Mental Health Medications

Question 1

First Generation (Conventional) Antipsychotics

Answer 1

• chlorpromaizne (Thorazine), haloperidol (Haldol)
• Use: suppress positive symptoms of schizophrenia
• Pharmacologic Action: suppresses the release of dopamine by blocking the receptors for norepinephrine, acetylcholine, dopamine, and histamine
• Adverse reactions: extrapyramidal effects (acute dystonia: hours to days, requires immediate intervention; tardive dyskinesia: months to years, requires immediate intervention, may get on benztropine to reverse effects, elevated temp, BP, HR, etc.; akathisia: days to weeks, treat side effect; pseudoparkinsonism: weeks to months, usually resolves, treat side effect; may need to hold med and call provider to discontinue), notice uncontrollable mouth movement
• Anticholinergic effects: dry mouth, constipation, urinary retention, blurred vision, tachycardia
• Neuroleptic malignant syndrome (NMS): MEDICAL EMERGENCY
• Sexual dysfunction
• Administration: Give with food or water for GI upset; lay recumbent for 30 minutes are IM or IV; give IV bolus slow
• Contraindications and Precautions: ETOH withdrawl, bone marrow suppression, CNS depression, pregnancy or lactation, COPD, glaucoma, diabetes, HTN, cardiac, liver, or thyroid disorders
• Interactions: CNS depressants, antacids, antidiarrheals, increase levels of anticonvulsants (MEASURE SERUM LEVELS ESPECIALLY WITH MEDS FOR BPD [i.e. valproic acid (Depakote)])

Question 2

Anticholinergic Side Effects

Answer 2

SAME EFFECTS OF ANTIHISTAMINES
- Blind as a bat
- Dry as a bone
- Red as a beet
- Mad as a hatter
- Full as a flask
- Hot as a hare
OR
- can’t pee
- can’t see
- can’t spit
- can’t shit

Question 3

Extrapyramidal Effects (EPS)

Answer 3

• Pseudoparkinsonism: stooped posture, shuffling gait, rigidity, bradykinesia, tremors at rest, pill-rolling motion of the hand, sluggish movements
• Acute Dystonia: facial grimacing, involuntary upward eye movement, muscle spasms of the tongue, face, neck, and back (back muscle spasms cause trunk to arch forward), laryngeal spasms, severe and painful spasms
• Akathisia: restless, trouble standing still, paces the floor, feet in constant motion (rocking back and forth), uncontrollable need for movement
• Tardive dyskinesia: protrusion and rolling of the tongue, sucking and smacking movements of the lips, chewing motion, facial dyskinesia, involuntary movements of the body and extremities

Question 4

Treatment of Extrapyramidal Effects (EPS)

Answer 4

• Acute dystonia: emergency IM or IV injection of anticholinergic
• Tardive dyskinesia: hold the med, then contact provider

Question 5

Neuroleptic Malignant Syndrome

Answer 5

Signs and Symptoms: very high fever (102 - 104 degrees F), irregular pulse, tachycardia,tachypnea, muscle rigidity, altered mental status, autonomic nervous system dysfunction resulting in high or low BP
- Nursing interventions: cooling blanket, aspirin or APAP for fever, hydration, IV admin of bromocriptine or dantrolene (dopamine agonist and muscle relaxer)

Question 6

Second Generation (Atypical) Antipsychotics

Answer 6

• risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel)
• Use: treats schizophrenia, bipolar disorders, irritability due to autism
• Pharmacologic Action: blocks dopamine and serotonin receptors
• Adverse Reactions: EPS at high doses, metabolic side effects (weight gain, dyslipidemia, diabetes), drowsiness, insomnia, dizziness, elected prolactin –> gynecomastia (male breast development)
• Administration: PO mix with juice, milk or H2O, sublingual, IM Q2Weeks
• Contraindications/Precautions: CNS disorders, cardiac concerns, cerebrovascular accidents, hypotension, seizure disorders, kids and older adults
• Interactions: increase effects of antihypertensives, interacts with anticonvulsants

Question 7

benztropine (Cogentin)

Answer 7

• Anticholinergic
• Use: treat side effects associated with antipsychotics (i.e. pseudoparkinsonism, acute dystonia, etc.)
• Pharmacologic Action: blocks histamine receptors and antagonizes (blocks) acetylcholine
• Adverse Reactions: anticholinergic effects (can’t see, can’t pee, can’t spit, can’t shit)
• Administration: PO, IV, or IM
• Contraindications/Precautions: glaucoma, tardive dyskinesia, GI obstruction or ileus, caution in kids and older adults
• Interactions: increased effects if taken with other antihistamines or anticholinergics, CNS depressants, decreased effects if taken with cholinergic medications

Question 8

clozapine (Clozaril)

Answer 8

• first developed 2nd generation (atypical) antipsychotics
• more adverse effects than other 2nd generations
• requires special licensing to prescribe
• high risk of weight gain, diabetes, dyslipidemia
• risk for fatal agranulocytosis - requires baseline and regular WBC monitoring
• notify provider of any indications of infections: no immune response to fight it off if infection occurs, abstinence symptoms if they discontinue it