Exam 3 Flashcards
Anticonvulsant Mood Stabilizers
- Valproate (depakote)
- Carbamazepine (tegretol)
- Lamotrigine (lamictal)
What meds do you treat bipolar disorders?
- Lithium
- Depakote
- Tegretol
- Lamictal
What are the first gen antipsychotics?
- Chlorpromazine (thorazine)
- Loxapine (adasuve)
- Haldol (haloperidol)
Chlorpromazine (thorazine)
- low potency
- significant reduction in agitation
- treats positive sx of schizophrenia
- SE: orthostatic hypotension, photosensitivity, lowers seizure threshold
Haldol (haloperidol)
- high potency
- targets positive symptoms
- low anticholinergic effects
- high EPS
- low sedative properties
- decanoate (Haldol D) prolixin is also administered in a decanoate form
Loxapine (Adasuve)
- inhaled
- black box warning for bronchospasm
- medium potency
What are the second gens antipsychotics?
- Olanzapine (Zyprexa)
- Risperidone (Risperdal)
- Asenaprine (Saphris)
- Lurasidone (Latuda)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
- Clozapine (Clozaril)
Olanzapine (Zyprexa)
- High risk of metabolic syndrome
- weight gain
- hypoglycemia
- agrunulocytosis
- metabolic syndrome
- WBC’s monitor
Risperidone (Risperdal)
- Low potential for agranulocytosis or convulsions
- Highest risk of EPS among second generation
- Risperdal Consta (INJ) every 2 weeks: increased compliance
Asenaprine (Saphris)
sublingual
Quetiapine (Seroquel)
- High sedation
- weight gain
Ziprasidone (Geodon)
- Take with food
- avoid in cardiac patients/hx of QT prolongation
Clozaril
- 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
1st gen adverse effects (typical)
- 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
2nd gen adverse effects (atypical)
- lowers the risk of EPS and tardive dyskinesia
- added risk for weight gain, diabetes, dyslipidemia
- agranulocytosis, seizures, ortho hypo
What’s the highest risk of EPS?
Haldol
What medication needs close monitor of CBC
Clozapine (Clozaril)
What antipsychotic somnolence? (sleepiness)
Quetiapine (Seroquel)
What’s the lowest risk of EPS but causes weight gain and gynecomastia (male gets breast)?
Risperidone (risperidal)
What causes hyperglycemia?
Olanzapine (Zyprexa)
What are the nursing interventions for agranulocytosis?
- if there’s infection, obtain WBC
- if WBC <3000 discontinue
agranulocytosis patient teaching?
- notify provider if they have signs of infection especially fever, more than 104 degrees
anticholinergic nursing actions?
- 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
EPS adverse side effects; acute dystonia
- manifestations
severe spasm of neck, face, and back
acute dystonia nursing actions
begin to monitor 1-5 days after first dose
- monitor airway until spasm subsides 5-15 mins
EPS psuedoparkinsonian manifestations
- bradykinesia (slowness of movement)
- rigidity (stiff)
- shuffling gait
- drooling
- tremors
Nursing actions of pseudoparkinsonian
- observe the symptoms between 15-30 days after first dose
- implement fall precautions
EPS Akathisia manifestations
- unable to sit or stand still
- restlestness
- continously pacing
- it can occur between 5-6 days after first dose
Akathisia nursing actions
- monitor for suicide
Tardive dyskinesia
- it takes months to year
- involuntarily movements of face and tongue (lip smacking, lip protrusion, movements of body)
nursing actions of TD
- 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
2nd gen/atypical neuroendocrine effects
manifestations
- gycomasta )breast in male patients)
- weight gain
nursing actions
monitor for weights
education
notify provider if they exist
Neuroleptic malignant syndrome
manifestations
- sudden high fever, more than or equal to 104
- high BP
- diaphoresis, excessive sweating
- tachycardia
- muscle rigidity
- decrease LOC
- coma, death
Nursing actions of NMS
- 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)
Orthostatic hypotension (second gen;nursing actions)
- to monitor bp and heart rate and hold med, notify provider
- increase fluid intake = more blood in circulation
Seizures
- higher risk if they have history
- increase their anti-seizure medication
- report to provider
Contraindications (antipsychotics)
- coma
- parkinsons disease
- liver damage
- severe hypotension
1st gen contraindications
- dementia patients
lithium
- 10-21 days onset of action
lithium used for
- elation
- flight of ideas
- anxiety
- irritability
- suicidal ideation
- self injury
Lithium contraindications
- mus asses renal and thyroid function
EKG - bresatfeeding
Lithium therapeutic dose
less than 1.5 mEq/L
How often do you have to measure for lithium?
- 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
Lithium side effects
-polyuria
- fine hand tremor
- mild thirst = may persist during treatment
- mild nausea
general discomfort
- weight gain = often subside, managed by diet = exercise
Lithium Early signs of toxicity
- 1.5-2.0 mEq/L
- GI upset
- course hand tremor
confusion - hyperirritability of muscles
- EKG changes
- sedation
- incoordination
Lithium Early signs of toxicity interventions
- hold dose
- close eval
- blood draw
lithium advanced signs toxicity
- 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
lithium advanced signs of toxicity interventions
- hospitalization
- stop drug and hasten excretion
- whole bowel irrigation
lithium severe toxicity
more than 2.5 mEq/L
- convulsions
- oliguria = none or small amounts of urine
- death
lithium severe toxicity interventions
in addition to previously mentioned interventions, hemodialysis may be needed
