing considerations for depots?

A
  1. Adverse effects can take longer to appear and resolve
  2. Can be a traumatic method of medication administration
  3. Dignity, respect, and privacy must be upheld at all times
  4. Client communication and education is essential
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8
Q

What are some adverse effects of typical antipsychotics?

A

Typical antipsychotics can cause severe adverse effects as they have additional effects at the synapse resulting in movement disorders; these are known as extrapyramidal effects; these include:
1. Extrapyramidal effects:
-tardive dyskinesia; involuntary muscle movements (rolling of the tongue or lip smacking)
-akathisia; restlessness or agitation
-acute dystonia’s; muscle spasms
-parkinsonism
2. Neuroleptic malignant syndrome:
-life threatening

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8
Q

What are the signs and symptoms of typical antipsychotics?

A

-hyperthermia
-mental status changes
-muscle rigidity
-autonomic instability

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9
Q

What is the nursing management for typical antipsychotics?

A
  1. assessing for signs and symptoms
  2. escalating and initiating immediate care
  3. ceasing antipsychotics medications
  4. supportive therapy and close monitoring
  5. potential transfer to ICU
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10
Q

What are atypical antipsychotics?

A

second generation antipsychotics that act on serotonin dopamine antagonists

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11
Q

What are atypical antipsychotics indicated for?

A

-acute psychosis
-bipolar disorder; acute mania or as maintenance therapy
-psychotic disorders; schizophrenia
-effective for treating the positive symptoms and negative symptoms of schizophrenia also

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12
Q

Explain the role of dopamine receptors in terms of atypical antipsychotics

A

Atypical antipsychotics have an effect on dopamine by antagonising D2 receptor sites, thus reducing the amount of dopamine and thereby treats the symptoms of psychosis
-although unlike typical antipsychotics, atypical antipsychotics also block serotonin receptors and therefore exert an effect over serotonin levels, this makes the mechanism of action different to that of typical antipsychotics

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13
Q

What are some adverse effects of antipsychotics?

A

-sedation
-anticholinergic effect (impaired concentration and memory impairment)
-hypotension
-prolonged QT interval
-impaired glucose tolerance
-weight gain
-neuroleptic malignant syndrome

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14
Q

What are some examples of atypical antipsychotics?

A

-olanzapine
-risperidone
-quetiapine
-clozapine

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15
Q

What are some adverse effects of atypical antipsychotics?

A

Atypical antipsychotics are less likely to cause extrapyramidal effects and neuroleptic malignant syndrome compared to typical antipsychotics (however they still have the potential to cause these adverse effects)
-sedation
-constipation
-dizziness
-increased hunger which can lead to weight gain
-anticholinergic effects; such as a dry mouth, orthostatic hypertension, blurred vision and tachycardia
-cardiac effects; arrhythmias and ECG changes
metabolic syndrome: a complication of weight gain atypical antipsychotics can cause

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16
Q

What are signs and symptoms of metabolic syndrome?

A
  1. hypertension
  2. hyperglycaemia
  3. hyperlipidaemia
  4. central obesity
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17
Q

What is the nursing management for atypical antipsychotics?

A
  1. establish a regular antipsychotic medication administration routine
  2. take antipsychotic medication early in the morning
18
Q

What is a severe adverse effect of clozapine?

A

agranulocytosis is the depletion of white blood cells as this places a person at serious risk of severe and life threatening infection

19
Q

What is the nursing management and education for clozapine?

A
  1. regular blood tests
  2. seek medical advice if experience cold or flu symptoms
20
Q

What are the four main side effects associated with antipsychotic medication?

A

-blurred vision
-confusion and agitation
-constipation
-dry mouth

21
Q

Identify the main groups of antidepressant medications

A
  1. Tricyclic antidepressants (TCAS)
  2. Monoamine oxidase inhibitors
  3. Selective serotonin reuptake inhibitors
  4. Atypical antidepressants
22
Q

Explain tricyclic antidepressants

A

older antidepressants, they work by stopping the reuptake of serotonin and noradrenaline back into the synapse, therefore they increase the amount of these neurotransmitters in the synaptic space and promote their transmission
-they have broad synaptic effects and can cause serious adverse effects such as hypotension; impacting on the cardiac conduction leading to arrhythmias and heart blocks

23
Q

Explain monoamine oxidase inhibitors

A

older antidepressants, they work by preventing the breakdown of serotonin and noradrenaline as this increases the amount of these neurotransmitters in the synaptic space
-they interact with tyramine-rich foods, examples of these are cheeses, avocado and bananas
-they interact with lots of medications, stimulants, hay fever, asthma medication, and narcotics
-this can lead to hypertensive crisis

24
Q

Explain selective serotonin reuptake inhibitors

A

newer and more common antidepressants, work by selectively inhibiting serotonin receptors, preventing the reuptake of serotonin back into the synapse, therefore increasing the amount of serotonin in the synaptic space and promoting serotonin transmission
-these are safer due to less adverse effects
-abruptly stopping SSRIs can cause withdrawal syndrome

25
Q

Explain atypical antidepressants

A

newer antidepressants and compromise of different types of antidepressants that do not fit into other categories, these include serotonin noradrenaline reuptake inhibitors, noradrenaline reuptake inhibitors and noradrenaline dopamine reuptake inhibitors

26
Q

What are the main side effects of antidepressants?

A

-nausea
-diarrhoea
-insomnia
-dizziness
-changes in weight
-drowsiness and fatigue
-decreased libido
-headaches
adverse effect: serotonin syndrome

27
Q

What are anxiolytics used for?

A

they are from the benzodiazepine family and are used in the treatment of acute anxiety symptoms, such as in the event of a panic attack
-an example is diazepam (benzodiazepine)

28
Q

What are beta blockers used for in regards to anxiety disorders?

A

beta blockers are now commonly prescribed for individuals who experience panic symptoms, as they can address many of the debilitating physical symptoms such as palpitations

29
Q

Identify the most common substances used

A
  1. alcohol
  2. amphetamines
  3. caffeine
  4. cannabis
  5. cocaine
  6. gamma hydroxybutyrate (GHB)
  7. methyl amphetamines/methamphetamines (Ice)
  8. methylenedioxymethamphetamine (MDMA - Ecstasy)
  9. nicotine
  10. opiates (pharmaceutical)
  11. opiates (illicit)
  12. psychedelics (Lysergic acid diethylamide (LSD), Psilocybin)
29
Q

What is the mechanism of action of benzodiazepines?

A

they increase the effects of the neurotransmitter GABA; the universal inhibitory neurotransmitter as it decreases neurotransmission, thus calming neuronal activity.
-therefore benzodiazepines are thought to decrease the symptoms of anxiety by enhancing this neurotransmitter, resulting in a calming effect on the brain
-due to this calming effect on neuronal activity, they can also be used in the management of alcohol withdrawal to prevent the risk of seizures

30
Q

Explain the use of amphetamines

A

-causes euphoria, increased energy and insomnia
-has extensive sympathomimetic effects, such as tachycardia and hypertension
-often implicated in drug induced psychosis

31
Q

Explain the use of cannabis

A

-use results in a sense of euphoria, relaxation and sleepiness
-cannabis is often mixed with tobacco, leading to a withdrawal syndrome when ceasing in regular users
-acute adverse effects often seen in clinical settings include severe anxiety and paranoia
-causative effect for those who suffer from schizophrenia

32
Q

Explain the use of cocaine

A

-cocaine primarily causes alertness, makes user talkative and confident
-recreational use is more common than a dependent state
-cocaine has a very brief duration of action, resulting in frequent administration in heavy users
-frequent cocaine users are seen clinically for cardiac damage associated with its use, heavy use can also cause paranoid psychosis

32
Q

Explain the use of gamma hydroxybutyrate (GHB)

A

-GHB causes euphoria, increased libido, and lowered inhibitions
-GHB has a small therapeutic window as there is a very fine line between dose and overdose
-combining GHB and alcohol and/or other recreational drugs this can increase the risk of overdose and cause seizures
-implicated in significant cognitive changes, such as deterioration in long-term memory, working memory and high levels of stress and anxiety

33
Q

Explain the use of methamphetamine (ice)

A

-meth typically causes feelings of alertness, pleasure, confidence, and insomnia in users
-it is frequently seen in dual diagnosis; it is cheap in comparison to other drugs and often readily available
-it also often causes a strong dependence in users and is strongly associated with psychosis

34
Q

Explain the use of methamphetamine (MDMA - Ecstasy)

A

-MDMA causes euphoria, heightened awareness and alertness in users
-MDMA has a pronounced ‘come down’ effect, often with restless sleep, irritability and paranoia
-pills sold as ‘MDMA’ or ‘MDMA’ mixed with other substances are both common reasons for harm and hospitalisation in users
-combining MDMA and alcohol is a great risk

35
Q

Explain the use of nicotine

A

-smoking can cause cardiovascular disease, COPD and many other preventable diseases
-it is up to nurses to ask about the smoking status of all patient’s and provide options on how to quit (nicotine replacement therapy)

36
Q

Explain the use of opiates (pharmacuetical)

A

-opiates are prescribed for treating severe pain such as post-operative pain

37
Q

Explain the use of opiates (illicit)

A

-the most common form of illicit opiate is heroin, used intravenously
-heroin produces euphoria and drowsiness in users
-heroin overdose, like all opiates, results in respiratory arrest, however this can be reversed with a drug called naloxone
-heroin produces severe dependency, and overdose is common. Repeated overdose can cause significant cognitive impairment due to hypoxia

38
Q

Explain the use of psychedelics (Lysergic acid diethylamide (LSD), Psilocybin)

A

-all psychedelics produce a state in users with pronounced visual hallucinations, and changes in perception, mood and cognitive processes
-clinically most people will be seen due to ‘bad trips’, producing panic and paranoia

39
Q

Explain the spectrum of use

A

alcohol and other drugs (AOD) use occurs on a spectrum;
1. Abstinent (no AOD use)
2. Experimental (occasional use-‘sensation seeking’)
3. Recreational (more regular, non problematic use)
4. Regular (regular use that begins to have negative consequences)
5. Dependent (habitual, compulsive use, despite negative effects)

40
Q

What are some physical complications of alcohol withdrawal?

A
  1. Wernicke’s encephalopathy- korsakoff syndrome: alcohol dependence causes pt. to have confused state, ataxia, ocular disturbance
  2. Delirium tremens: severe form of alcohol withdrawal, characterised by rapid onset confusional state as it is a medical emergency

Mental Health Exam (5 decks)

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