Antipsychotics Flashcards
What causes parkinsons disease?
Lack of dopamine
What causes schizophrenia?
Excess dopamine in the brain
How do antipsychotics work?
By blocking dopamine receptor sites
S/Sx of pseudoparkinsonism (6)
Rigidity, shuffling gait, mask like features, stooped posture, tremors, bradykinesia
Typical antipsychotics MOA and classes
Block dopamine receptors
Pheno and nonphenothiazines
Atypical antipsychotics MOA
Moderate blockage of dopamine receptors, stronger blockage of serotonin receptors
Differences btw typical and atypical antipsychotics
MOA and likelihood of EPS sx
Phenothiazine medications (3)
Chlorpromazine (Thorazine)
Thioridazine (Mellaril)
Fluphenazine (Prolixin)
Nonphenothiazines (3)
Haloperidol (Haldol)
Loxapine (Loxitane)
Molindone (Moban)
Which 2 phenothiazines are used as antiemetics?
Promethazine and prochlorperazine
Typical antipsychotic uses (4) and adverse effects (4)
Schizophrenia, Tourette’s, etoh w/d Intractable hiccups (Thorazine)
Drowsiness, orthostatic HoTN, EPS, anticholinergic effects
What are EPS sx? (3)
Acute dystonia
Akathesia
Tardive Dyskinesia
What is acute dystonia?
treatment & teaching
Muscle spasm of tongue/neck/face/back
Tx: antiparkinson/anticholinergics (benztropine)
Edu: possible laryngospasm
What is akathesia?
Treatment
Inability to stand still
Tx: benzodiazepine, possibly beta blocker
What is tardive dyskinesia?
Treatment and teaching
Protrusion/rolling of the tongue, lip smacking, chewing
Tx: valvenazine (Ingreza)
Edu: higher incidence in smokers and anticholinergic effects
A patient taking fluphenazine would expectedly have these side effects? (5)
Constipation Shuffling gait Mask like features Tremors Dry mouth
Neuroleptic malignant syndrome
w/ sx (7) and tx (6)
Potentially fatal reaction to antipsychotics
Sx: muscle rigidity, high fever, AMS, seizures, tachycardia/dysrhythmias, rhabdo, acute renal failure
Tx: immediate attention, stop med, antipyretics, hypothermic blanket, benzo, muscle relaxants
Typical agents Nursing considerations (4)
Patients avoid alcohol, sedatives, hypnotics, narcotics
Dose individualized
D/C gradually
Monitor for cheeking
Kava kava reaction with phenothiazines
Increased risk for dystonic reactions
Esp. W/ fluphenazine
What does gingko biloba do to antipsychotics?
Potentiates the effects
haloperidol, olanzapine, clozapine
St john’s wort effect on clozapine
Decreases levels of clozapine
Atypical antipsychotic s/e (5)
Weight gain (esp. clozapine and olanzapine) Increased prolactin Teratogenic effects Diabetes Agranulocytosis
Atypical antipsychotic nursing considerations
Monitor weight
Encourage healthy diet and exercise
Monitor BG
Monitor for cheeking
Atypical antipsychotic teaching
Increased prolactin = menstrual disorders, sexual dysfunction and osteoporosis
Watch WBC, report signs of infection, schedule returns for labwork
Reactive depression
Benzodiazepine
Major depression
Antidepressants
Bipolar
Mood stabilizer
SJW MOA
Decreases reuptake of serotonin, dopamine and norepi
How long does it take antidepressants to work?
1-3 weeks initially
6-12 weeks for full response
Serotonin syndrome sx (5) tx (2)
Sx: confusion, anxiety, restlessness, HTN, tremors
Tx: stop med, treat symptoms
Tricyclic antidepressants (TCA) MOA, s/e, meds
Amitriptyline (Elavil)
Imipramine (Tofranil)
MOA: blocks reuptake of norepi and serotonin
S/e: sedation, orthostatic HoTN, drowsiness, anticholinergic effects
Selective serotonin reuptake inhibitors (SSRI)
MOA, uses, s/e
MOA: blocks reuptake of serotonin
Uses: OCD, panic disorder, social phobia, anorexia, PTSD
S/e: sexual dysfunction, insomnia, nausea, risk of suicide
SSRIs (6)
Fluoxetine (Prozac) Fluvoxamine (Luvox) Sertraline (Zoloft) Paroxetine (Paxil) Citalopram (Celexa) Escitalopram (Lexapro)
Atypical antidepressants MOA, uses
MOA: effects reuptake of 1/3 or 2/3 of the neurotransmitters
Uses: major and reactive depression
Atypical antidepressant meds
SNRIs:
Venlafaxine (Effexor)
Desvenlafaxine (pristiq)
Duloxetine (Cymbalta)
NDRIs: bupropion (Wellbutrin)
Serotonin antagonist:
Mirtazapine (Remeron)
Trazodone (Desyrel)
Which atypical antidepressant may increase sexual desire and pleasure and is used for smoking cessation?
Bupropion (Wellbutrin)
Monoamine oxidase inhibitor (MAOI)
MOA
Inhibits the deactivation of norepi, dopamine and serotonin
MAOI meds
Tranylxypromine (Parnate)
Isocarboxazid (Marplan)
Phenelzine (Nardil)
MAOI teaching
Avoid tyramine rich food
Tyramine rich foods
Cheese, cream, yogurt, bananas, raisins, coffee, chocolate, italian green beans, liver, sausage, soy sauce, beer, red wine
Drugs used for bipolar
Mood stabilizers (lithium, valproic acid, carbamazepine)
Lithium therapeutic range/monitoring frequency
Sx of toxicity
0.5-1.5 needs checked q1-3 days
S/sx: n/v/d, ataxia, blurred vision, tinnitus
Which electrolyte interacts with lithium?
Na, hyponatremia = reduced lithium excretion
Lithoum teaching
Maintain adequate Na intake
Na effected by v/d, sweating, diuretics
2 antiepileptic meds used for bipolar
Valproic acid and carbamazepine
Valproic acid MOA
Increases GABA
which suppresses seizure activity, decreases manic episodes, and treats migraine headaches
Carbamazepine MOA
Affects Na channels in neurons decreasing mania
