Antipsychotics

Question 1

Traditional (First generation)

Answer 1

Fluphenazine (Prolixin)
Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Z*endaya is a DOL

Question 2

Traditional (First generation) SE

Answer 2

Increased EPS (extrapyramidal symptoms)

Increased NMS (neuroleptic malignant syndrome)

Anticholinergic effects

Question 3

Atypical (Second generation)

Answer 3

Clozapine (Clozaril) — Agranulocytosis! WBC <3,500/mm3
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Risperidone (Risperidol)

Question 4

Atypical (Second generation) SE

Answer 4

Increased metabolic syndrome

Decreased EPS/NMS

Sexual side effects

Orthostatic hypotension

Anticholinergic side effects

Question 5

Atypical (Third generation)

Answer 5

Aripiprazole (Abilify)

Question 6

Available in LONG-ACTING DEPOT INJECTIONS:

Answer 6

Fluphenazine
Haloperidol
Olanzapine
Risperidone

Question 7

Anticholinergic (tx of EPS)

Answer 7

Benztropine (Cogentin)
Diphenhydramine (Benadryl)

Question 8

EPS Symptoms

Answer 8

1. Acute Dystonia: severe spasms of tongue, neck, face and back
2. Pseudoparkinsonism: bradykinesia, rigidity, shuffling gait, drooling, tremors
3. Akathisia: inability to sit still, pacing, agitation
4. Tardive dyskinesia: involuntary movements of tongue and face, lip smacking, worm-like movements of the tongue, involuntary movements of arms, leg, trunk. Can be permanent.

(PRN benztropine or diphenhydramine)

Question 9

NMS symptoms

Answer 9

1. Usually manifests after initial exposure or abrupt discontinuation of antipsychotic medications.
2. First generation/traditional - particularly haloperidol, carry a higher risk of developing NMS.
3. Nursing considerations for a client who is experiencing NMS include immediately discontinuing the antipsychotic, monitoring fluid and electrolytes, initiating cooling measures, and placing the client on cardiac monitoring

The acronym FEVER can be used to help memorize the manifestations of NMS:
Fever
Encephalopathy
Vital sign instability
Elevated creatine kinase
Rigidity (Lead pipe rigidity)

Question 10

Depot Injections

Answer 10

Helps with medication adherence
Fluphenazine, Haloperidol, Olanzapine
Monitor 3 hrs after injection for adverse reactions
Lasts 3-4 weeks

Question 11

Clozapine

Answer 11

-Requires monitoring of WBC for potentially fatal agranulocytosis
-Notify provider of indications of infection: fever, sore throat, mouth lesions
-Nurse should immediately contact the health care provider if the client’s WBC value is less than 3,500/mm3
-Weekly, biweekly and then monthly

Question 12

Sublingual tablets

Answer 12

Oral disintegrating tablets are prescribed for those who have difficulty swallowing or might “Cheek” medication
Olanzapine

Question 13

Metabolic syndrome

Answer 13

Second Generation antipsychotics have increased risk of Metabolic Syndrome (SE)
-increased levels of blood sugar
-increased blood pressure
-increased cholesterol
-Weight gain
Monitor clients who are high risk of developing type 2 diabetes mellitus or previously diagnosed with diabetes
monitor blood glucose and lipid levels
*B.B.C for W