ATI Ch 15, Psychotic Disorders Flashcards
1
Q
What do schizophrenia spectrum and other psychotic disorders affect?
A
Thinking, behavior, emotions, and the ability to perceive reality.
2
Q
What are the contributing factors to schizophrenia?
A
Genetic, neurobiological, and nongenetic factors such as injury at birth, viral infection, and nutritional factors.
3
Q
What is the typical age at onset for schizophrenia?
A
Mid teens to mid 20s.
4
Q
Can schizophrenia occur in young children or later adulthood?
A
Yes.
5
Q
What is a prodromal period in the context of psychotic disorders?
A
A period during which the client experiences negative symptoms or a reduced level of positive symptoms.
6
Q
When do psychotic disorders become problematic?
A
When manifestations interfere with interpersonal relationships, self-care, and ability to work.
7
Q
What is the duration requirement for schizophrenia diagnosis?
A
At least 6 months.
8
Q
What is the primary impairment in schizophrenia?
A
Significant impairment in areas such as school or work, self-care, and interpersonal relationships.
9
Q
How severe is the impairment in schizotypal personality disorder compared to schizophrenia?
A
Not as severe as with schizophrenia.
10
Q
What characterizes delusional disorder?
A
Experiencing delusional thinking for at least 1 month without marked impairment in self or interpersonal functioning.
11
Q
What is the duration of psychotic manifestations in brief psychotic disorder?
A
1 day to 1 month.
12
Q
What is the duration for schizophreniform disorder?
A
1 to 6 months.
13
Q
In schizophreniform disorder, is social or occupational dysfunction always apparent?
A
No, it might not be apparent.
14
Q
What are the criteria for schizoaffective disorder?
A
Meets the criteria for both schizophrenia and depressive or bipolar disorder.
15
Q
What causes substance/medication-induced psychotic disorder?
A
Psychosis due to substance intoxication or withdrawal, or after exposure to or withdrawal from a medication.
16
Q
True or False: In substance/medication-induced psychotic disorder, the psychotic manifestations are less severe than typically expected.
A
False.
17
Q
Fill in the blank: Schizophrenia is characterized by psychotic thinking or behavior present for at least _______.
A
6 months.
18
Q
What is a psychotic or catatonic disorder due to another medical condition?
A
The client exhibits psychotic features, bizarre behavior, or significant change in motor activity behavior but does not meet criteria for diagnosis with another specific psychotic disorder.
19
Q
What are positive symptoms in psychotic disorders?
A
Manifestation of things that are not normally present, including:
* Hallucinations
* Delusions
* Alterations in speech
* Bizarre behavior
20
Q
What are negative symptoms in psychotic disorders?
A
Absence of things that are normally present, including:
* Blunted or flat affect
* Alogia
* Anergia
* Anhedonia
* Avolition
21
Q
Define alogia in the context of negative symptoms.
A
Poverty of thought or speech, where the client might only mumble or respond vaguely to questions.
22
Q
What does anhedonia refer to in negative symptoms?
A
Lack of pleasure or joy, where the client is indifferent to things that typically make others happy.
23
Q
What are cognitive findings associated with psychotic disorders?
A
Problems with thinking that make it difficult for the client to live independently, including:
* Disordered thinking
* Inability to make decisions
* Poor problem-solving ability
* Difficulty concentrating
* Short-term memory deficits
* Impaired abstract thinking
24
Q
What are affective findings in psychotic disorders?
A
Manifestations involving emotions, including:
* Hopelessness
* Suicidal ideation
* Unstable or rapidly changing mood
25
What are alterations in thought (delusions)?
False fixed beliefs that cannot be corrected by reasoning, usually bizarre.
26
What is 'ideas of reference' in the context of delusions?
Misconstruing trivial events and attaching personal significance to them.
27
What does persecution refer to in delusions?
Feeling singled out for harm by others, such as believing one is being hunted down.
28
Fill in the blank: Negative symptoms are generally more difficult to treat successfully than _______.
[positive symptoms]
29
True or False: Positive symptoms are manifestations of absence of things that are normally present.
False
30
What is an example of bizarre behavior in positive symptoms?
Walking backward constantly.
31
What is grandeur?
Believes that they are all powerful and important, like a god
32
Define somatic delusions.
Believes that their body is changing in an unusual way, such as growing a third arm
33
What does jealousy refer to in a psychological context?
Believes that their partner is sexually involved with another individual even though there is not any factual basis for this belief
34
What is the belief of being controlled?
Believes that a force outside their body is controlling them
35
Define thought broadcasting.
Believes that their thoughts are heard by others
36
What is thought insertion?
Believes that others' thoughts are being inserted into their mind
37
What does thought withdrawal mean?
Believes that their thoughts have been removed from their mind by an outside agency
38
What is religiosity in a psychological context?
Is obsessed with religious beliefs
39
Define magical thinking.
Believes their actions or thoughts are able to control a situation or affect others
40
What is associative looseness?
Unconscious inability to concentrate on a single thought
41
What is flight of ideas?
Client's speech moves rapidly from one thought to another that it is incoherent
42
Define neologisms.
Made-up words that have meaning only to the client
43
What is echolalia?
The client repeats the words spoken to them
44
What does clang association mean?
Meaningless rhyming of words, often forceful
45
What is word salad?
Words jumbled together with little meaning or significance to the listener
46
Define circumstantiality.
Including multiple and unneeded details during a conversation
47
What is tangentiality?
Starts talking about trivial information rather than focusing on the main topic of conversation
48
What are hallucinations?
Sensory perceptions that do not have any apparent external stimulus
49
What type of hallucination involves hearing voices?
Auditory
50
What is a command hallucination?
The voice instructs the client to perform an action
51
Define visual hallucinations.
Seeing persons or things
52
What are olfactory hallucinations?
Smelling odors
53
What does gustatory hallucination refer to?
Experiencing tastes
54
What are tactile hallucinations?
Feeling bodily sensations
55
Define depersonalization.
Nonspecific feeling that a client has lost their identity
56
What is derealization?
Perception that the environment has changed
57
What are illusions?
Misperceptions or misinterpretations of a real experience
58
What is extreme agitation?
Including pacing and rocking
59
Define stereotyped behaviors.
Motor patterns that had meaning to client but now are mechanical and lack purpose
60
What is automatic obedience?
Responding in a robot-like manner
61
Define waxy flexibility.
Maintaining a specific position for an extended period of time
62
What does stupor refer to in altered behavior?
Motionless for long periods of time, coma-like
63
What is negativism?
Doing the opposite of what is requested
64
What is echopraxia?
Purposeful imitation of movements made by others
65
Define catatonia.
Pronounced decrease or increase in the amount of movement
66
What is motor retardation?
Pronounced slowing of movement
67
What does impaired impulse control mean?
Reduced ability to resist impulses
68
What is gesturing or posturing?
Assuming unusual and illogical expressions
69
Define boundary impairment.
Impaired ability to see where one person's body ends and another's begins
70
What is the Abnormal Involuntary Movement Scale (AIMS)?
Tool used to monitor involuntary movements and tardive dyskinesia
71
What is milieu therapy?
Used for clients who have a psychotic disorder in various facilities
72
What is the purpose of providing a structured, safe environment (milieu)?
To decrease anxiety and distract the client from constant thinking about hallucinations
73
What is Assertive Community Treatment (ACT)?
Intensive case management and interprofessional team approach to assist clients with community-living needs
74
What is the purpose of promoting therapeuic communication?
To lower anxiety in the client and encourage participation in the milieu.
75
How should a nurse address hallucinations with a client?
Ask the client directly about hallucinations without arguing or agreeing with their view.
76
What should a nurse focus on when dealing with a client's delusions?
Focus on the client's feelings and offer reasonable explanations.
77
What is a risk associated with paranoid delusions?
Increased risk for violence against others.
78
What should be done if a client is experiencing command hallucinations?
Provide for safety due to the increased risk for harm to self or others.
79
What types of subjects should conversations with clients focus on?
Reality-based subjects.
80
What are some triggers for auditory hallucinations?
Loud noises.
81
How should a nurse approach interactions with a client?
Be genuine and empathetic.
82
What needs should be determined for client discharge?
Ability to perform activities of daily living (ADLs).
83
What is a strategy to promote self-care in clients?
Modeling and reinforcing teaching about self-care activities.
84
What techniques can be used for manifestation management?
* Using music to distract from voices
* Attending activities
* Walking
* Talking to a trusted person
* Interacting with hallucinations
85
What is the primary reason for administering antipsychotic medications?
Schizophrenia spectrum disorders.
86
What are positive symptoms of schizophrenia?
* Agitation
* Bizarre behavior
* Delusions
* Hallucinations
* Flight of ideas
* Loose associations
87
What are negative symptoms of schizophrenia?
* Social withdrawal
* Lack of emotion
* Lack of energy
* Flattened affect
* Decreased motivation
* Decreased pleasure in activities
88
What are the goals of psychopharmacological treatment for schizophrenia?
* Suppression of acute episodes
* Prevention of acute recurrence
* Maintenance of the highest possible level of functioning
89
What antidepressant is used to treat depression in clients with psychotic disorders?
Paroxetine.
90
What should be monitored when a client is taking antidepressants?
Suicidal ideation.
91
What is a nursing action regarding antidepressants?
Notify the provider of any adverse effects.
92
What should clients avoid to prevent withdrawal effects from antidepressants?
Abrupt cessation of medication.
93
What medications are used to treat anxiety in clients with psychotic disorder
* Valproate
* Lamotrigine
* Lorazepam
94
What nursing action should be taken when using mood stabilizing agents and benzodiazepines?
Use these medications with caution in older adult clients.
95
What is the primary goal in promoting therapeutic communication?
To lower participation in the milieu
## Footnote
This focuses on reducing anxiety and encouraging constructive interaction.
96
What should the nurse establish with the client?
A private and therapeutic relationship
## Footnote
This is essential for effective communication and support.
97
How should a nurse address hallucinations and delusions?
Use appropriate communication techniques
## Footnote
This involves acknowledging the client's feelings without validating hallucinations.
98
What should a nurse do when a client reports hallucinations?
Ask the client directly about the hallucinations
## Footnote
The nurse should not argue or agree but offer empathetic comments.
99
What type of delusions should be monitored for increased risk?
Paranoid delusions
## Footnote
These delusions can increase the risk of violence against others.
100
What is a critical safety measure for clients with command hallucinations?
Provide for safety due to the increased risk for harm
## Footnote
This is vital to protect both the client and others.
101
What should conversations with clients focus on?
Reality-based subjects
## Footnote
This helps ground the client in the present and reduces distress.
102
What are some triggers that can manifest hallucinations?
Loud noises
## Footnote
Certain clients may experience auditory hallucinations triggered by such stimuli.
103
What qualities should a nurse exhibit when dealing with clients?
Genuine and empathetic
## Footnote
This fosters trust and encourages open communication.
104
What needs should be determined for client discharge?
Ability to perform activities of daily living (ADLs)
## Footnote
This is crucial for assessing readiness for discharge.
105
How can self-care be promoted among clients?
By modeling and reinforcing teaching about self-care activities
## Footnote
This supports client independence and wellness.
106
What is the relationship between wellness and manifestation management?
Wellness relates to elements of manifestation management
## Footnote
This includes coping strategies for depressive findings and anxiety.
107
What are some techniques for manifestation management?
Using music, attending activities, walking, talking to a trusted person
## Footnote
These strategies help clients cope with hallucinations.
108
What should be provided regarding medications?
Teaching about medications
## Footnote
This ensures clients understand their treatment and adhere to it.
109
What should be incorporated into all aspects of care?
Family involvement
## Footnote
This can enhance support and improve treatment outcomes.
110
What social skills should clients develop?
Social skills and friendships
## Footnote
These are essential for reintegration into the community.
111
What activities should clients participate in?
Group work and psychoeducation
## Footnote
Engaging in these activities promotes learning and socialization.
112
What is essential for clients regarding medication?
Compliance with the medication
## Footnote
This is critical for effective management of their condition.
113
What are the primary reasons for the administration of antipsychotic medications?
Schizophrenia spectrum disorders
114
What is the typical clinical course of schizophrenia?
Acute exacerbations with intervals of semi-remission
115
What are positive symptoms of schizophrenia?
* Agitation
* Bizarre behavior
* Delusions
* Hallucinations
* Flight of ideas
* Loose associations
116
What are negative symptoms of schizophrenia?
* Social withdrawal
* Lack of emotion
* Lack of energy
* Flattened affect
* Decreased motivation
* Decreased pleasure in activities
117
What are the goals of psychopharmacological treatment for schizophrenia?
* Suppression of acute episodes
* Prevention of acute recurrence
* Maintenance of the highest possible level of functioning
118
What medication is commonly used to treat depression in psychotic disorders?
Paroxetine
119
What nursing action should be taken when a client is prescribed antidepressants for psychotic disorders?
Monitor the client for suicidal ideation
120
What is a key client education point regarding antidepressants?
Avoid abrupt cessation to prevent withdrawal effects
121
What types of symptoms do mood stabilizing agents and benzodiazepines treat in psychotic disorders?
Anxiety, as well as some positive and negative symptoms
122
Name three medications used as mood stabilizing agents or benzodiazepines in psychotic disorders.
* Valproate
* Lamotrigine
* Lorazepam
123
What should be noted about the use of mood stabilizing agents and benzodiazepines in older adult clients?
Use these medications with caution
124
What are the sedative effects of medications for mood stabilizing agents and benzodiazepines
Medications could have sedative effects.
## Footnote
This is relevant for client education regarding medication management.
125
What is the role of case management in client education?
Case management provides follow-up for the client and family.
## Footnote
This helps ensure continued support and monitoring.
126
What types of psychoeducation are important for clients?
Group, family, and individual psychoeducation improve problem-solving and interpersonal skills.
## Footnote
These skills are critical for effective communication and social interactions.
127
What does social skills training focus on?
Reinforcing teaching about social and ADL (Activities of Daily Living) skills.
## Footnote
This training is essential for enhancing daily functioning.
128
What should clients understand about their disorder?
Understanding of the disorder is crucial.
## Footnote
This helps in managing the condition effectively.
129
What is the need for self-care in preventing relapse?
Self-care is needed to prevent relapse.
## Footnote
This emphasizes the importance of personal health management.
130
What are clients advised about medication effects?
Clients need to understand medication effects, adverse effects, and the importance of compliance.
## Footnote
Knowledge of medication helps in adherence to treatment.
131
Why is attending support groups important?
It is important to attend support groups.
## Footnote
These groups provide community support and shared experiences.
132
What should clients abstain from to aid their recovery?
Clients should abstain from the use of alcohol and/or other substances.
## Footnote
Substance use can interfere with treatment efficacy.
133
What is advised for monitoring medication effectiveness?
Keeping a log or journal of feelings and changes in behavior is advised.
## Footnote
This helps track progress and side effects.
134
What are first-generation antipsychotics primarily used for?
They are used mainly to control positive symptoms of psychotic disorders.
## Footnote
Positive symptoms include hallucinations and delusions.
135
Who are first-generation antipsychotic medications reserved for?
They are reserved for clients who:
* Use them successfully and can tolerate the adverse effects
* Are concerned about the cost associated with second-generation antipsychotic medications.
## Footnote
This indicates careful patient selection based on needs.
136
How are first-generation agents classified?
They are classified as low-, medium-, or high-potency based on:
* Association with extrapyramidal symptoms (EPSs)
* Level of sedation
* Anticholinergic adverse effects.
## Footnote
This classification impacts treatment decisions.
137
What characterizes low potency first-generation antipsychotics?
Low potency: low EPSs, high sedation, and high anticholinergic adverse effects.
## Footnote
This affects the choice of medication based on patient tolerance.
138
What characterizes medium potency first-generation antipsychotics?
Medium potency: moderate EPSs, moderate sedation, and low anticholinergic adverse effects.
## Footnote
This balance helps manage symptoms with fewer side effects.
139
What characterizes high potency first-generation antipsychotics?
High potency: high EPSs, low sedation, and low anticholinergic adverse effects.
## Footnote
This type is often used for more severe symptoms.
140
What is the primary use of second-generation antipsychotics?
They are often chosen as first-line treatment for schizophrenia.
## Footnote
They are preferred due to their efficacy and side effect profile.
141
What are second-generation antipsychotic agents often chosen for?
First-line treatment for schizophrenia
## Footnote
They are preferred for initial treatment and breakthrough episodes.
142
What are the advantages of second-generation antipsychotics?
* Relief of both positive and negative symptoms
* Decrease in affective findings (depression, anxiety) and suicidal behaviors
* Improvement of neurocognitive defects, such as poor memory
* Fewer or no EPSs, including tardive dyskinesia
* Fewer anticholinergic effects (except clozapine)
* Less relapse
## Footnote
EPSs refers to extrapyramidal symptoms.
143
What is a key advantage of third-generation antipsychotics?
Improves cognitive function while treating both positive and negative symptoms
## Footnote
They also have a decreased risk of EPSs.
144
What is the prototype medication for first-generation antipsychotics?
Chlorpromazine
## Footnote
This medication is commonly used to represent the class.
145
List three other medications classified as first-generation antipsychotics.
* Haloperidol
* Fluphenazine
* Loxapine
## Footnote
These medications vary in potency.
146
What is the expected pharmacological action of first-generation antipsychotic medications?
Block dopamine (D2), acetylcholine, histamine, and norepinephrine receptors
## Footnote
D2 blockade in the brain is believed to inhibit psychotic findings.
147
What are some therapeutic uses of first-generation antipsychotics?
* Treatment of acute and chronic psychotic disorders
* Schizophrenia spectrum disorders
* Bipolar disorder (primarily manic phase)
* Tourette disorder
* Agitation
* Prevention of nausea/vomiting
## Footnote
They block dopamine in the chemoreceptor trigger zone to prevent nausea.
148
What serious complication can occur with first-generation antipsychotics?
Agranulocytosis
## Footnote
This condition requires monitoring of white blood cell counts.
149
What nursing actions should be taken if indications of infection appear in a patient on first-generation antipsychotics?
Obtain a CBC and discontinue medication if WBC count is less than 3,000 mm
## Footnote
Patients should also be educated to observe for fever or sore throat.
150
True or False: Second-generation antipsychotics have a higher incidence of extrapyramidal symptoms compared to first-generation antipsychotics.
False
## Footnote
They typically have fewer or no EPSs.
151
Fill in the blank: Third-generation antipsychotics have a lower risk for _______.
weight gain
## Footnote
They also have a lower risk for anticholinergic effects.
152
What are the anticholinergic effects of first generation antipsychotics?
* Dry mouth
* Blurred vision
* Photophobia
* Urinary hesitancy or retention
* Constipation
* Tachycardia
## Footnote
These effects are common side effects associated with first generation (conventional) antipsychotic medications.
153
What nursing actions can decrease anticholinergic effects?
* Chewing sugarless gum
* Sipping on water
* Avoiding hazardous activities
* Wearing sunglasses when outdoors
* Eating foods high in fiber
* Participating in regular exercise
* Maintaining fluid intake of 2 to 3 L/day from beverages and food sources
* Voiding just before taking medication
## Footnote
These strategies can help manage the discomfort associated with anticholinergic side effects.
154
What is acute dystonia?
Severe spasm of the tongue, neck, face, and back
## Footnote
Acute dystonia is a crisis situation that requires rapid treatment.
155
When should monitoring for acute dystonia begin after administration of the first dose?
1 to 5 days
## Footnote
Early detection is crucial for effective management of acute dystonia.
156
What are the treatment options for acute dystonia?
* Antiparkinsonian agents such as benztropine
* IM or IV administration of diphenhydramine
## Footnote
These treatments can alleviate symptoms of acute dystonia.
157
What nursing actions should be taken during a crisis of acute dystonia?
Stay with the client and monitor the airway until spasms subside (usually 5 to 15 min)
## Footnote
Monitoring the airway is essential to prevent complications.
158
What are the manifestations of pseudoparkinsonism?
* Bradykinesia
* Rigidity
* Shuffling gait
* Drooling
* Tremors, including pill-rolling
* Mask-like face
## Footnote
Pseudoparkinsonism can occur in patients taking first generation antipsychotics.
159
When should pseudoparkinsonism be observed after the initiation of therapy?
For the first month after initiation; can occur in 5 to 30 days following the first dose
## Footnote
Early observation allows for timely intervention.
160
What are the treatment options for pseudoparkinsonism?
* Antiparkinsonian agents (benztropine, trihexyphenidyl)
## Footnote
These medications can help alleviate the symptoms of pseudoparkinsonism.
161
What interventions can be implemented for patients with pseudoparkinsonism?
Implement interventions to reduce the risk for falling
## Footnote
Safety is a priority due to the risk of falls associated with motor symptoms.
162
What is akathisia?
Inability to sit or stand still, continual pacing and agitation
## Footnote
Akathisia is a common side effect of antipsychotic medications that can lead to significant discomfort.
163
What should be observed for during the first 2 months after initiating treatment with first-generation antipsychotics?
Akathisia
## Footnote
Akathisia can occur in as little as 5 to 60 days following the first dose.
164
How can akathisia be managed?
With antiparkinsonian agents, beta blockers, or lorazepam/diazepam.
165
What is the increased risk associated with severe akathisia?
Increased risk for suicide.
166
What are the manifestations of tardive dyskinesia (TD)?
* Late EPSs
* Involuntary movements of the tongue and face
* Involuntary movements of the arms, legs, and trunk.
167
What nursing action should be taken if tardive dyskinesia appears?
Lower the dosage or switch to a second-generation antipsychotic agent.
168
What happens to tardive dyskinesia once it develops?
It usually does not decrease, even with discontinuation of the medication.
169
Is there a reliable treatment for tardive dyskinesia?
No.
170
What can help control involuntary movements associated with tardive dyskinesia?
Purposeful muscle movement.
171
What are the neuroendocrine effects of first-generation antipsychotics?
* Gynecomastia
* Weight gain
* Menstrual irregularities
* Galactorrhea.
172
What nursing action should be taken regarding weight for clients on first-generation antipsychotics?
Monitor weight.
173
What should clients be educated to observe for when taking first-generation antipsychotics?
Manifestations of neuroendocrine effects and to notify the provider if they occur.
174
What are the manifestations of neuroleptic malignant syndrome?
* Sudden high fever
* Blood pressure fluctuations
* Diaphoresis
* Tachycardia
* Muscle rigidity
* Decreased level of consciousness
* Coma.
175
What should be done if neuroleptic malignant syndrome occurs?
Stop antipsychotic medication.
176
What nursing actions should be taken in case of neuroleptic malignant syndrome? (List at least three)
* Monitor vital signs
* Apply cooling blankets
* Administer antipyretics.
177
What should be increased in the client's fluid intake during neuroleptic malignant syndrome?
Fluid intake.
178
What medications can be administered to induce muscle relaxation in neuroleptic malignant syndrome?
Dantrolene or bromocriptine.
179
What should be done with the client experiencing neuroleptic malignant syndrome?
Assist with immediate transfer to an ICU.
180
How long should a client wait before resuming therapy after experiencing neuroleptic malignant syndrome?
2 weeks.
181
What should be considered when resuming therapy after neuroleptic malignant syndrome?
Switching to an atypical agent.
182
What are the adverse effects related to orthostatic hypotension from first generation antipsychotics?
• Lightheadedness
• Dizziness
• Significant decrease in blood pressure
• Increase in heart rate
## Footnote
Clients should develop tolerance to orthostatic hypotension in 2 to 3 months.
183
What nursing actions should be taken for a client experiencing orthostatic hypotension?
• Monitor blood pressure and heart rate
• Hold medication if significant changes occur
• Encourage increased fluid intake
## Footnote
Clients are advised to sit or lie down if symptoms occur.
184
How can sedation effects from first generation antipsychotics be managed?
• Effects should diminish within a few weeks
• Take medication at bedtime
• Do not drive until sedation subsides
## Footnote
Sedation can interfere with daily activities.
185
What is the greatest risk of seizures associated with first generation antipsychotics?
Existing seizure disorder
## Footnote
An increase in antiseizure medication may be necessary.
186
What nursing actions should be taken to monitor for severe dysrhythmias?
• Obtain baseline ECG and potassium level
• Monitor periodically throughout treatment
## Footnote
Concurrent use with medications that prolong QT interval should be avoided.
187
What are common manifestations of skin effects from first generation antipsychotics?
• Photosensitivity
• Contact dermatitis
## Footnote
Clients should avoid excessive sun exposure.
188
What nursing actions should be taken regarding liver impairment in clients on first generation antipsychotics?
• Monitor liver function periodically
• Observe for indications such as anorexia, jaundice
## Footnote
Clients should notify the provider if symptoms occur.
189
What are contraindications for using first generation antipsychotics?
• Coma
• Parkinson's disease
• Liver damage
• Severe hypotension
• Dementia in older adults
## Footnote
Use cautiously in clients with prostate enlargement, heart disorders, glaucoma, etc.
190
What interactions should be noted with first generation antipsychotics?
• Increased effects with anticholinergic medications
• Additive CNS depressant effects with alcohol and opioids
## Footnote
Clients should avoid over-the-counter medications containing anticholinergic agents.
191
What client education should be provided regarding CNS depressants?
• Avoid alcohol
• Avoid hazardous activities like driving
## Footnote
CNS depression can be exacerbated by concurrent medication use.
192
What should clients avoid when taking first generation antipsychotics?
• Concurrent use of levodopa and direct dopamine receptor agonists
## Footnote
Levodopa counteracts the effects of antipsychotic agents.
193
What is the purpose of the Abnormal Involuntary Movement Scale (AIMS)?
To screen for the presence of extrapyramidal symptoms (EPS)
## Footnote
It helps differentiate between EPS and worsening psychotic disorders.
194
What should be done if a client experiences intolerable adverse effects from first generation antipsychotics?
Switch to a low-potency or atypical antipsychotic agent
## Footnote
Anticholinergics, beta blockers, and benzodiazepines can help control early EPS.
195
What is the recommended administration schedule for first generation antipsychotics?
Begin with twice-daily dosing, switch to daily dosing at bedtime
## Footnote
This helps decrease daytime drowsiness.
196
True or False: Antipsychotic medications can cause physical or psychological dependence.
False
## Footnote
Clients are encouraged to take medication as prescribed.
197
How long can it take for significant therapeutic effects of first generation antipsychotics to be noticeable?
2 to 4 weeks
## Footnote
Full effects may take several months.
198
What is the prototype medication for second- and third-generation antipsychotics?
Risperidone
## Footnote
Risperidone is the primary example of atypical antipsychotics.
199
List some other medications classified as second- and third-generation antipsychotics.
* Asenapine
* Clozapine
* Hoperidone
* Lurasidone
* Olanzapine
* Paliperidone
* Quetiapine
* Ziprasidone
* Aripiprazole
* Cariprazine
* Brexpiprazole
## Footnote
These medications vary in their pharmacological profiles and side effects.
200
What is the expected pharmacological action of antipsychotic agents?
They mainly block serotonin and to a lesser degree, dopamine receptors
## Footnote
Additionally, they block norepinephrine, histamine, and acetylcholine receptors.
201
What are the therapeutic uses of second- and third-generation antipsychotics?
* Negative and positive symptoms of schizophrenia spectrum disorders
* Psychosis induced by levodopa therapy
* Relief of psychotic manifestations in other disorders
* Impulse control disorders
## Footnote
These medications are used in various psychiatric conditions.
202
What serious complication can arise from the use of antipsychotics?
Agranulocytosis
## Footnote
This condition involves a dangerously low level of neutrophils, increasing infection risk.
203
What nursing actions should be taken if indications of infection appear in a patient on antipsychotics?
Obtain a CBC
## Footnote
This helps assess the white blood cell count and detect agranulocytosis.
204
What is metabolic syndrome associated with second- and third-generation antipsychotics?
* New onset of diabetes mellitus
* Dyslipidemia
* Weight gain
## Footnote
These factors increase the risk for hypertension and cardiovascular disease.
205
What nursing actions should be taken regarding metabolic syndrome in antipsychotic patients?
* Obtain baseline fasting blood glucose
* Monitor cholesterol and triglycerides
* Monitor blood glucose if weight gain exceeds 14 kg
## Footnote
Monitoring helps in early detection and management of metabolic issues.
206
What client education should be provided regarding symptoms of metabolic syndrome?
Report indications like increased thirst, urination, and appetite to the provider
## Footnote
Early reporting can help in timely intervention.
207
What is a potential side effect of antipsychotics related to blood pressure?
Orthostatic hypotension
## Footnote
This can cause dizziness or fainting upon standing.
208
What nursing actions should be taken to monitor for orthostatic hypotension in patients?
Monitor blood pressure and heart rate for orthostatic changes
## Footnote
Significant changes should prompt holding the medication and notifying the provider.
209
What are common anticholinergic effects of antipsychotics?
* Urinary hesitancy or retention
* Dry mouth
## Footnote
These effects can significantly affect patient comfort and adherence.
210
What nursing actions should be taken for managing anticholinergic effects?
* Monitor for adverse effects
* Encourage measures to relieve dry mouth
## Footnote
Sipping water can help alleviate dry mouth symptoms.
211
What are some common adverse effects of antipsychotics?
* Agitation
* Dizziness
* Sedation
* Sleep disruption
## Footnote
These effects can impact daily functioning.
212
What should be monitored if a patient on antipsychotics exhibits mild EPS?
Monitor for EPS and instruct clients to recognize symptoms
## Footnote
The AIMS test can be used to screen for EPS.
213
What nursing action is indicated if elevated prolactin levels occur in a patient?
Obtain prolactin level if indicated
## Footnote
This helps assess the impact of antipsychotics on hormonal balance.
214
What client education should be provided regarding sexual dysfunction from antipsychotics?
Observe for possible sexual adverse effects and notify the provider if intolerable
## Footnote
Adjunct medications like sildenafil may be considered for management.
215
What should risperidone not be used for?
Clients who have dementia
## Footnote
Use can cause death related to cerebrovascular accident or infection.
216
What substance should clients avoid while taking atypical antipsychotics?
Alcohol
217
In which conditions should atypical antipsychotics be used cautiously?
Cardiovascular disease, cerebrovascular disease, seizures, diabetes mellitus
218
What should clients with diabetes mellitus do before starting atypical antipsychotics?
Have a baseline fasting blood sugar and monitor blood glucose carefully
219
What is Aripiprazole classified as?
Third-generation antipsychotic
220
What forms does Aripiprazole come in?
* Tablets
* Orally disintegrating tablets
* Oral solution
* Short-acting injectable
* Long-acting injectable
221
What is the risk of EPS with Aripiprazole?
Low or no risk
222
List some common adverse effects of atypical antipsychotics.
* Sedation
* Headache
* Anxiety
* Insomnia
* Gastrointestinal upset
223
What should clients be warned about when using Asenapine?
Not to swallow sublingual tablets and to avoid eating and drinking for 10 minutes after dosing
224
What is a significant risk associated with Clozapine?
Fatal agranulocytosis
225
What monitoring is required for clients on Clozapine?
Baseline and regular monitoring of WBC per protocol
226
What are common adverse effects of Clozapine?
* Sedation
* Orthostatic hypotension
* Hypersalivation
* Anticholinergic effects
227
What nursing actions are required for Iloperidone?
Follow titration schedule to minimize hypotension
228
What are common adverse effects of Iloperidone?
* Dry mouth
* Sedation
* Fatigue
* Nasal congestion
229
How should Lurasidone be administered for maximum absorption?
With food, at least 350 kcal
230
What are common adverse effects of Lurasidone?
* Sedation
* Akathisia
* Parkinsonism
* Agitation and anxiety
* Nausea
231
What is the risk of EPS with Olanzapine?
Low risk
232
What are the forms of Olanzapine?
* Orally disintegrating tablets
* Short-acting injectable
* Extended-release injection
233
What monitoring is required after administering Olanzapine's extended-release injection?
Observation for at least 3 hours
234
What is the risk of diabetes and weight gain with Paliperidone?
Significant risk
235
What are common adverse effects of Quetiapine?
* Cataracts
* Sedation
* Orthostatic hypotension
* Anticholinergic effects
236
What is the risk of EPS with Quetiapine?
Low risk
237
What is unique about Ziprasidone's mechanism?
It affects both dopamine and serotonin
238
What should be done for maximum absorption of Ziprasidone?
Administer with food
239
What are common adverse effects of Ziprasidone?
* Sedation
* Orthostatic hypotension
* Anticholinergic effects
* ECG changes and QT prolongation
240
What is agranulocytosis?
A serious side effect associated with second generation (atypical antipsychotics) characterized by a decrease in white blood cells leading to increased infection risk
## Footnote
Onset is gradual and usually occurs during the first 6 months of therapy. Can occur with chlorpromazine.
241
What nursing actions should be taken for agranulocytosis?
* Advise clients to observe for indications of infection
* If indications of infection appear, obtain a CBC
242
What are the components of metabolic syndrome related to atypical antipsychotics?
* New onset of diabetes mellitus or loss of glucose control
* Dyslipidemia with increased risk for hypertension and cardiovascular disease
* Weight gain
243
What nursing actions should be taken for metabolic syndrome?
* Obtain baseline fasting blood glucose
* Monitor blood glucose periodically
* Monitor cholesterol and triglycerides if weight gain is greater than 14 kg (31 lb)
244
What client education is important regarding metabolic syndrome?
* Report indications (increased thirst, urination, appetite) to the provider
* Follow a healthy, low-calorie diet
* Engage in regular exercise
* Monitor weight gain
245
What is orthostatic hypotension?
A drop in blood pressure upon standing, which can occur with atypical antipsychotics
246
What nursing actions should be taken for orthostatic hypotension?
* Monitor blood pressure and heart rate for orthostatic changes
* Hold medication while notifying the provider of significant changes
247
What are anticholinergic effects?
Adverse effects such as urinary hesitancy or retention and dry mouth
248
What nursing actions should be taken for anticholinergic effects?
* Monitor for these adverse effects
* Report occurrences to the provider
* Encourage measures to relieve dry mouth, such as sipping water
249
What adverse effects are associated with agitation, dizziness, sedation, and sleep disruption?
These are common side effects of atypical antipsychotics
250
What nursing actions should be taken for agitation, dizziness, sedation, and sleep disruption?
* Monitor for these adverse effects
* Report occurrences to the provider
* Administer an alternative medication if prescribed
251
What are mild EPS?
Extrapyramidal symptoms such as tremors that can occur with atypical antipsychotics
252
What nursing actions should be taken for mild EPS?
* Monitor for EPS
* Instruct clients to recognize EPS
* Use AIMS test to screen for EPS
253
What should be done if elevated prolactin levels are indicated?
Obtain prolactin level if indicated
254
What client education is important regarding elevated prolactin levels?
Observe for galactorrhea, gynecomastia, and amenorrhea, and notify the provider if these occur
255
What sexual dysfunctions can occur with atypical antipsychotics?
* Anorgasmia
* Impotence
* Low libido
256
What client education is important regarding sexual dysfunction?
* Observe for possible sexual adverse effects
* Notify provider if intolerable
* Methods for managing sexual dysfunction can include using adjunct medications like sildenafil
257
What should risperidone not be used for?
Clients who have dementia
## Footnote
The use of these medications can cause death related to cerebrovascular accident or infection.
258
What substances should clients avoid while using risperidone?
Alcohol
259
In which conditions should risperidone be used cautiously?
Cardiovascular or cerebrovascular disease, seizures, diabetes mellitus
260
What baseline test should clients with diabetes mellitus have before using risperidone?
Baseline fasting blood sugar
261
What should be monitored carefully in clients with diabetes mellitus taking risperidone?
Blood glucose
262
What types of medications should be avoided in clients taking clozapine?
Immunosuppressive medications, such as anticancer medications
## Footnote
These medications can further suppress immune function.
263
What additive effects can occur with concurrent use of alcohol and other CNS depressants?
CNS depressant effects
## Footnote
This can lead to increased sedation and respiratory depression.
264
What should clients avoid while taking antipsychotics?
Alcohol and other medications that cause CNS depression
## Footnote
Clients should also avoid hazardous activities like driving.
265
How does levodopa interact with antipsychotic agents?
By activating dopamine receptors, levodopa counteracts the effects of antipsychotic agents
## Footnote
This can lead to reduced effectiveness of the antipsychotics.
266
What medications should be avoided concurrently with atypical antipsychotics that prolong the QT interval?
Tricyclic antidepressants, amiodarone, and clarithromycin
## Footnote
These medications increase the risk of cardiac dysrhythmias.
267
What effect do barbiturates and phenytoin have on medication levels of certain antipsychotics?
They stimulate hepatic medication-metabolizing enzymes, decreasing medication levels
## Footnote
Specifically affects aripiprazole, quetiapine, and ziprasidone.
268
What is the effect of fluconazole on medication levels of certain antipsychotics?
Inhibits hepatic medication-metabolizing enzymes, increasing medication levels
## Footnote
Affects aripiprazole, quetiapine, and ziprasidone.
269
What is the administration schedule for risperidone depot injection?
IM once every 2 weeks
## Footnote
Extended-release injection of paliperidone is administered every 28 days.
270
How often is Invega Trinza administered?
Every 3 months
## Footnote
This is a long-acting injectable form of paliperidone palmitate.
271
What is a good option for clients who have difficulty adhering to a medication schedule?
Long-acting injectable antipsychotics
## Footnote
These provide therapeutic effects 2 to 6 weeks after the first depot injection.
272
What should be done for clients who have difficulty swallowing tablets?
Use oral disintegrating tablets
## Footnote
This method helps clients who might attempt to 'cheek' or 'pocket' medications.
273
How should lurasidone and ziprasidone be administered to enhance absorption?
With food
## Footnote
This increases the effectiveness of these medications.
274
What is the initial dosing strategy for antipsychotic medications?
Start low and go slow
## Footnote
This approach helps to minimize side effects.
275
What should clients avoid doing after taking asenapine?
Eating or drinking for 10 minutes
## Footnote
This is to ensure proper absorption of the medication.
276
What indicators show effectiveness of antipsychotic medications?
Improvement and/or prevention of acute psychotic manifestations, absence of hallucinations, delusions, anxiety and hostility
## Footnote
Includes improvement in ability to perform ADLs, social interactions, and sleeping/eating habits.
