Psychotherapeutic agents

Question 1

Antipsychotic/neuroleptic drugs(actions)

Answer 1

-typical antipsychotic drugs blocked dopamine, receptors, preventing the stimulation of the postsynaptic neurons by dopamine
- depress the RAS, limiting the stimuli coming into the brain
-Atypical antipsychotic block both dopamine and serotonin receptors

Question 2

Antipsychotic/neuroleptic drugs(indications)

Answer 2

-schizophrenia, hyperactivity, combative and agitated behavior, severe behavioral problems in children
-adjunct therapy to major depressive disorder

Question 3

Pharmacokinetics (antipsychotic/neuroleptic drugs)

Answer 3

-IM dose provides 4 to 5 times the active dose as oral doses

Question 4

Antipsychotic/neuroleptic drugs(relative contraindications)

Answer 4

• CNS depression
  -blood dycrasias
  -Parkinson’s disease
  -Prolonged QT interval
  -blackbox warning: serious CV events, including death, can occur patients with dementia

Question 5

Antipsychotic/neuroleptic drugs(caution and interactions)

Answer 5

Caution
-Conditions that would be worsened by anticholinergic effects
-Seizure disorder
-liver, renal, cardiac disease

Interactions
-CNS depressants, including alcohol
-anticholinergics

Question 6

Antipsychotic/neuroleptic drugs(adverse effects)

Answer 6

CNS
-drowsiness/sedation
-weakness
-tremors
-Extrapyramidal effects
-neuroleptic malignant syndrome
Anticholinergic (can’t see can’t pee can’t spit can’t shit)
Cardiac: prolonged QT interval, hypotension
Bone marrow suppression
Atypical antipsychotic : diabetes and weight gain

Question 7

Antipsychotic/neuroleptic drugs(nursing diagnosis/conclusions)

Answer 7

• impaired physical mobility
  -Altered cardiac output
  -fall risk/injury risk
  -urinary retention
  -Constipation risk

Question 8

Antipsychotic/neuroleptic drugs (implementation)

Answer 8

Parenteral forms: recumbent for 30 minutes
Monitor CBC and blood glucose
Arrange for gradual dose reduction after long-term use
Provide safety and comfort measures
-Encourage patient to avoid before taking a dose
-Provide sugar list, candy and ice chips
Provide for vision examinations

Question 9

Drugs for bipolar disorders

Answer 9

-lithium
-aripiprazole
-olanzapine
-quetiapine
-ziprasidone

Question 10

Typical antipsychotics (drug names)

Answer 10

(work to block the dopamine receptor)
-AZINE

Prochlorperazine
Thioridazine
Chlorpromazine

and randomly, haloperidol

Question 11

Atypical antipsychotic (drug names)

Answer 11

(block both dopamine and serotonin receptors)

-PIPRAZOLE
aripiprazole
Brexpiprazole

-APINE
Quetiapine
Olanzapine
Clozapine

-IDONE
risperidone
Ziprasidone
Iloperidone

Question 12

Lithium (action)

Answer 12

• unknown how the action affects mania
  -Altered sodium transport in nerve and muscle cells
  -Influences the reuptake of neurotransmitters Norepinephrine and dopamine

Question 13

Lithium (pharmacokinetics)

Answer 13

• therapeutically effective serum level is 0.6 to 1.2 mEq/L
  -Kidney reabsorbs more lithium during dehydrated and hyponatremic states (this leads to toxicity)

Question 14

Lithium(relative contraindications)

Answer 14

• significant renal or cardiac disease
  -dehydration/risk of dehydration/hyponatremia

Question 15

Lithium (adverse effects)

Answer 15

-leukocytosis
-insipidus (diabetes insipidus: increased thirst, and urination)
-tremors/teratogenic/thyroid issues
-Hypothyroidism

LITH^

Question 16

Lithium toxicity

Answer 16

• levels 1.3 to 1.4: lethargy, slurred, speech, muscle, weakness, nausea, vomiting
• levels 1.5 to 2: above signs plus ECG changes
• levels 2 to 2.5: ataxia, clonic movements, hyperreflexia, seizures
• levels greater than 2.5: complex multi organ toxicity, significant risk of death

Question 17

Lithium drug interactions

Answer 17

-Haloperidol
-carbamazepine
-diuretics
-psyllium

Question 18

Anti-manic drugs implementation

Answer 18

• Monitor serum levels closely
  -May administer your drug with food or milk
  -Arrange to decrease dose after acute manic episodes
  -Ensure that patient maintains adequate intake of salt and fluid