Medications / Side effects

Question 1

What is a typical antipsychotic?

Answer 1

First generation

• Blocks neurorecepters dopamine
• Higher risk EPS

Question 2

What are some examples of typical antipsychotics?

Answer 2

Haldol
Loxapine
Chlorpromazine

Question 3

What is a Atypical antipsychotic?

Answer 3

Second generation

• Blocks neuroreceptors of dopamine AND serotonin
• lower EPS risk, higher metabolic side effects

Question 4

Examples of atypical antipsychotics?

Answer 4

Abilify
Seroquel
Olanzapine
Risperidone

Question 5

Name 6 common SSRI’s

Answer 5

Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac) 
Paroxetine (Paxil)
Vilazdone (Viibryd) 
(Vul-la-zuh-done)

Question 6

Which medications require blood monitoring?

Answer 6

Lithium 
Clozapine 
Epival 
Carbamazepine 
(Kar-buh-maz-zuh-peen)

Question 7

Lithium side effects?

Answer 7

Seizures, fatigue, headache, sedation, confusion, tremors, ECG changes, metallic taste, drowsiness, psychomotor retardation

Question 8

Common SSRI / antidepressant side effects?

Answer 8

GI: nausea, emesis, diarrhea 
Agitation
Nervousness
Drowsiness 
Dry mouth
Dizziness
Headaches, sexual problems, insomnia

Question 9

Common antidepressants?

Answer 9

Zoloft, prozac, lexapro

Question 10

Common antidepressant side effects?

Answer 10

Drowsiness 
dizziness
dry mouth
fatigue
headache
nausea / vomiting
agitation 
restlessness

Question 11

What causes serotonin syndrome?

Answer 11

Antidepressants can cause high levels of serotonin

more risk when two different types are combined

Question 12

Signs of serotonin syndrome?

Answer 12

THINK: panic, confused, hot, BP

Anxiety, agitation, fever, sweating, confusion, tremors, major BP changes, increased heart rate

Question 13

What is the treatment for serotonin syndrome?

Answer 13

Benzo’s

Muscle relaxants

Question 14

What are side effects of Epival?

Answer 14

DRESS
Suicidal thoughts
Agitation
Dizziness 
GI symptoms 
Pancreatitis

Question 15

What is DRESS?

Answer 15

Inflammation of liver, lungs and heart
Thrombocytopenia (Low blood platelet count) 
Alopecia (hair loss) 
Rash 
Leukopenia (low WBC) 
Hyperammonemia (Increased ammonia)
Ataxia (Abnormal movement)

Question 16

What are the 9 medication rights?

Answer 16

Right patient (two identifiers) 
Right medications 
Right dose 
Right time 
Right route
Right reason 
Right documentation 
Right to refuse 
Right patient education

Question 17

What are the signs / symptoms of EPS?

Answer 17

Dystonia ( muscle spasms )
Dyskinesia ( involuntary movements)
Akathisia ( Rigidity, slow movements)
Pesudoparkinsonism (drooling, shuffling gait)
Rabbit syndrome ( Rapid movements of lips)
Oculogyric crisis ( eyes roll back, EMERGENCY)

Question 18

Treatment of EPS?

Answer 18

Lowering dose or different antipsychotic

Cogentin

Question 19

What are the signs and symptoms of neuroleptic malignant syndrome (NSM)?

Answer 19

High fever 
BP abnormalities 
Tachycardia, Tachypnea, Tremors 
Dysphagia (trouble swallowing) 
Incontinence 
Agitation, drowsiness, confusion or coma

Question 20

Treatment for NSM?

Answer 20

Supportive care
temperature reduction
Hydration
Mild cases treated with benzo's 
Severe is 911

Question 21

What are the signs and symptoms of Tardive dyskinesia?

Answer 21

Involuntary movements of tongue, toes, neck, pelves
Tongue protrusion
Lip smacking / movements of the mouth
Rapid blinking
Disfigured facial features (drooping, grimacing)
Awkward gait
Difficulty swallowing and speaking

Question 22

What is tardive dyskinesia?

Answer 22

Late onset extrapyramidal symptoms.

TDK is persistent EPS that usually appears after long treatment

Question 23

What level of Lithium in blood indicates toxicity?

Answer 23

Greater than 1.5 mEq/L (Milliequivalents per litre)

Severe toxicity: Serum levels of lithium above 2.0 mEq/L

Question 24

Symptoms of mild to moderate lithium toxicity?

Answer 24

Diarrhea, vomiting, stomach pains, fatigue, tremors, uncontrollable movements, muscle weakness, drowsiness, weakness

Question 25

Severe symptoms of lithium toxicity?

Answer 25

Slurred speech, kidney failure, rapid heartbeat, hyperthermia, uncontrollable eye movements, low blood pressure, confusion, coma, delirium, death

Question 26

General side effects of Lithium?

Answer 26

SEIZURES, fatigue, headache, impaired memory, sedation, confusion, dizziness, drowsiness, tremors, muscle weakness, psychomotor retardation, restlessness, stupor, aphasia, blurred vision, tinnitus, ECG changes, arrhythmias, leukocytosis bloating, diarrhea, nausea, dry mouth, metallic taste

Question 27

Teaching for lithium?

Answer 27

Low sodium levels may lead to toxicity. The patient should drink 2000–3000 mL fluid each day and eat a diet with consistent and moderate sodium intake. Excessive amounts of coffee, tea, and cola should be avoided because of the diuretic effect.

Question 28

What does overdose look like?

Answer 28

Face is clammy to touch and has lost color, Blue lips and fingertips, Non-responsive to his/her name or a firm sternum rub using the knuckles, Slow or erratic breathing, or no breathing at all, Deep snoring or a gurgling sound (i.e. what would be described as a “death rattle”), Heartbeat is slow or has stopped

Question 29

Steps for dealing with overdose?

Answer 29

SAVE ME
Stimulate- shake the person
Airway- assess airway
Ventilate- 1 breath every 5 seconds
Evaluate- are they breathing on thier own?
Medication- administer naloxone (ampoule)
Evaluate- again (if nothing happens in 5 min, administer another dose)

Question 30

Side effects of risperidone?

Answer 30

severe dizziness, fainting, seizures. respiratory depression, NMS