Mental Health Pharm NUR Flashcards
Blocks Dopamine
Used for acute and chronic psychoses when accompanied by psychomotor activity, psychotic disorders, positive and/or negative symptoms, and improves cognitive function
Antipsychotics
Antipsychotic side effects
anticholinergic effects, nausea, GI upset, skin rash, sedation, orthostatic hypotension, photosensitivity, hormonal effects(weight gain, decreased libido, sexual dysfunction, GYNECOMASTIA IN MEN), reduction of seizure threshold, salivation, AGRANULOCYTOSIS, EXTRAPYRAMIDAL SYMPTOMS, TARDIVE DYSKINESIA, NEUROLEPTIC MALIGNANT SYNDROME
Self management of nausea and GI upset as a side effect of medication
Take with food or milk
Intervention for appearance of a skin rash after taking an antipsychotic
Stop medication and notify HCP
Self management of sedative effects of medication
Take medication at night if possible and maintain a structured schedule
Self management of photosensitivity as a side effect of medications
Wear sunscreen SP50 or higher, sun shades, long sleeves, and hat. Avoid sun in peak hours of 10am-2pm if possible.
Self management of salivation as a side effect of medication
For severe salivation, use hand towel or bib. For mild salivation, chew gum. Sit up straight when eating due to risk of choking.
Self management of anticholinergic effects of medication (Can’t see, can’t spit, can’t pee, can’t shit)
Use eye drops for dry eyes. Chew on hard candy for dry mouth. Wear chap stick for chapped lips. Increase fluids for urinary retention and constipation. Increase fiber for constipation.
Self management of weight gain as a side effect of medication
Low calorie diet, weigh weekly, exercise regularly
What and when should you report to the HCP when you have agranulocytosis as a side effect of medication
At the first sign of infection
Healthcare management of tardive dyskinesia as a side effect of medication
Intervene immediately due to being irreversible if untreated for too long. Do not leave patient along. Have another nurse call the HCP. Administer Benztropine IM or IV.
Signs and symptoms of tardive dyskinesia as a side effect of medication
Involuntary facial and tongue movements, stiff neck, difficulty swallowing
Signs and symptoms of neuroleptic malignant syndrome as a side effect of medication
First sign= high fever (above 103). Excessive sweating. Tremors. Incontinence. Tachycardia. Unstable BP. Decreased LOC. Dilated pupils.
Healthcare management of neuroleptic malignant syndrome as a side effect of medication
Intervene immediately because progression is rapid (24-72 hours). Do not leave patient alone and have another nurse call HCP. Stop medication and start IV fluids. Apply cooling blanket and then administer antipyretic. Administer bromocriptine or dantrolene IV. Monitor HR for arrythmias and administer anti-arrythmic medication if prescribed. Monitor muscle rigidity, I&O, and LOC. Prepare for transfer to ICU.
Signs and symptoms of extrapyramidal symptoms as side effect of medication
Pseudoparkinsonism- Tremors, shuffling gait, drooling, muscle rigidity. Akinesia- absence or slowed movements, muscle weakness. Akathisia- Restlessness or inability to sit still. Dystonia- Involuntary muscle movements of face, arms, legs, and neck. Oculoglyric crisis- Uncontrolled rolling back of the eyes.
Healthcare management if extrapyramidal symptoms occur as a side effect of medication
Notify HCP. Administer Benztropine IM or IV.
When and why are injectable antipsychotic medications administered
They are used when there is a noncompliance with PO antipsychotics and if patient has a strong support system. They are given IM in a healthcare setting every 30 days, where the patient has to come in with a responsible party. They are is given in a deep muscle using large-guage needle. Do not massage site, rotate injection sites, and administer within 15 minutes of preparation.
Additional patient education for antipsychotics
May turn urine pink to red brown color. Drug may take 2-6 weeks to achieve therapeutic effect. Avoid smoking. Do not combine with alcohol, narcotics, or other CNS depressants. Do not abruptly stop medication.
Elderly need _______ doses of antipsychotic medications than young and middle aged adults due to risk of toxicity because of their slower excretion rate.
Smaller. 25-50% less than young and middle aged adults.
Side effects of antiparkinsonian agents
Anticholinergic effects, GI upset, nausea, orthostatic hypotension, sedation/dizziness
When should a consent form be signed for medication administration
Every time a new medication is started due to the risk of side effects that can be severe
What classification of medicine can be used to treat extrapyramidal symptoms?
Antiparkinsonians
Side effects of antiparkinsonians
Anticholinergic effect, nausea, GI upset, hypotension, dizziness, drowsiness
Antiparkinsonians are used for _________ term treatment of anxiety, restlessness, agitation, insomnia, tremors, and nausea
Short
What classification of medicine can be given for short term treatment of anxiety, phobias, acute alcohol withdrawal, skeletal muscle spasm, convulsive disorders and preoperative sedation
Anxiolytics
What anxiolytic medication is the only one that does not effect cognition and is not addictive?
Buspirone/Buspar
Side effects of anxiolytics
Drowsiness/dizziness, confusion, lethargy, TOLERANCE, PHYSICAL AND PSYCHOLOGICAL DEPENDENCE, Possibility of aggravating symptoms of depression, BLURRED VISION Orthostatic hypotension, PARADOXICAL EXCITEMENT, Dry mouth, sleep disturbances, HALLUCINATIONS Nausea & vomiting, DELAYED ONSET (BUSPIRONE)
Contraindications of anxiolytics
Other CNS depressants; pregnancy/breastfeeding; glaucoma, shock, and coma
Anxiolytic interactions:
____________ decreases antianxiety effects.
_____________ may increase sedation.
Smoking decreases antianxiety effects. KAVA KAVA MAY INCREASE SEDATION.
Withdrawals from anxiolytic drugs develop ___________ in ____-____ days, and may last ________ weeks
Develop slowly, in 2 -10 days, and may last several weeks
Anxiolytic withdrawal symptoms
Tremors, agitation, nervousness, sweating, insomnia
The therapeutic response of Buspirone may take up to _____ weeks to take effect.
May take up to 2 weeks
Clients should not take anxiolytic drugs for more than ___ to _____ months as tolerance develops and effectiveness decreases. (Short term medication because they are very addictive)
3 to 4 months
This anxiolytic drug may not be effect until 1 to 2 weeks after continuous use, but has fewer side effects of sedation and physical and psychological dependency associated with many other anxiolytic drugs. Most common side effects: drowsiness/dizziness, headache, nausea, nervousness, and excitement
Buspirone
What beverage should be avoided when taking Buspirone due to the risk of toxicity?
Grapefruit juice
Anxiolytic administration should be avoided in clients with a history of _______.
Drug abuse
What is the oldest class of antidepressants? It is least commonly used. It elevates mood, increased interest in ADLs. and decreases insomnia, but treats fewer problems than newer antidepressants.
Tricyclics
Clients with _______ problems can not take tricyclic antidepressants because of the risk of arrythmias.
Heart problems
Clients with a history of ________ disorders can not take tricyclic antidepressants because of the side effect, reduced seizure threshold.
Seizures
