Chapter 12 Flashcards
What are the main 4 Extrapyramidal Syndrome Side Effects?
- Pseudoparkinsonism
- Akathisia
- Dystonia
- Tardive Dyskinesia
What are characteristics of pseudoparkinsonism?
slow movement, rigid muscles, drooling, shuffling gait, dysphagia, tremor, mask-like facial expression, postural instability
What are characteristics of akathisia?
restlessness, difficulty sitting or standing still, pacing/marching in place, agitation
What are characteristics of dystonia?
involves muscles of mouth head and face. Protruding/twisting tongue, difficulty swallowing/talking, twisting neck, extending trunk, oclelogyric crisis
What are characteristics of tardive dyskinesia?
involuntary mouth/lips/tongue movement, vermicular movements of the tongue, lip smacking, lateral jaw movements, puffing of cheeks, blinking/frowning, involuntary quick purposeless flailing movements of the extremities, wave like slow movements of the limbs, to and fro movement of the spine.
Name the 6 drugs used to treat extrapyramidial side effects.
- Cogentin
- Artane
- Symmetrel
- Benadryl
- Inderal
- Ativan
What are some of the symptoms of Neuroleptic Malignant Syndrome?
exaggerated pseudoparkinsonism, fever, muscle rigidity, aloc, unstable BP, tachycardia, diaphoresis, increased WBC and CPK
What are symptoms of lithium toxicity?
apathy, lethargy, diminished concentration, ataxia, hand tremors, muscle weakness, nausea vomiting and diarrhea, slurred speech, tinnitus, blurred vision, muscle twitching, nystagmus, deep tendon hyperreflexia, visual/tactile hallucinations, seizure, coma, death
What are symptoms of central serotonin syndrome?
hyperactivity, restlessness, tachycardia, CV shock, fever, elevated BP, altered mental states, irritability, mood swings, hostility, seizures, myoclonus, incoordination, tonic rigidity, abdominal pain, diarrhea, bloating, apnea, death
What are some anticholinergic symptoms?
dry mouth, urinary retention and hesitancy, constipation, blurred vision, photosensitivity, dry eyes, impotence
Symptoms of agranulocytosis?
sore throat, fever, malaise, mouth sores, flu like symptoms
What second generation antipsychotic drug produces agranulocytosis?
clozapine (therefore patients taking this must have weekly WBC counts for the first 6 months taking it and frequent monitoring thereafter)
What are symptoms of cholestatic jaundice?
fever, malaise, nausea, abdominal pain, jaundice (1 week later)
What are positive symptoms of schizophrenia?
hallucinations, delusions, disorganized speech (associative looseness), and bizarre behavior. positive symptoms are the presence of something not normally present
What are negative symptoms of schizophrenia?
blunted affect, poverty of thought (alogia), loss of motivation (avolition), anhedonia. negative symptoms are the absence of something that should be present
What are cognitive symptoms of schizophrenia?
inattention, easily distracted, impaired memory, poor problem-solving skills, poor decision making skills, illogical thinking, impaired judgement
What are affective symptoms of schizophrenia?
dysphoria, suicidality, hopelessness
What is a conventional antipsychotic?
a first-generation antipsychotic
What is an atypical antipsychotic?
a second-generation antipsychotic
What is the only third-generation antipsychotic?
abilify
What kind of symptoms do conventional (first-generation antipsychotics) treat?
positive symptoms
What side effects are caused with conventional (first-generation) antipsychotics?
EPS’s, anticholinergic side effects, tardive dyskinesia, weight gain, sexual dysfunction, endocrine disturbances, sedation.
What 3 receptors do conventional (first-generation) antipsychotics block?
acetycholine, norepinephrine, histamine
Name the 8 conventional (first-generation) antipsychotics.
- Haldol (haloperidol)
- Orap (pimozide)
- Prolixin (fluphenazine)
- Thorazine (chlorpromazine)
- Trilafon (perphenazine)
- Mellaril (thioridazine)
- Navane (thithixene)
- Compazine (prochlorperazine)
What do atypical (second-generation) antipsychotics treat?
both positive and negative symptoms
What kind of antipsychotic is the first line treatment and why?
atypical (second-generation) antipsychotics (less side effects: minimal EPS and tardive dyskinesia)
What 2 neurotransmitters are blocked by atypical (second-generation) antipsychotics?
dopamine and serotonin
Name the 9 atypical (second-generation) antipsychotics.
- paliperidone (Invega)
- Iloperidone (Fanapt)
- lurasidone (Latuda)
- asenapine (Saphris)
- clozapine (clozaril)
- risperidone (Risperdal)
- Quetiapine (Seroquel)
- olanzapine (Zyprexa, Zyprexa relprevv)
- ziprasidone (Geodon)
Schizophreniform Disorder
when your patient has symptoms of schizophrenia but has had them for less than 6 months.
Schizoaffective Disorder
when an episode of major depression, mania, or mixed depression occur with symptoms of schizophrenia.
Neologisms
made-up words that have meaning for the patient but a different or nonexistent meaning to others
Word Salad
a jumble of words meaningless to the listener
Clang Association
choosing words based on their sound rather than their meaning (rhyming)
Waxy flexibility
extended maintenance of posture (nurse puts patient’s arm up and patient holds it up for a while)
Anosognosia
an inability to realize they are ill (caused by the illness itself)
What is the goal of Phase 1 (acute)?
patient safety and stabilization
What is the goal of Phase 2 (stabilization)?
help patient understand illness and treatment, become stabilized on meds and control or cope with symptoms
What is the goal of Phase 3 (maintenance)?
maintaining achievement, treatment adherence, achieving independence, quality of life
What are some things you can teach the patient and family to use to cope with auditory hallucinations?
use competing auditory stimuli, promote reality testing, engage in activity, do something physical, make contact with others, and talk to yourself (tell voices to go away)
patients with schizophrenia die how many years prematurely?
28 years
polydipsia can lead to what? what should you do for your patient?
can lead to fatal water intoxication; I need to restrict fluid intake and evaluate for water intoxication via daily weights.
