Ch. 4 Psychopharm 2 - Meds Flashcards
What happens when there’s too much dopamine? What happens when there’s too little dopamine?
+ Schizophrenia
+ parkinsonism
Signs of parkinsonism
+ Shuffle
+ pill rolling
+ challenge initiating movement
+ challenge initiating speech 
Medication given for EPS due to antipsychotic meds
+ Anticholinergic: Benztropine / cogentin
+ CNS depressant/anticholinergic: diphenhydramine (Benadryl)
+Anti convulsant Benzo: clonazepam
+ beta 2 blocker: (not 1st choice) propranolol
What are 5 EPS symptoms/groups
+ acute dystonia
+ parkinsonism
+ akathesia
+ tardive dyskinesia
+ NMS - neuroleptic malignant syndrome
Symptoms of acute dystonia
Uncontrolled muscle spasms - mostly face, neck (torticaulis) throat
Symptoms of parkinsonism
+ pill rolling
+ shuffling
+ trouble initiating movement & speech
+ rigidity & tremors
+ bradykinesia
Symptoms of akathesia
+ restlessness
+ irresistible urge to move legs & arms, whole body
Symptom of tardive diskynesia
+ involuntary movements of face mainly
+ Lipsmacking
+ cheek, puffing
+ I blinking and rolling assign tongue movements
What is NMS?
Symptoms of NMS?
What is so important about NMS?
+ 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
What causes NMS?
What is the antidote/treatment, nursing interventions?
+ 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
What preparations to antipsychotic meds come in
+ Oral
+ IM
+ depot - long acting injectable: 1-3 month
Atypical - antipsychotic name endings
_zole - Aripiprazole
_pine - clozapine, olanzapine, quetiapine
_done - risperidone, ziprasidone
Typical - antipsychotic name endings
_zine - chlorpromazine (Thorazine)
_dol - haloperidol (Haldol)
What is the action of first generation antipsychotics?
What symptoms do the effect?
- Block/inhibit release of dopamine in brain
- positive symptoms only: hallucinations, delusions
What is the action of second generation atypical antipsychotics?
What symptoms do the effect?
- block/modulate dopamine & serotonin
- both positive & negative (inward, flat affect, withdrawal, avolition, anhedonia, alogia) symptoms
What kind of drug is benz(a)tropine/Cogentin
Anticholinergic – blocks acetylcholine
What is benztropine/Cogentin used for?
Parkinsonism
dystonia
EPS symptoms
Anticholinergic drugs of choice for dystonia and parkinsonism
+ Cogentin/banzatropine
+ Benadryl/diphenhydramine
+ Artane/trihexaphenadryl
What needs to be in balance to combat EPS?
Balance between dopamine and acetylcholine
What is anticholinergic overdose?
What are nursing implications of anticholinergic crisis/overdose?
+ 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
What needs to be in balance in order to maintain smooth muscle movement
Dopamine and acetyl choline
Which dopamine pathway is related to extraparametal syndromes, and increased cholinergic activity?
Nigrostriatal - 3rd
What is the extraparametal system responsible for?
Modulating movement – particularly walking, to make smooth, rhythmic transitions
Telltale signs of dystonia
+ Involuntary muscle spasms mainly in upper body/neck
+ abnormal postures
+ oculogyric crisis
+ torticollis
+ oropharyngeal dysphasia 
What is akathisia?
Inability to sit, still, restlessness
chronic syndrome that comes from long-term antipsychotic use and is irreversible?
Tardive dyskinesia
Risk factors of NMS
+ dehydration
+ history of NMS
+ recent dosage increase
+ psycho motor agitation
Early signs of NMS
+ Low-grade fever
+ tachycardia
+ elevated blood pressure
+ catatonia
+ diaphoresis
classic or late signs and symptoms of NMS
FEVER (mnemonic)
+ fever
+ elevated enzymes - CPK (from rhabdomyolysis)
+ vital sign instability
+ encephalopathy
+ rigidity
+ autonomic instability - smooth muscle issues (organs)
Side effects of second generation, atypical antipsychotics
+ Metabolic syndrome
+ Agranulocytosis – blood disorders (clozapine)
+ NMS
Symptoms of agranulocytosis
+ 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
What labs do you check for 2nd gen. antipsychotics?
patient teaching?
+ Blood sugar, LDL, triglycerides
+ can cause metabolic syndrome – advised to exercise, low calorie, diet, monitor weight
Major side effects of first GEN antipsychotics
+ Higher risk of TD, EPS, NMS
+ orthostatic hypotension
Depression is related to deficiency in what neurotransmitters?
+ Serotonin
+ norepinephrine
+ dopamine
What is the intention or action of antidepressants?
How long does it take for antidepressants to work?
+ To increase the level of Neuro transmitters up to normal level equaling normal mood
+4 to 6 weeks
What does MDD cause – major depressive disorder?
+ Psycho motor retardation – slowing down or hampering of mental or physical activities
What causes serotonin syndrome?
Signs and symptoms?
+ Overstimulation of serotonin receptors – when SSRIs are used together
+ Agitation, fever, hypertension, hyperthermia, muscle rigidity, myoclonus (jerky)

First line medication mood stabilizer?
What does it treat?
+ lithium
+ bipolar swings - depression/mania
adverse reactions/SE of lithium
+ Nausea
+ drowsiness/fatigue
+ thirst
+ dry mouth
+ weight gain
Signs of toxicity from lithium?
What is the therapeutic level?
+ 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
Other drugs that can be mood stabilizers a second line of defense
+ Antiepileptic drugs – valproic acid, Tegretol
+ they raise GABA - for rapid -/+ of biploar
Contra indications and education of lithium
+ 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
How does lithium toxicity occur?
+ Dehydration
+ hyponatremia
+ impaired thyroid
+ patients over 50
+ kidney failure
What neurotransmitters does lithium affect?
+ ⬇️ Dopamine (excitatory)
+ ⬇️ glutamate (excitatory)
+ ⬆️ GABA (inhibitory)
Class of antianxiety drugs – anxiolytics
What do they treat?
Which neurotransmitter do they work on?
+ Benzos – benzodiazepines
+ acute anxiety, seizures, alcohol withdrawal
+ Also a sedative/muscle relaxer - EPS, NMS
+ ⬆️ GABA – slows/calms nerve/brain activity
Antidote for lorazepam/Ativan - antianxiety
Flumazenil - “ I flu fast in my Mercedes Benz”
Adverse reactions of benzos
+ Sedation
+ lightheadedness, dizzy
+ visual disturbances
+ anger/restlessness
+ G.I. upset
+ apathy, fatigue
+ dry mouth
