Exam 2 Meds

Question 1

chlorpromazine (Thorazine)
haloperidol (Haldol)
perphenazine(Trilafon)
fluphenazine (Prolixin)

Answer 1

Typical/conventional antipsychotics

Question 2

5 Dopamine receptor sites in the brain with millions of branches (D1-D5)
Typical antipsychotics indiscriminately antagonize these sites to reduce dopamine

Answer 2

Typical action

Question 3

Typical only treats…

Answer 3

positive symptoms of schizophrenia

Question 4

Thorazine
Trilafon
Haldol

Answer 4

Thorazine (max 400 mg) weakest 100 mg= 1 mg of Haldol
Trilafon mid range 8-32 mg
Haldol (10-20 mg daily) prolixin 10-20 mg

Question 5

clozapine (Clozaril)- late 80s
risperidone (Risperdal)
quetiapine (Seroquel)
olanzapine (Zyprexa)
aripipazole (Abilify)
paliperidone palmitate (Invega)
asenapine (Saphris)
lurasidone hydrochloride (Latuda)
caripraziine (Vraylar)
Brexpiprazole (Rexulti)

Answer 5

Atypical antipsychotics

Question 6

There are 7 known receptor sites in the brain (5HT1-7)
The atypical antipsychotics selectively antagonize dopamine and serotonin at these sites to create the response needed to reduce positive and negative symptoms of schizophrenia/ schizoaffective disorders.

Answer 6

Action of atypical antipsychotics

Question 7

Haldol old one
Prolixin old one
Invega sustenna
Risperdal consta
Can be used alone or in conjunction with other psychotropic medications

Answer 7

Decanoate injections (Depot)

Question 8

Benztropine (Cogentin)
Diphenhydramine (Benadryl)
Trihexyphenidyl HCl (Artane)

Answer 8

Antiparkinsonian meds

Question 9

Dystonias
Oculogyric crisis- eye backwards
Pseudoparkinsonism- low dopamine, resting tremors drooling
Akathisia- restless legs
Tardive Dyskinesia- mouth going back and fort, involuntary

Answer 9

EPS: Extrapyramidal symptoms

Question 10

Torticollis- slightly turned, neck problem no pill, give subq or IM

Answer 10

Dystonia

Question 11

Pseudoparkinsonism

Answer 11

rigidity
resting tremors
drooling
facial masking
lack of arm movement
shuffling gait

Question 12

Tardive dyskinesia

Answer 12

buccal movements lateral
lip smacking
tongue protrusion
torso movements

Question 13

High fever: >105 degrees
Sweating
Stupor
Muscular rigidity
Elevated CPK
Vital Sign fluctuation
Incontinence
Coma

Answer 13

NMS: neuroleptic malignant syndrome

Question 14

ICU setting
Stop antipsychotic
Administer bromocriptine (Parlodel)
Aggressive IV fluids
Administer dantrolene (Dantrium) (muscle relaxer)
Cooling blanket
Antipyretics

Answer 14

Treatment of NMS

Question 15

Akathisia

Answer 15

Restlessness

Question 16

Dry eyes/mouth
Thirst
Decreased BP
Sedation
Constipation
Blurry vision
Urinary retention
Confusion
Visual hallucinations
Increased memory difficulties
Photosensitivity
Weight Gain
Hormonal effects

Answer 16

Anticholinergic SE

Question 17

Black Box warning for anticholinergic

Answer 17

Warning: Increased Mortality in Elderly Patients With Dementia-Related Psychosis
Results in MI or CVA

Question 18

Metabolic syndrome

Answer 18

olanzapine (Zyprexa)
risperidone (Risperdal)

Question 19

Fever
Sore throat
Painful mouth ulcers
Anal ulcers
Reduced immune response
Prone to bacterial infections

Answer 19

Agranulocytosis: Decreased WBCs

Question 20

Cardiovascular

Answer 20

Orthostatic hypotension
prolonged QT segment
S&S CHF

Question 21

Seizures

Answer 21

Clozaril lowers seizure threshold

Question 22

General Health Teaching

Answer 22

Response 1-2 weeks initially
Compliance is a major issue
Sun precautions
F/U lab work
Monitor for weight gain and hyperglycemia
Do not drink alcohol
If abrupt discontinuation will get flu-like symptoms and rebound psychosis.
Usually not lethal in overdosing

Question 23

inhibits acetylcholinesterase which slows the degradation of acetylcholine; relies on intact cholinergic neurons, slows breakdown of acetylcholine, raise acetylcholine more activation, think clearer, relies on non injured parts

Answer 23

Donepezil (Aricept)

Question 24

works with glutamate, neuron destruction, protects cells form destruction, work for ADL

Answer 24

Nemenda

Question 25

Donepezil and Nemenda phases of AD

Answer 25

All phases- mild, moderate, severe, want to maintain quality of life, slow down progression, still going to progress, not doing well, quality to try and slow down the lose

Once stop can not be put back again, maintain quality of life as long as you can

Question 26

Donepezil and Nemenda nursing implications

Answer 26

Take with food, give in AM, titrate dose slowly over 30 days

Question 27

Donepezil and Nemenda SE

Answer 27

GI upset, headache, insomnia, dizziness, can get a patch, Exelon

Question 28

Action same as donepezil
inhibits acetylcholinesterase which slows the degradation of acetylcholine; relies on intact cholinergic neurons, slows breakdown of acetylcholine, raise acetylcholine more activation, think clearer, relies on non injured parts

Answer 28

Rivastagmine (Excelon)

Question 29

Rivastagmine (Excelon) phases of AD

Answer 29

Mild to moderate

Question 30

Nursing implications of Rivastagmine (Excelon)

Answer 30

can be administered as a patch or PO

Question 31

Rivastagmine (Excelon) SE

Answer 31

patch have less GI side effects
GI upset, headache, insomnia, dizziness, can get a patch

Question 32

it is an NMDA receptor antagonist, meaning it protects the cells from glutamate destruction and calcium infusing into the neurons causing disruption of nerve cells

Answer 32

N-methyl-D-aspartate (NMDA)-

Question 33

NMDA phases of AD

Answer 33

moderate to severe

Question 34

NMDA nursing implications

Answer 34

ADL assessment, MOCA assessment- Apraxia

Question 35

NMDA SE

Answer 35

Dizziness, headache, constipation

• These drugs work different than cholinesterase inhibitors so they can be given with them

Question 36

Discontinuance of Neurocognitive

Answer 36

once these drugs have been stopped they cannot be resumed. They do not work the same.