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Psychopharm > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Anticonvulsant Mood Stabilizers

A
  • Valproate (depakote)
  • Carbamazepine (tegretol)
  • Lamotrigine (lamictal)
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2
Q

What meds do you treat bipolar disorders?

A
  • Lithium
  • Depakote
  • Tegretol
  • Lamictal
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3
Q

What are the first gen antipsychotics?

A
  • Chlorpromazine (thorazine)
  • Loxapine (adasuve)
  • Haldol (haloperidol)
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4
Q

Chlorpromazine (thorazine)

A
  • low potency
  • significant reduction in agitation
  • treats positive sx of schizophrenia
  • SE: orthostatic hypotension, photosensitivity, lowers seizure threshold
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5
Q

Haldol (haloperidol)

A
  • high potency
  • targets positive symptoms
  • low anticholinergic effects
  • high EPS
  • low sedative properties
  • decanoate (Haldol D) prolixin is also administered in a decanoate form
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6
Q

Loxapine (Adasuve)

A
  • inhaled
  • black box warning for bronchospasm
  • medium potency
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7
Q

What are the second gens antipsychotics?

A
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Asenaprine (Saphris)
  • Lurasidone (Latuda)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)
  • Clozapine (Clozaril)
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8
Q

Olanzapine (Zyprexa)

A
  • High risk of metabolic syndrome
  • weight gain
  • hypoglycemia
  • agrunulocytosis
  • metabolic syndrome
  • WBC’s monitor
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9
Q

Risperidone (Risperdal)

A
  • Low potential for agranulocytosis or convulsions
  • Highest risk of EPS among second generation
  • Risperdal Consta (INJ) every 2 weeks: increased compliance
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10
Q

Asenaprine (Saphris)

A

sublingual

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11
Q

Quetiapine (Seroquel)

A
  • High sedation

- weight gain

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12
Q

Ziprasidone (Geodon)

A
  • Take with food

- avoid in cardiac patients/hx of QT prolongation

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13
Q

Clozaril

A
  • treats + and - symptoms of schizo
  • 1st atypical antipsychotic
  • Low EPS and ACH
  • slow dosage increases
  • Monitor wbc’s
  • weekly blood levels
  • incidence of seizures
  • monitor smoking habits of patients
    side effects: sedation, hypotension, tachycardia, and severe drooling
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14
Q

1st gen adverse effects (typical)

A
  • SEA
  • sedation
  • EPS: pill rolling, parkinsonian-like sx
  • anticholinergic (dry mouth, constipation, urinary retention and hesitancy, blurred vision, nasal congestion, photophobia, dry eyes, inhibits ejaculation tachycardia)
  • TANS
  • tardive dyskinesia (lip smacking, tongue protruding, neck jerking)
  • agranolucytosis
  • neuroleptic malignant syndrome
  • seizures
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15
Q

2nd gen adverse effects (atypical)

A
  • lowers the risk of EPS and tardive dyskinesia
  • added risk for weight gain, diabetes, dyslipidemia
  • agranulocytosis, seizures, ortho hypo
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16
Q

What’s the highest risk of EPS?

A

Haldol

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17
Q

What medication needs close monitor of CBC

A

Clozapine (Clozaril)

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18
Q

What antipsychotic somnolence? (sleepiness)

A

Quetiapine (Seroquel)

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19
Q

What’s the lowest risk of EPS but causes weight gain and gynecomastia (male gets breast)?

A

Risperidone (risperidal)

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20
Q

What causes hyperglycemia?

A

Olanzapine (Zyprexa)

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21
Q

What are the nursing interventions for agranulocytosis?

A
  • if there’s infection, obtain WBC

- if WBC <3000 discontinue

22
Q

agranulocytosis patient teaching?

A
  • notify provider if they have signs of infection especially fever, more than 104 degrees
23
Q

anticholinergic nursing actions?

A
  • for dry mouth, chew sugarless gums or sip water
  • avoid hazardous activities
  • eat high food in fiber for constipation
  • wear sunglasses outdoors cuz of photophobia
  • exercise
  • 2 to 3 liters of water
  • pee before taking medication
24
Q

EPS adverse side effects; acute dystonia

- manifestations

A

severe spasm of neck, face, and back

25
Q

acute dystonia nursing actions

A

begin to monitor 1-5 days after first dose

- monitor airway until spasm subsides 5-15 mins

26
Q

EPS psuedoparkinsonian manifestations

A
  • bradykinesia (slowness of movement)
  • rigidity (stiff)
  • shuffling gait
  • drooling
  • tremors
27
Q

Nursing actions of pseudoparkinsonian

A
  • observe the symptoms between 15-30 days after first dose

- implement fall precautions

28
Q

EPS Akathisia manifestations

A
  • unable to sit or stand still
  • restlestness
  • continously pacing
  • it can occur between 5-6 days after first dose
29
Q

Akathisia nursing actions

A
  • monitor for suicide
30
Q

Tardive dyskinesia

A
  • it takes months to year

- involuntarily movements of face and tongue (lip smacking, lip protrusion, movements of body)

31
Q

nursing actions of TD

A
  • evaluate them after 12 months then every 3 months
  • lower the dose or switch to another med
  • once there is TD, it usually doesnt decrease NOT CURABLE
  • teach them make purposeful movements
32
Q

2nd gen/atypical neuroendocrine effects

manifestations

A
  • gycomasta )breast in male patients)
  • weight gain

nursing actions
monitor for weights

education
notify provider if they exist

33
Q

Neuroleptic malignant syndrome

manifestations

A
  • sudden high fever, more than or equal to 104
  • high BP
  • diaphoresis, excessive sweating
  • tachycardia
  • muscle rigidity
  • decrease LOC
  • coma, death
34
Q

Nursing actions of NMS

A
  • THIS IS MEDICAL EMERGENCY within the first week of their first dose
  • stop the med!!!
  • monitor vital signs
  • apply cooling blankey
  • administer antipyretics
  • increase fluid intake
  • muscle relaxant for rigidity
  • meds for arryhtmias
  • go to ICU if they were hospitalized
  • gotta wait for 2 weeks before they start another antipsychotic med (usually 2nd gen)
35
Q

Orthostatic hypotension (second gen;nursing actions)

A
  • to monitor bp and heart rate and hold med, notify provider

- increase fluid intake = more blood in circulation

36
Q

Seizures

A
  • higher risk if they have history
  • increase their anti-seizure medication
  • report to provider
37
Q

Contraindications (antipsychotics)

A
  • coma
  • parkinsons disease
  • liver damage
  • severe hypotension
38
Q

1st gen contraindications

A
  • dementia patients
39
Q

lithium

A
  • 10-21 days onset of action
40
Q

lithium used for

A
  • elation
  • flight of ideas
  • anxiety
  • irritability
  • suicidal ideation
  • self injury
41
Q

Lithium contraindications

A
  • mus asses renal and thyroid function
    EKG
  • bresatfeeding
42
Q

Lithium therapeutic dose

A

less than 1.5 mEq/L

43
Q

How often do you have to measure for lithium?

A
  • 5 days after beginning and any after dosage change until therapeutic reached
  • blood levels checks 6 to 1 year after stable, every 3 mo
  • drawn in the morning 10-12 hrs after last dose
44
Q

Lithium side effects

A

-polyuria
- fine hand tremor
- mild thirst = may persist during treatment
- mild nausea
general discomfort
- weight gain = often subside, managed by diet = exercise

45
Q

Lithium Early signs of toxicity

A
  • 1.5-2.0 mEq/L
  • GI upset
  • course hand tremor
    confusion
  • hyperirritability of muscles
  • EKG changes
  • sedation
  • incoordination
46
Q

Lithium Early signs of toxicity interventions

A
  • hold dose
  • close eval
  • blood draw
47
Q

lithium advanced signs toxicity

A
  1. 0-2.5mEq/L
    - ataxia
    - giddiness
    - serious EKG changes
    - blurred vision
    - clonic movements
    - large output of dilute urine
    - seizures
    - stupor
    - hypotension
    - coma
    - death associated with pulmonary
48
Q

lithium advanced signs of toxicity interventions

A
  • hospitalization
  • stop drug and hasten excretion
    • whole bowel irrigation
49
Q

lithium severe toxicity

A

more than 2.5 mEq/L

  • convulsions
  • oliguria = none or small amounts of urine
  • death
50
Q

lithium severe toxicity interventions

A

in addition to previously mentioned interventions, hemodialysis may be needed

Psychopharm (1 decks)

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