Antipsychotics Flashcards
Indications for Antipsychotics
Psychosis, agitation and hyperactivity in Schizophrenia, Tourette’s syndrome, and also to augment treatment of biopolar disorder
Older antipsychotics
haloperidol (haldol) and chlorpromazine (thorazine)
Block dopamine
Newer antipsychotics
clozapine (Clozaril), risperdone (Risperdal), olanzapine (zyprexa), quetiapine (Seroquel), apriprazole (Abilify), ziprazadone (Geodon)
Regulate serotonin, norepinephrine, and dopamine
Side effects
Extrapyramidal side Effects (dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia) Neuroleptic Malignant Syndrome Agranulocytosis Photosensitivity Orthostatic hypotension Sedation Anticholinergic effects Substantial weight gain Seizures Increase of prolactin levels
Serious side effect of ziprazadone (Geodon)
QT prolongation leading to sudden death
Serious side effect of clozapine (Clozaril)
agranulocytosis- monitor WBC lab biweekly. Watch for infection, sore throat or fever
Which new drugs cause substantial weight gain?
clozapine (Clozaril)
risperidone (Risperdal)- also causes increase in prolactin
**olanzapine (Zyprexa)
quetiapine (Seroquel)
Nursing considerations for NMS
Rare but lethal due to reaction to antipsychotics
Monitor VS for increase or fluctuation (increase in BP)
Assess for lead pipe rigidity of limbs, muteness, incontinence, fever, and confusion.
Can cause rhabdomyolysis.
Nursing consideration for serotonin syndrome
Can be confused for NMS
Due to reaction to antidepressants
S/S include confusion, agitation, restlessness, dilated pupils, headache, changes in VS- specifically BP and/or temp
Nausea, vomiting, diarrhea, rapid HR, tremor, loss of muscle coordination or twitching muscles, shivering, goosebumps, profuse sweating
Indications for Antidepressants
Mostly for depression, but also for anxiety disorders (social phobia, OCD), PMS, addictions, eating disorders, personality disorders, pain management, sleep problems
Side effects of SSRIs
Used most because of minimal side effects (except for sexual problems). This is due to their selectivity to block the serotonin reuptake receptors in the synaptic cleft.
Side effects of Tricyclics
Can cause cardiac dysrhythmias, orthostatic hypotension, sedation, anticholinergic effects, and rarely some EPS.
Overdose is quite lethal.
They inhibit the reuptake of both serotonin and norepinephrine in the synaptic cleft.
Side effects of MAOIs
require a low tyramine diet to prevent hypertensive crisis and could be lethal for a suicidal patient.
Cannot be mixed with SSRIs which could cause serotonin syndrome.
They do not mix very well because they are not selective in the fact that they bind to Monamine Oxidase Enzymes and prevent the breakdown of catecholamines like dopamine, serotonin, epinephrine and norepinephrine.
Examples of SSRIs
fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro)
All can cause HA, insomnia, tremors, sedation, weight loss/gain, sexual problems.
Examples of Tricyclics
amitriptyline (Elavil), tofranil, sinequan, norpramin
Cardiac problems, orthostatic hypotension, sedation, anticholinergic effects
Examples of MAOIs
phenelzine (Nardil)
Must be kept on a low tyramine diet: nothing pickled, aged, fermented; no cheese, wines, or beer
Could cause hypertensive crisis: stiff neck, high BP, severe HA
Example of Atypical Other
zyban (Wellbutrin) used for nicotine addiction (not for patients with seizure or anorexia)
Indications for mood stabilizers (antimanics)
Used with bipolar disorder.
Lithium
Requires good renal function and close monitoring of lithium levels.
Essential to balance fluids and have a normal salt intake.
Can have long term problems of the thyroid (goiter) or renal.
Dehydration will lead to toxicity (seizrues, coma, dea`th)
Other Anticonvulsants/ Mood stabilizers
divalproex sodium (Depakote)- liver problems, GI upset, tremors and weight gain, carbamazepine (Tegretol)- blood dyscrasias and agranulocytosis, gabapentin (Neurontin)- popular with less side effects, but might have increased suicidal thinking and Stevens-Johnson syndrome.
Lithium levels
1.0mEq/L is good
Toxic above 1.5
Levels should be drawn 12 hours post last dose.
Avoid diuretics and dehydration in summer, plus do NOT restrict salt.
Takes a week to reach therapeutic levels.
Lithium side effects
Mild: Fine tremor, polydipsia, polyuria, weight gain
Severe: Coarse tremors, confusion, oliguria, seizures, coma, death
Indications for Anxiolytics
Used for anxiety, alcohol detox, insomnia
Do not mix with alcohol or other CNS depressants
Major withdrawal symptom is seizures (anxiety and insomnia)
Can also cause drowsiness, ataxic gait, slurred speech
Addictive!
Benzodiazepines- addictives
chlordiazepoxide (Librium), lorazepam (Ativan), alprazolam (Xanax), oxazepam (Serax)
Effective for detox and anxiety
Non-addictive Anxiolytics
buspirone (Buspar), hydroxyzine (Vistaril)
clozapine
agranulocytosis
haloperidol
major EPS
ziparazidone
cardiac problems (QT prolongation)
olanzapine
metabolic syndrome- major weight gain, diabetes, high cholesterol
congentin
anticholinergic used for treating symptoms of EPS (dystonia, akathisia and pseudoparkinsonism)
risperidone
increase in prolactin- breasts in men
negative symptoms
apathy, social withdrawal, lack of motivation
positive symptoms
hallucinations, delusions
dystonia
muscle contractions of the neck, jaw, back, “oculogyric crisis” & risk of laryngospasm and airway problems
akithisia
restlessness, cannot stop moving, “jumping out of their skin”
pseudoparkinsonism
shuffling gait, tremors, maske like face, akinesia, “cogwheel” rigidity
tardive dyskinesia
irreversible and involuntary mouth and torso movements with lip smacking, chewing, blinking, tongue thrusting, cheek puffing
Prevention through testing with the AIMS test
Early sign is vermicular (worm like) tongue movements
SSRIs
sexual problems + HA, tremors, insomnia, sedation, weight loss/gain
Tricyclics
cardiac problems, orthostatic hypotension, sedation, anticholinergic effects
LETHAL overdose
MAOIs
low tyramine diet to avoid hypertensive crisis
Lithium
good renal function, toxic at 1.5, do not restrict salt
carbamazepine
blood dyscrasias, agranulocytosis (not as bad as clozapine)
divalproex sodium
liver problems, weight gain, tremors, GI upset
