antipsychotics ppt

Question 1

pscyhosis is characterized by

Answer 1

Disordered and often bizarre thinking
Blunted or inappropriate emotional responses
Bizarre behavior, social withdrawal
Deterioration from previous levels of occupational and social functioning
Hallucinations, paranoid delusions

Question 2

Psychosis is an acute or chronic severe mental disorder.

t or f

Answer 2

true

Question 3

what conditions do hallucinations occur in

are hallucinations pos or neg symptoms

Answer 3

Delirium
Dementias
Schizophrenia
Other psychotic states
-some hallucinations are typical of seizure disorder (eg they think theres someone grabbing their shoulder. Also smelling burnt toast)

positive

Question 4

what are delusions

Answer 4

False beliefs that persist in the absence of reason or evidence
Indicate severe mental illness
Commonly associated with schizophrenia
Also occur with delirium, dementias, other psychotic disorders

Question 5

t or f
men are more affected by schizophrenia

which gender does it appear in first

Answer 5

ales and females equally affected

Manifests earlier in males

Question 6

to get a Dx of schizophrenia you must have symptoms for at least __ months

do symptoms appear gradually or suddenly or both

what are the two broad categories of symptoms

Answer 6

6months

Symptoms may appear gradually or suddenly
Symptoms manifest as ****positive or negative

Question 7

what are positive sympoms of schizo

Answer 7

CNS stimulation
Agitation, behavioral disturbances
Delusions, disorganized speech
Hallucinations, insomnia, paranoia

Question 8

what are neg symptoms of schizo

Answer 8

Lack of pleasure, motivation
Blunted affect
Poor grooming and hygiene
Poor social skills
Poverty of speech
Social withdrawal

Question 9

medical causes of psychosis
-endocrine
-autoimmune
autoimmune
infections
neuro
-other

(she said we dont need to memorize)

Answer 9

Endocrine: thyroid, steroid producing tumors, insulinomas, pheochromocytoma

Metabolic: acute intermittent porphyria

Autoimmune: Systemic lupus erythematosus, Hashimoto encephalopathy

Infections: cerebral malaria, toxoplasmosis, neurocysticercosis, sleeping sickness, neurosyphilis

Neurological: Narcolepsy, Seizures: temporal lobe epilepsy (video), Brain tumors, Strokes, head injury, demyelinating disease, nutritional

-substances

Question 10

what are typical antipsychotics names

Answer 10

phenothiazines

• thioxananthenes
• holoperidol
• loxapine
• pimozide

Question 11

phenothiazines

• thioxananthenes
• holoperidol
• loxapine
• pimozide

which of these holds risk of tardive dyskinesia with long term use

which are only slightly sedative but has

Answer 11

****phenothiazines can lead to tardive dyskinesia with long term use…also pimozide has a risk of tardive dyskinesia

thioxanthenes and haloperidol lightly sedative but high EPS

Question 12

if a pt is having EPS or tardive dyskinesia what could you use to assess them

Answer 12

the abnormal involuntary movement scale

Question 13

what are the ebenefits of atypical antipsych AAP compared to typical

Answer 13

Greater effectiveness treating negative symptoms

Fewer movement disorders

Question 14

names of AAPs

Answer 14

-clozapine
olanzapine
risperidone
quetiapine

Question 15

clozapine
is it used much these days?

what is the major risk

why is it used

Answer 15

isnt used as much
-is second line therapy d/t monitoring requirements and assoc w **agranulocytosis and ***inc risk of myocarditis especially in first month

it has these risks but it works great and is effective when other things arent

Question 16

which AAP have a risk of agranulocytosis and which of these is more likely to cause EPS

Answer 16

clozapine and olanzapine both have this risk but olanzapine has less risk of EPS

Question 17

which AAP med is invega sustenna and what is its active metabolite? this med is an offshoot of which AAP

Answer 17

**invega sustenna is a form of risperidone and its active metabolite is **paliperidone

Question 18

which of the following drugs comes in a wafer form that is best offered to the pt from the package (dont touch it)
clozapine
olanzapine
risperidone
quetiapine

Answer 18

olanzapine

Question 19

t or f

AAPs can lead to hypoglycemia

Answer 19

***f they can lead to hyperglycemia

Question 20

MOA of antipsychotics

-which NTM are they working on

Answer 20

Most antipsychotic medications block the action of dopamine
Chronic drug administration results in up-regulation of dopamine receptors
Overall, medications “re-regulate” the abnormal neurotransmission systems associated with psychosis

Question 21

indications for antipsychotics

which condition are they commonly given for but shouldnt be

Answer 21

Major clinical indication is schizophrenia
Other indications
Psychotic symptoms associated with head trauma
Tumor, stroke
Alcohol withdrawal
CNS stimulant overdose, other disorders

Generally not to be used for dementia

Question 22

is this T or f

Antipsychotic medications are given only for psychiatric illness.

if f which conditions

Answer 22

Antipsychotic medications are indicated in psychiatric illness and for nausea, vomiting, intractable hiccups, sedation, etc.

Question 23

if pt has the following conitions is it ok to give antipsychotics

Seizure disorders
Diabetes mellitus
Glaucoma
Prostatic hypertrophy
Peptic ulcer disease
Chronic respiratory disorders

Answer 23

yes but use caution

Question 24

contraindications for use of anitpsychotics

Answer 24

Liver damage
Coronary artery disease
Cerebrovascular disease
Parkinsonism, bone marrow depression
Severe hypotension, coma
Hypertension, severely depressed states

Question 25

under what conditions is it appropriate to use antipsychotics in the elderly

why so restricted

Answer 25

alternative therapies are ineffective on their own;
there is an identifiable risk of harm to the resident and others; and
the symptoms are severe enough to cause suffering and distress to the individual.

research has demonstrated that antipsychotic medications have little to no effect on
many behavioural and psychological symptoms of dementia.”*******!!

Question 26

neuroleptic malignant symptom is NMS

Answer 26

**A rare but potentially fatal reaction that may occur hours to months after initial drug use. Symptoms usually develop rapidly over 24–72 h.

Question 27

NMS symptoms

Answer 27

Symptoms: *Fever (may be confused with heat stroke), muscle rigidity, agitation, confusion, delirium, dyspnea, tachycardia, respiratory failure, and acute renal failure

Question 28

Tx of NMS

names of the three drugs used for it***

Answer 28

stopping the anti-psychotic drug, giving supportive care related to fever and other symptoms, and drug therapy ***(dantrolene, a skeletal muscle relaxant, and **amantadine or bromocriptine, dopamine- stimulating drugs)

Question 29

info on phenothiazine p.kinetics

does it cause psychological dependence or physical dependence?

Answer 29

Well absorbed after oral and parenteral administration; distributed to most body tissues
Reach high concentrations in the brain
Metabolized in the liver
Metabolites are excreted in urine
Do not cause psychological dependence
May cause physical dependence if abruptly discontinued

Question 30

For patients taking clozapine, the nurse should assess which of the following laboratory values weekly?

a. complete blood count (CBC)
b. hemoglobin and hematocrit
c. blood urea nitrogen and creatinine
d. liver enzyme studies

Answer 30

a. complete blood count (CBC)

Question 31

Patients taking ziprasidone (Zeldox) may have prolonged QT intervals, placing them at risk for which of the following?

a. atrial fibrillation
b. torsades de pointes
c. complete heart block
d. atrial tachycardia

Answer 31

b. torsades de pointes (a type of ventricular tachycardia)

Question 32

The nurse should administer long-acting injections of antipsychotic drugs in which of the following ways?

a. intramuscularly into the deltoid muscle
b. subcutaneously into the abdomen
c. intramuscularly into the gluteal muscle
d. intravenously into a large vein

Answer 32

C

IM into gluteal

Question 33

When administering atypical antipsychotics, the nurse should be alert to possible

a. renal failure
b. liver failure
c. diabetes mellitus
d. hypertension

Answer 33

c-diabetes mellitus

Question 34

In monitoring the status of a patient on a long-term course of a phenothiazine antipsychotic, the nurse needs to be most aware that an adverse effect of long-term use of phenothiazine antipsychotics is the development of which of the following?

a. glaucoma
b. tardive dyskinesia
c. hypertension
d. diabetes

Answer 34

b. tardive dyskinesia