Mental Health - Antipsychotics

Question 1

Mental Disorders Treatments Goals

Answer 1

• Stabilize disorder
• Dcr debility
• Maintain functionality
• Limist AEs
• Maintain compliance

Question 2

Typical Antipsychotic MOA

Answer 2

• Dopamine receptor blockers
• Due to blocking of dopamine receptor sites:
  > anticholingeric
  > antihistamine
  > alpha-adrenergic blocking effect

Question 3

Atypical Antipsychotic MOA

Answer 3

• Blocks both dopamine & serotonin receptors
  > less dopamine blockage = less severe EPS symps
  > less cholinergic blockage = less severe anticholinergic effects

Question 4

Antipsychotics General AEs

Answer 4

• CNS effects
  > drowsiness
• Anticholinergic effects (DUCT)
• Cardiovascular effects
  > orthostatic hypotension
  > arrhythmias (some prolong QTc)
• Gynecomastia
• Sexual dysfunction
• Extrapyramidal Symps (EPS)
  > acute dystonia (inititation)
  > dystonia
  > pseudo parkinsonsism
  > tardive dyskinesia (late)
• Liver impairment
• Metabolic syndrome

Question 5

EPS

Answer 5

• Dystonia: spasms of tongue, neck, back, & legs
• Akathisia: continuous restlessness, constant movement; foot tapping
• Pseudo Parkinsonism: muscle tremors, drooling, shuffling gait
• Tardive dyskinesia: abn muscle movemenst; lip smacking, tongue darting, chewing movements

Question 6

Neuroleptic Malignant Syndrome

Answer 6

• Manis
  > fever
  > altered mental stat to coma
  > muscle rigidity
  > autonomic dysfunc: BP fluctuations, dysrhythmias
• Interventions
  > stop med
  > monitor VS
  > cooling blankets
  > antipyretics
  > meds to induce muscle relaxation & treat dysrhythmias

Question 7

Antipsychotics Cautions

Answer 7

• CNS depression
• Parkinson’s disease
• Dysrhythmias
• Dementia
• Conditions exacerbated by anticholinergic effects

Question 8

Antipsychotics Drug-Drug Interactions

Answer 8

• Incr risk for sedation
  > CNS depressants
  > alcohol
• Incr anticholinergic effects
  > anticholinergic drugs
• Incr risk for serotonin syndrome
  > SSRI & SNRI
• Incr risk of prolonged QTc
  > antidysrhythmic, any other med prolongs QTc

Question 9

Haloperidol (Haldol) - Class & MOA

Answer 9

• Class: Typical Antipsychotic
• MOA: block dopamine receptors; depresses reticular activating system of brain; anticholinergic, antihistaminic, alpha-adrenergic blocking

Question 10

Haloperidol (Haldol) - Use & Route

Answer 10

• Use: acute psychotic disorders
• Route:
  > PO: 150% of parenteral dose
  > IM: inject large muscle
  > IVP 5mg/min, monitor EKG, switch to oral ASAP

Question 11

Haloperidol (Haldol) - AEs & Nursing

Answer 11

• CNS effects
  > drowsiness
• Anticholinergic effects (DUCT)
• Cardiovascular effects
  > orthostatic hypotension
  > arrhythmias (some prolong QTc)
• Gynecomastia
• Sexual dysfunction
• Extrapyramidal Symps (EPS)
  > acute dystonia (inititation)
  > dystonia
  > pseudo parkinsonsism
  > tardive dyskinesia (late)
• Liver impairment
• Metabolic syndrome
• Nursing: general, tele monitor if IVP

Question 12

Clozapine - Class & MOA

Answer 12

• Class: Atypical Antipsychotic
• MOA: block dopamine & serotonin receptors; depresses reticular activating system of brain; anticholinergic, antihistaminic, alpha-adrenergic blocking

Question 13

Clozapine - Route & AEs

Answer 13

• Route: oral only; tablet, oral disintergrating, oral suspension
• AEs
  > incrd BG
  > weight gain
  > dcrd WBC (neutropenia)
  > EPS mild if occurs

Question 14

Clozapine - Nursing Considerations

Answer 14

• Periodically monitor BG
• Check WBC b4 starting therapy though 1st 6mnths

Question 15

Antipsychotics Assessment

Answer 15

• Head to toe, VS
• Labs as appropriate

Question 16

Antipsychotics Interventions

Answer 16

• Taper w/ long term use
  > abrupt withdrawal: gastritis, N/V. dizziness, arrhythmias, insomnia
• Manage AEs
• Fall precautions
• Teach: drug name, dose, AE & how to manage, do not abruptly discontinue
• Evaulate: therapeutic response, AE, teach, compliance