Ch. 17 Drugs - Psychoses Flashcards
Schizophrenia Positive Symptoms
ADD to normal behavior
Hallucinations, delusions, or paranoia
Strange and irrational behavior, actions
Rapid alternation between extreme hyperactivity and stupor
Schizophrenia Negative Symptoms
SUBTRACT from normal behavior
Lack of motivation; detachment
Deterioration of hygiene, job, academic performance
Withdrawal from social and interpersonal relationships
Conventional or “typical” antipsychotics
First Generation Psych Meds
Example of first generation psych med
chlorpromazine
(early 1950s, “first generation”)
Second generation psych meds
Atypical antipsychotics with fewer side effects
Third generation psych meds
also atypical; dopamine-serotonin system stabilizers
Example of third generation psych med
aripiprazole (Abilify)
chlorpromazine MOA
blocks positive symptoms
chlorpromazine pharmacologic class
D2 dopamine receptor antagonist; phenothiazine
Adverse Effects of First Generation Psych Meds
Acute dystonia
Akathisia
Anticholinergic effects
Disparity
Hypotension
Neuroleptic malignant syndrome
Secondary parkinsonism
Sedation
Sexual dysfunction
Tardive dyskinesia
Severe Adverse Effects of First Generation Psych Meds
Increased risk of suicide
Agranulocytosis
Pancytopenia
Sudden unexplained death
Body Systems to Monitor when taking First Generation Psych Meds
Decrease of psychotic symptoms, side effects
Anticholinergic side effects
Alcohol, illegal drug, caffeine, and nicotine use
Cardiovascular changes
Seizures and patient’s environment
Neuroleptic malignant syndrome (NMS)
haloperidol (Haldol) Pharmacologic class
D2 dopamine receptor antagonist; NONphenothiazine
haloperidol (Haldol) MOA
blocks positive symptoms
Adverse effects of nonphenothiazine (haloperidol [Haldol])
SAME AS PHENOTHIAZINES
Acute dystonia
Akathisia
Anticholinergic effects
Disparity
Hypotension
Neuroleptic malignant syndrome
Secondary parkinsonism
Sedation
Sexual dysfunction
Tardive dyskinesia
risperidone (Risperdal) - atypical antipsychotic treats what symptoms?
Both positive and negative symptoms
risperidone (Risperdal) MOA
block dopamine type 2 receptors, serotonin and alpha-adrenergic receptors
Atypical antipsychotic side effects
Less dramatic side effects than first generation, but still significant
Dopamine-serotonin system stabilizers
Third generation psych meds
Newest antipsychotic class
New drug class, approved in 2002
Example of third generation psych med
Aripiprazole (Abilify)
Aripiprazole (Abilify) controls what schizophrenia symptoms?
Positive and negative
Third generation psych med side effects
Low incidence of serious side effects compared to other antipsychotic drugs
Severe spasms, particularly the back muscles, tongue, and facial muscles; twitching movements
Acute dystonia
Constant packing with repetitive compulsive movements
Akathisia
Dy mouth, tachycardia, blurred vision, orthostatic hypotension, and urinary retention
Anticholinergic effects
High risk of suicide among patients receiving antipsychotic therapy
Disparity
Particularly severe when the patient when the patient moves quickly from a recumbent to an upright position
hypotension
High fever, tachycardia, incontinence, confusion, muscle rigidity, and high serum creatine kinase; can be fatal
Neuroleptic malignant syndrome
Tremor, muscle rigidity, stooped posture and shuffling gait
Secondary parkinsonism
Usually diminishes with continued therapy
Sedation
Impotence and diminished libido
Sexual dysfunction
Bizarre tongue and face movements, such as lip smacking and wormlike motions of the tongue; puffing of cheeks, uncontrolled chewing movements
Tardive dyskinesia
Acute dystonia
Akathisia
Secondary Parkinsonism
Tardive Dyskinesia
Extrapyramidal Symptoms
Most common EPS
Akathisia - inability to rest or relax.
Patient paces, has trouble sitting or remaining still, and has difficulty sleeping
Drugs that cause anticholinergic side effects
phenothiazine drugs -chlorpromazine
haloperidol (Haldol) may be given with what other drugs?
Short-acting benzodiazepines - Lorazepam
Normal side effects of haloperidol (Haldol)
Dystonic Behavior in EPS
Killer Side Effect of haloperidol (Haldol)
Neuroleptic Malignant Syndrome
Potential life-threatening reaction most often seen with typical antipsychotics
Neuroleptic Melignant Syndrome (NMS)
High fever and diaphoresis
Change in mental status
Muscle Rigidity
Tremors
Signs & Symptoms of NMS
Chlorpromazine and haloperidol (Haldol) treat what symptoms of schizophrenia?
Positive symptoms
Risperidone (Risperdal) treat what symptoms of schizophrenia
Positive and negative symptoms
Priority nursing actions for NMS
Hold haloperidol (Haldol)
Assess the patient
Notify HCP IMMEDIATELY
Risperidone (Risperdal) indication for use
Schizoprenia, schizoaffective disorder & patient’s not responding to other antipsychotics
Common side effects of risperidone (Risperdal)
Weight gain, hypersalivation (drooling), & sedation
Major Adverse effects of risperidone (Risperdal)
Agranularocytosis
Leukopenia - low WBCs & low immunity - decreased neutrophils
High risk for infections
Sore throat, fever, flu like symptoms
Priority action for adverse effects of risperidone (Risperdal)
IMMEDIATELY report to HCP
risperidone (Risperdal) contraindications
Patients with dementia - increased mortality
Can occur early in treatment or with an increased dose of medication
Acute Dystonia
Severe form of restlessness associated with a compulsion to move. Usually the legs or torso, not the head
Akathisia
Drug-induced movement disorder which mimics (or reveals) the S&S of idiopathic Parkinson’s Disease
Parkinsonism
(Secondary Parkinson’s)
Collective term for a set of late-onset and sometimes irreversible movement disorders which can include cborea, dysphonia, dystonia, tics, and myoclonus
Tardive Dyskinesia
Increase in dose or addition of medication that increases the levels of serotonin above the threshold that induces toxicity
Serotonin Syndrome
Acute onset of symptoms
Serotonin Syndrome
Signs of Serotonin Syndrome
Tremors & hyperreflexia
NMS symptoms arise when?
Days, weeks, or months
NMS is thought to be mediated by what?
Dopamine antagonism
Signs of NMS
Slowed movements and lead pipe rigidity
