Psychiatric drugs and Bipolar disorder

Question 1

Bipolar is characterized by

Answer 1

alternating feelings of extreme sadness and extreme mania

significantly impacts social + occupational functioning.

Question 2

What are some non-pharmacological interventions to treat bipolar disorder

Answer 2

-better sleep, reduce stress, improve nutrition.
-support groups.
-ECT

Question 3

Pharmacological interventions for bipolar disorder is highly

Answer 3

individualized based on severity and predominant symptoms

Question 4

what is a problem with bipolar disorder pharmacologic interventions

Answer 4

nonadherence is a serious problem (do to highs, feeling great)

Question 5

Lithium drug interactions

Answer 5

-diuretics= increase risk of lithium toxicity (lasix)
-NSAID=
(can increase lithium levels)
-antithyroid drugs, drugs containing iodine cause increase of hypothyroid effect.
-haloperidol causes increase of neurotoxicity.
-SSRI’s, MAOIs, dextromethorphan may result in SES.
-some herbal, some food.

Question 6

how often should serum levels be monitored when a patient is taking lithium

Answer 6

Q1-3 days initially and 2-3 months after.

Question 7

before and after lithium treatment, what should the nurse assess for

Answer 7

bipolar disorder before and after treatment.
and
weight changes, edema, changes in skin turgor

Question 8

what baseline levels should the nurse obtain when a patient is taking lithium

Answer 8

thyroid, kidney, cardiac function, electrolyte

Question 9

what are S+S of lithium toxicity

Answer 9

1. Nausea/Vomiting
2. Persistent diarrhea
3. Coarse trembling of hands or legs.
4. Frequent muscle twitching such as pronounced jerking of arms or legs.
5. Blurred vision.
6. Marked dizziness.
7. Difficulty walking.
8. Slurred speech.
9. Irregular heart beat.
10. Swelling of the feet or lower legs.

Question 10

what should the patient be told about table salt when on lithium, and what should the nurse monitor

Answer 10

contiune to take in dietary table salt to maintain osmotic hydration but do not over do it. The nurse should monitor sodium levels

Question 11

what does dehyration or over hydration do to lithium levels

Answer 11

-dehydrated increases lithium
-over hydrated decreases lithium levels.

pts who increase exercise, or are N/V/D should be watched.

Question 12

Etiology schizophrenia

Answer 12

etiology remain unknown

Question 13

What is the genetic component of schizophrenia

Answer 13

5-10 times greater risk if a first degree relative has disorder.

Question 14

What neurotransmitter is imbalanced in schizophrenia

Answer 14

• overactive dopaminergic pathways in basal nuclei
• association with dopamine type 2 (D2) receptors.
  (antipsychotic drugs block receptors)

Question 15

what is the drug of choice for schizoprenia treatment?

Answer 15

second generation (atypical) antipsychotics
-risperidone, olanzapine, quetiapine, and aripiprazole

Question 16

What route are most antipsychotic drugs administered

Answer 16

orally

Question 17

during the intial treatment of psychoses what should the nurse know about drug dosing of antipsychotics

Answer 17

first doses of antipsychotic drugs may be higher than normal
-produces sedation if patient agitated, aggressive, or posing danger to others

Question 18

What drug is given to relax patients in sychoses and may allow intial dose of antipsychotic medication to be reduced

Answer 18

benzodiazepenes
(Lorazapam) given IM

Question 19

How long do acute symptoms of psychoses take to resolve

Answer 19

3-7 days

Question 20

What does extrapyramidal side effects (EPS) refer too?

Answer 20

locations in the CNS associated with postural and automatic movements

(1st gen) - haloperidol

Question 21

What type of movements are associated with extrapyramidal side effects

Answer 21

Acute dystonia (contractions)
Akathisia (restless, inability to sit still)
Parkinsonism
Tardive dyskinesia (TD) (common with typical anti-psychotics) - involuntary, repetitive movements

Think ADAPT

Question 22

Neuroleptic malignant syndrome (NMS) treatment includes

Answer 22

antipyretics, electrolytes, muscle relaxants.

Question 23

Neuroleptic malignant syndrome symptoms

Answer 23

high fever, diaphoresis, muscle rigidity, tachycardia, BP fluctuations

(Think - “ fever”
Fever, encephalopathy, vital signs unstable, extra sweaty, rigidity

Question 24

neuroleptic malignant syndrome can deteriorate to

Answer 24

stupor or coma

Question 25

neuroleptic malignant syndrome is a a)...

Answer 25

potenially fatal adverse reaction of antipyschotics

Question 26

What are major causes of nonadherence in regards to antipyschotic medications

Answer 26

Sexual, menstrual, breast dysfunction

Question 27

What is akathisias

Answer 27

a EPS characterized by a subjective feeling of restlessness motor activity -inability to sit still, rocking back and fourth, pacing

Question 28

Tardive dyskinesia ambulation vs oral

Answer 28

one involved the lips, tongue, jaw, mouth. While the other is more to do with the lower limbs during walking. -Involuntary movements.

Question 29

What is tardive dyskinesia a result of

Answer 29

dopamine blockage

Question 30

what medication is tardive dyskinesia common with

Answer 30

1st gen typical antipsychotics (Haloperidol)

Question 31

what is the treatment for tardive dyskinesia

Answer 31

D/C antipsychotic

Question 32

What is tardive dyskinesia characterized by

Answer 32

bizarre facial and tongue movements and a stiff neck, and difficulty swallowing.

Question 33

What is the treatment for extrapyramidal symptoms

Answer 33

anticholinergic drugs such as benzotropine (cogentin)

Question 34

EPS symptoms

Answer 34

tremors, chorea, dystonia, akinesia, akathisia, and others.

Question 35

Where do EPS originate

Answer 35

originate outside the pyramidal tracts and in the basal ganglion of the brain.

Question 36

what is EPS a result of

Answer 36

dopamine blockage

Question 37

Haloperidol adverse symptoms

Answer 37

-anticholingeric symptoms. -weight gain. -HA -anemia -phototoxicity -EPS

Question 38

is phenothiazines or haloperidol more likely to cause EPS

Answer 38

Haloperidol (haldol)

Question 39

Serious adverse effects of haloperidol

Answer 39

Tachycardia Cardiac arrest Laryngospasm Respiratory depression Seizures Agranulocytosis/leukopenia/leukocytosis Neuroleptic malignant syndrome (NMS)

Question 40

What considerations should the nurse take when administering Risperidone

Answer 40

* If medications cause drowsiness – take at bedtime. * Watch pt for orthostatic hypotension (rise slowly). * Assess for EPS/TD/Akathesias/NMS * Educate pt for S&S of above and what to watch for and when to contact HCP. * Encourage sips of water or hard candies for dry mouth and anticholinergic-like symptoms. * Avoid alcohol & caffeine Increase fluids and fiber. * Watch liver lab results and educate pt of S&S of liver involvement (jaundice/stool). * Tell pt to report significant wt gain (5lb/week). * Ensure pt knows that definite improvement may not be seen for 6-8 weeks.

Question 41

What drugs are similar to risperidone (Second generation atypical antipsychotics)

Answer 41

1. Quetiapine (seroquel) 2. Olanzapine (Zyprexa) 3. Clozapine (Clozaril, FazaClo)

Question 42

# Aripiprazole What considerations should the nurse make when administering (Dopamine system stabilizers) DSS second generation atyical antipsychotics

Answer 42

* Monitor for EPS symptoms or anticholinergic effects * Ensure adequate nutrition, fluid * Monitor for signs of Neuroleptic malignant syndrome (NMS) * Watch labs (liver – hepatic pathway, CYP)

Question 43

# Aripiprazole What patient education should be included for a patient taking DSS second generation atypical antipsychotics

Answer 43

* Monitor for weight gain or changes in sexual characteristics (lactation in men) (Can result in non-compliance; tell pt not to stop suddenly) * Teach and document what you shared with patient what they need to do to protect their health * No alcohol use or illegal drug use * No caffeine use * No smoking