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_NS 126 > Ch. 4 Psychopharm 2 - Meds > Flashcards

Ch. 4 Psychopharm 2 - Meds Flashcards

1
Q

What happens when there’s too much dopamine? What happens when there’s too little dopamine?

A

+ Schizophrenia
+ parkinsonism

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2
Q

Signs of parkinsonism

A

+ Shuffle
+ pill rolling
+ challenge initiating movement
+ challenge initiating speech 

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3
Q

Medication given for EPS due to antipsychotic meds

A

+ Anticholinergic: Benztropine / cogentin
+ CNS depressant/anticholinergic: diphenhydramine (Benadryl)
+Anti convulsant Benzo: clonazepam
+ beta 2 blocker: (not 1st choice) propranolol

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4
Q

What are 5 EPS symptoms/groups

A

+ acute dystonia
+ parkinsonism
+ akathesia
+ tardive dyskinesia
+ NMS - neuroleptic malignant syndrome

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5
Q

Symptoms of acute dystonia

A

Uncontrolled muscle spasms - mostly face, neck (torticaulis) throat

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6
Q

Symptoms of parkinsonism

A

+ pill rolling
+ shuffling
+ trouble initiating movement & speech
+ rigidity & tremors
+ bradykinesia

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7
Q

Symptoms of akathesia

A

+ restlessness
+ irresistible urge to move legs & arms, whole body

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8
Q

Symptom of tardive diskynesia

A

+ involuntary movements of face mainly
+ Lipsmacking
+ cheek, puffing
+ I blinking and rolling assign tongue movements

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9
Q

What is NMS?
Symptoms of NMS?
What is so important about NMS?

A

+ neuroleptic malignant syndrome
+ High fever
+ muscular rigidity - lead pipe, stiff posture
+ altered mental status, reduced consciousness
+ autonomic disturbances - hyperpyrexia, HBP, tachycardia, oculogryation
*** it can be deadly if not treated

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10
Q

What causes NMS?
What is the antidote/treatment, nursing interventions?

A

+ antipsychotic medications - MAINLY 1st gen

+ STOP ANTPSYCHOTICS
+ administer:
- dopamine agonist: bromocriptine
- muscle relaxer: dantrolene
- benzodiazepines / diazepam for CNS depression agitation
* ASSESS VITALS, ABCs
* reduce temp - cooling measures
* IV fluids, monitor, ICU

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11
Q

What preparations to antipsychotic meds come in

A

+ Oral
+ IM
+ depot - long acting injectable: 1-3 month

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12
Q

Atypical - antipsychotic name endings

A

_zole - Aripiprazole
_pine - clozapine, olanzapine, quetiapine
_done - risperidone, ziprasidone

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13
Q

Typical - antipsychotic name endings

A

_zine - chlorpromazine (Thorazine)
_dol - haloperidol (Haldol)

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14
Q

What is the action of first generation antipsychotics?
What symptoms do the effect?

A
  • Block/inhibit release of dopamine in brain
  • positive symptoms only: hallucinations, delusions
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15
Q

What is the action of second generation atypical antipsychotics?
What symptoms do the effect?

A
  • block/modulate dopamine & serotonin
  • both positive & negative (inward, flat affect, withdrawal, avolition, anhedonia, alogia) symptoms
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16
Q

What kind of drug is benz(a)tropine/Cogentin

A

Anticholinergic – blocks acetylcholine

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17
Q

What is benztropine/Cogentin used for?

A

Parkinsonism
dystonia
EPS symptoms

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18
Q

Anticholinergic drugs of choice for dystonia and parkinsonism

A

+ Cogentin/banzatropine
+ Benadryl/diphenhydramine
+ Artane/trihexaphenadryl

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19
Q

What needs to be in balance to combat EPS?

A

Balance between dopamine and acetylcholine

20
Q

What is anticholinergic overdose?
What are nursing implications of anticholinergic crisis/overdose?

A

+ Potentially life-threatening anticholinergic delirium.
+ Occurs in patients taking multiple medications with anticholinergic effects
+ mad as a hatter, red is a beat, hot as a hair, blind as a bat, dry as a bone
+ confusion and hallucinations
+ discontinue medication
+ gastric lavage
+ Charcoal

21
Q

What needs to be in balance in order to maintain smooth muscle movement

A

Dopamine and acetyl choline

22
Q

Which dopamine pathway is related to extraparametal syndromes, and increased cholinergic activity?

A

Nigrostriatal - 3rd

23
Q

What is the extraparametal system responsible for?

A

Modulating movement – particularly walking, to make smooth, rhythmic transitions

24
Q

Telltale signs of dystonia

A

+ Involuntary muscle spasms mainly in upper body/neck
+ abnormal postures
+ oculogyric crisis
+ torticollis
+ oropharyngeal dysphasia 

25
Q

What is akathisia?

A

Inability to sit, still, restlessness

26
Q

chronic syndrome that comes from long-term antipsychotic use and is irreversible?

A

Tardive dyskinesia

27
Q

Risk factors of NMS

A

+ dehydration
+ history of NMS
+ recent dosage increase
+ psycho motor agitation

28
Q

Early signs of NMS

A

+ Low-grade fever
+ tachycardia
+ elevated blood pressure
+ catatonia
+ diaphoresis

29
Q

classic or late signs and symptoms of NMS

A

FEVER (mnemonic)
+ fever
+ elevated enzymes - CPK (from rhabdomyolysis)
+ vital sign instability
+ encephalopathy
+ rigidity
+ autonomic instability - smooth muscle issues (organs)

30
Q

Side effects of second generation, atypical antipsychotics

A

+ Metabolic syndrome
+ Agranulocytosis – blood disorders (clozapine)
+ NMS

31
Q

Symptoms of agranulocytosis

A

+ Decreased granulocytes/wbc’s (mainly neutrophils)
+ fever/chills/weakness
+ sore throat, sores in the mouth or throat
+ bleeding gums
+ bone pain
+ ⬇️ BP, tachycardia
+ trouble breathing

32
Q

What labs do you check for 2nd gen. antipsychotics?
patient teaching?

A

+ Blood sugar, LDL, triglycerides
+ can cause metabolic syndrome – advised to exercise, low calorie, diet, monitor weight

33
Q

Major side effects of first GEN antipsychotics

A

+ Higher risk of TD, EPS, NMS
+ orthostatic hypotension

34
Q

Depression is related to deficiency in what neurotransmitters?

A

+ Serotonin
+ norepinephrine
+ dopamine

35
Q

What is the intention or action of antidepressants?
How long does it take for antidepressants to work?

A

+ To increase the level of Neuro transmitters up to normal level equaling normal mood
+4 to 6 weeks

36
Q

What does MDD cause – major depressive disorder?

A

+ Psycho motor retardation – slowing down or hampering of mental or physical activities

37
Q

What causes serotonin syndrome?
Signs and symptoms?

A

+ Overstimulation of serotonin receptors – when SSRIs are used together
+ Agitation, fever, hypertension, hyperthermia, muscle rigidity, myoclonus (jerky)


38
Q

First line medication mood stabilizer?
What does it treat?

A

+ lithium
+ bipolar swings - depression/mania

39
Q

adverse reactions/SE of lithium

A

+ Nausea
+ drowsiness/fatigue
+ thirst
+ dry mouth
+ weight gain

40
Q

Signs of toxicity from lithium?
What is the therapeutic level?

A

+ 0.6-1.2
+ Toxicity begins at 1.5
+ Severe toxicity above 3
+ Confusion, blurred vision, diarrhea
+ slurred speech
+ coma, convulsions, tremors/ataxia
+ vomiting/diarrhea

41
Q

Other drugs that can be mood stabilizers a second line of defense

A

+ Antiepileptic drugs – valproic acid, Tegretol
+ they raise GABA - for rapid -/+ of biploar

42
Q

Contra indications and education of lithium

A

+ Pregnancy, breast-feeding - teratogenic
+ renal, cardiovascular disease
+ severe dehydration
+ on thiazide diuretics
+ low sodium levels
+ avoid NSAIDs
+ serum lithium levels checked 1 to 2 months
+ avoid excess water and low salt diet

43
Q

How does lithium toxicity occur?

A

+ Dehydration
+ hyponatremia
+ impaired thyroid
+ patients over 50
+ kidney failure

44
Q

What neurotransmitters does lithium affect?

A

+ ⬇️ Dopamine (excitatory)
+ ⬇️ glutamate (excitatory)
+ ⬆️ GABA (inhibitory)

45
Q

Class of antianxiety drugs – anxiolytics
What do they treat?
Which neurotransmitter do they work on?

A

+ Benzos – benzodiazepines
+ acute anxiety, seizures, alcohol withdrawal
+ Also a sedative/muscle relaxer - EPS, NMS
+ ⬆️ GABA – slows/calms nerve/brain activity

46
Q

Antidote for lorazepam/Ativan - antianxiety

A

Flumazenil - “ I flu fast in my Mercedes Benz”

47
Q

Adverse reactions of benzos

A

+ Sedation
+ lightheadedness, dizzy
+ visual disturbances
+ anger/restlessness
+ G.I. upset
+ apathy, fatigue
+ dry mouth

_NS 126 (14 decks)

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