Antipsychotics Flashcards
First generation antipsychotics / conventional
What antipsychotics for schizophrenia block receptors for dopamine in the CNS but cause serious movement disordeers known as extrapyramidal symptoms (EPS)?
a. Haloperidol & Chlorpromazine
b. Clozapine & Lithium
c. Divalproex & Zolbidem
d. Secobarbital & Ramelteon
a. Haloperidol & Chlorpromazine
second generation antipsychotics / conventional
What antipsychotics for schizophrenia block receptors for serotonin in the CNS and because they are second generation have fewer extrapyramidal symptoms (EPS), but have increased metabolic effects?
a. Haloperidol
b. Clozapine
c. Divalproex
d. Secobarbital
*effects: weight gain, dyslipidemia CV events
b. clozapine
What is the key drug for schizophrenia that has a high potency and suppresses psychosis by blocking D2 receptor?
a. Haloperidol
b. Clozapine
c. Divalproex
d. Secobarbital
a. Haloperidol
Extrapyramidal symptoms are more severe when a patient is taking chlorpromazine rather than Haloperidol. True or false?
- Acute dystonia
- Parkinsonism
- Akathisia
- Tardive Dyskinesia
False
Extrapyramidal symptoms are more severe when a patient is taking Haloperidol rather than chlorpromazine because haloperidol is a first generation antipsychotic that has a stronger blockade for dopamine in the CNS where these symptoms manifest.
Which of the following is not an early onset symptom that responds to pharmacological intervention when a patient is taking haloperidol?
a. Acute dystonia
b. Parkinsonism
c. Akathisia
d. Tardive Dyskinesia
d. Tardive Dyskinesia
Tardve Dyskinesia is a late onset symptom that does not respond to pharmacological intervention, therefore once schizophrenia progresses past the early onset symptoms of (acute dystonia, parkinsonism, akathisia) it can no longer be treated.
Extrapyramidal early onset symptoms
Acute dystonia is the contraction of involuntary muscle and will appear when after taking the first dose of Haloperidol?
a. 3 weeks
b. 6 months
c. the first 15 minutes
d. first few hours to days
d. first few hours to days
- after the first dose the nurse must differentiate acute dystonia from their psychosis because of the positive and negative effects of schizophrenia where they may be flinching or reacting to things they see and the nurse doesnt (psychosis) or if they are experiencing (acute dystonia) and having spasms of their tongue, face, neck, and/or back.
Intense effects from haloperidol require rapid intervention with what anticholinergic?
Benztropine
IV or IM short -term for a few months
Extrapyramidal early onset symptoms
Parkinsonism is the development of symptoms seen in parkinson’s but due to the effect of haloperidol tx and will appear when after taking the first dose of Haloperidol?
a. 3 weeks
b. multiple days
c. the first 15 minutes
d. first 5 hours
b. multiple days
needs to switch to 2nd generation chlorpromazine
Extrapyramidal early onset symptoms
Akathisia is the feeling of inner restlessness and the inability to stay still. Often people feel like they need to crawl out of their own skin. What anticholinergics will help a patient with these affects?
- benztropine
- benzodiazepines
- beta blockers
the three bees
the nurse must also differentiate the akathisia from psychosis that will occur days to months after treatment.
Extrapyramidal LATE onset symptoms
Tardive Dyskinesia is the development of facial ticks due to the effect of haloperidol tx and will appear when after taking the first dose of Haloperidol?
a. 3 weeks
b. months to years
c. the first 15 minutes
d. first 5 hours
lip-smacking, tongue thrusting and rapid blinking
b. months to years
Tardive Dyskinesia is irreversible and there is no reliable tx. True or false?
True.
The nurse knows that a patient taking a high potency drug like haloperidol needs to report what syndrome immediately?
a. fragie x syndrome
b. turner syndrome
c. klinefelter syndrome
d. neuroleptic malignant syndrome (NMS)
d. neuroleptic malignant syndrome (NMS)
DEADLY
rare, but potentially deadly without treatment – report immediately, stop medication immediately
death from RF, Cardio collapse, dyrhysthmias if medication cannot be flushed out of the system
If a patient is experiencing “lead pipe” rigidity from NMS the nurse should tx the patient with what?
and autonomic instability
dantrolene
to relax the muscles
If a patient is experiencing a sudden high fever from NMS the nurse should tx the patient with what?
cooling blankets, acetaminophen
If a patient is experiencing a sweating/diaphorisis from NMS the nurse should tx the patient with what?
fluids
for hydration
A first generation antipsychotic drug with low potency used to suppress acute psychotic episodes by blocking D2 receptor and reduce relapse.
also used for emesis, intractable hiccups, and severe behavioral problems in children
chlorpromazine
The use of chlorpromazine also blocks acetylcholine, histamine, and norepinephrine actions. true or false?
true
thu can cause seizures and sexual dysfunction
**Anticholinergic **effects – educate patients on minimizing discomfort
Orthostatic hypotension (sympatholytic effects) – in the hospital setting monitor blood pressure before and after dosing
**Sedation **– advise patients to take at bedtime
A schizophrenic patient notifies the nurse that they are prone to having seizures. The nurse will question what rx?
a. Haloperidol
b. Chlorpromazine
c. Clozapine
d. Lithium
e. Ivalproex
b. Chlorpromazine
chlorpromazine can lower the threshhold of the patients seizure activity.
Which of the following is not a second generation antipsychotic that suppresses psychosis by blocking serotonin (5-HT) receptors?
a. clozapine
b. risperidone
c. labetalol
d. ziprasidone
c. labetalol
which of the following has a high risk for agranulocytosis where the nurse must monitor their WBC and ANC to observe early signs of infection?
a. Clozapine
b. Risperidone
c. Ziprasidone
ANC = absolute neutrophil count
a. Clozapine
the nurse must also be aware of orthostatic hypotention when a pt is taking Clozapine, Risperidone, and Ziprasidone.
A nurse understands that the main difference between first generation antipsychotics and second generation antipsychotics is the adverse effects they propose.
First generation antipsychotics have EPS while second generation antipsychotics have metabolic effects. What three metabolic effects does the nurse know may occur?
a. weight gain
b. hypothyroidism
c. diabetes
d. dyslipidemia
a. weight gain
c. diabetes
d. dyslipidemia
- Weight gain – baseline and monitoring every 3 months
- Diabetes – baseline fasting glucose and monitoring 12 weeks later, then annually
- Dyslipidemia – baseline fasting lipid levels and monitoring 12 weeks later, then every 5 years
Patients taking ziprasidone may have dysrhythmias and experience prolonged QT interval. True or false?
True.
NI of Antipsychotic Drugs
- Adherence is critical and sometimes requires monitoring
- Avoid alcohol or other CNS-depressants outside of the hospital setting (opioids, antihistamines, barbiturates, benzodiazepines)
- NOT safe in dementia
-
Monitor QT
Avoid other QT Prolonging Agents (haloperidol, dysrhythmic drugs, tricyclic antidepressants, macrolide antibiotics) - Monitor potassium and magnesium
what is the drug of choice for BPD that a pt can take during a acute manic episode to reduce mania without sedation and can be taken long-term for prophylaxis?
a. Lithium
b. Divalproex
c. Carbamazepine
d. Fluoxetine
works slowly - 5 days to 2 weeks
a. LITHIUM
The nurse knows that a pt experiencing most adverse affects of lithium may subside, but a patient may still experience which of the following?
a. fine hand tremors
b. polyuria
c. renal toxicity
d. hepatotoxicity
a. fine hand tremors
b. polyuria
c. renal toxicity
Because the nurse knows that lithium has a narrow therapeutic window she will need to monitor what lab value?
a. Plasma
b. RBC
c. WBC
d. H & H
a. Plasma
- Measured 12 hours after the evening dose
- Every 2-3 days, then every 3-6 months
lithium toxicity
A good plasma level LESS THAN 1.5
GREATER THAN 1.5 = HOLD LITHIUM
the risk of a high lithium level is increased in patients with poor kidney function, hyponatremia and dehydration.
lithium adverse effects
L - levels
I - increased urination
T - thirsty tremors
H - air thinning Hypothyroidism
I - interactions
U - upset stomach
M - muscle weakness
S - skin affects
